Desmopressin (DDAVP) is prescribed via IN route for a child with von Willebrand's disease. The nurse instructs the parents regarding the adinistration of this medication. Which statement by the parents indicates a need for further instructions?

a. be need to refrigerate DDAVP

b. we do not need to reduce our child's fluid intake

c. nausea and abdominal cramps can occur as a side effect of this medication

d. headache and drowsiness may be a sign of water intoxication that can occur with this medication

b. we do not need to reduce our child's fluid intake

Parents should be instructed to reduce fluid intake during initial treatment, since the treatment will prevent continued fluid loss and the result will be fluid buildup. The medication should be refrigerated, but freezing should be avoided. Side effects of the medication include facial flushing, nasal congestion, increased blood pressure, nausea, abdominal cramps, decreased urination, and vulval pain. Signs and symptoms of water intoxication include headache, drowsiness and confusion, weight gain, seizures, and coma.

A child is brought to the ER after being bitten by a dog. The nurse performs a focused assessment, cleanses the wound as prescribed, and continues to perform a thorough assessment on the child. Which of the following is the priority question for the nurse to ask the mother of the child?

a. how old is the dog

b. did the dog have rabies

c. are the child's immunizations up to date?

d. are the dog's shots up to date?

c. are the child's immunizations up to date?

When a bite occurs, the injury site of the bite should be cleansed carefully and the child should be given tetanus prophylaxis if immunizations are not up-to-date. Option c is the priority consideration.

Options a, b, and d identify information that may have to be obtained, but are not the priority questions. Additionally, the mother may not have the answers to these questions.

A nurse is assessing a child admitted to the hospital with a diagnosis of rheumatic fever. The nurse asks the child's mother which significant question during the assessment?

a. Has your child had difficulty urinating?

b. Has your child been exposed to anyone with chickenpox?

c. Has any family member had a sore throat within the past few weeks?

d. Has any family member had a GI disorder in the past few weeks?

c. Has any family member had a sore throat within the past few weeks?

Rheumatic fever characteristically presents 2 to 6 weeks following an untreated or partially treated group A beta-hemolytic streptococcal infection of the respiratory tract. Initially, the nurse determines whether any family member has had a sore throat or unexplained fever within the past few weeks. Options 1, 2, and 4 are unrelated to the assessment findings of rheumatic fever.

The parents of a child with mumps express concern that their child will develop orchitis as a result of having mumps and ask the nurse about the signs of this complication. The nurse tells the parents that which of the following is a sign of this complication?

a. fever

b. facial swelling

c. swollen glands

d. difficulty urinating

a. fever

Unilateral orchitis occurs more frequently than bilateral orchitis. About 1 week after the appearance of parotitis, there is an abrupt onset of testicular pain, tenderness, fever, chills, headache, and vomiting. The affected testicle becomes red, swollen, and tender. Atrophy, resulting in sterility, occurs only in a small number of cases. Difficulty urinating is not a sign of this complication. Swollen glands and facial swelling normally occur in mumps.

A nurse is caring for a child with a dx of rheumatic fever. The nurse notes that the physician has documented the presence of erythema marginatum. Based on this documentation, which of the following would the nurse expect to note in the chil?

a. tender painful joints, especially the elbows, knees, ankles, and wrists

b. inflammation of all parts of the heart, primarily the mitral valve

c. involuntary movements affecting the legs, arms, and face

d. red skin lesions that start flat or slightly raised macules over the trunk

d. red skin lesions that start flat or slightly raised macules over the trunk

Erythema marginatum is characterized by red skin lesions that start as flat or slightly raised macules, usually over the trunk, that spread peripherally. Option 1 identifies polyarthritis. Option 2 identifies carditis. Option 3 identifies chorea.

When obtaining a hx from parents of a 5 month old child suspected of having intussusception, which assessment area would be most important for the nurse to address?

a. pattern of abdominal pain

b. known allergies

c. dietary intake during the past 24 hours

d. usual pattern of bowel movements

Intussusception is an invagination or telescoping of one portion of the intestine into another. A report of severe colicky abdominal pain in a healthy thriving child between 3 and 17 months of age is the classic presentation of intussusception. Typical behavior includes screaming and drawing the knees up to the chest.

Options 2, 3, and 4 are important aspects of a health history but are not specific to the diagnosis of intussusception.

A 3 year old is admitted to the hospital with a dx of acute lymphocytic leukemia (ALL). The nurse assigned to care for the child is concerned because the child is crying and stating. "My knees hurt." Which intervention would the nurse provide for the child?

a. aspirin

b. apply cold pack to the knees

c. apply heat to the knees

d. attempt to involve the child in distraction

b. apply cold pack to the knees

Bleeding into joints is a clinical manifestation of ALL, and cold applications will decrease joint discomfort. Aspirin has anticoagulant properties and would not be prescribed. Heat application will increase blood circulation to the site, which will increase pain and bleeding if it is present. Diversional activities will not relieve the pain.

A 5 year old male child has a deficiency in factor VIII. An important goal is to relieve pain caused by bleeding into the joints. Which intervention would the nurse expect to be prescribed to achieve this goal?

a. administer NSAIDs

b. provide for joint immobilization

c. apply hot packs to the affected joints

d. schedule physical therapy

b. provide for joint immobilization

Joint immobilization will assist in preventing bleeding. NSAIDs can prolong bleeding time and increase the bleeding and the pain caused by pressure of the confined fluid in the narrow joint space. Heat application will increase blood flow to the area and increase the bleeding. Physical therapy can be helpful after the bleeding episode is under control, but during the acute period it can increase bleeding.