Case Studies Exam 3

What medication is given to Jody for the treatment of DI? Why is this medication given?

- vasopressin - DI causes hyposecretion of ADH, also known as vasopressin. It's given as a replacement to manage DI.

The patient is in the acute stage, and his paralysis is continuing to ascend. What actions by the nurse should be taken to monitor for respiratory complications of GBS? Select all that apply. 1. Stay with the child while he is eating or drinking. 2. Check lung sounds with vital signs. 3. Continually monitor his oxygen saturation. 4. Maintain the patient in the supine position. 5. Reposition the child every 4 hours.

1, 2, 3

After Tara has remained afebrile for 24 hours, she is discharged from the hospital on oral antibiotics. What is the most appropriate teaching priority to discuss with Tara's mother? 1. Tara's toileting and wiping habits should be closely monitored. 2. Tara should drink plenty of water when taking oral antibiotics. 3. Tara should complete all her medication. 4. Tara needs to practice appropriate hand washing.

3

A 28-month-old toddler who has been on life support for 2 days after a submersion injury. The vehicle in which he was riding flipped over and landed upside down in a shallow lake. The toddler was submerged for approximately 6 minutes. He was resuscitated at the accident site within 10 minutes after being rescued and transferred to the pediatric intensive care unit. The charge nurse is assessing some of the information obtained during the hourly routine. Which assessment data would provide some indications of a good outcome? 1. The pupils react sluggishly but equally, and the child's toes move when tickled. 2. The heart rate is regular, and the child lies quietly when his endotracheal tube is suctioned. 3. The body temperature has been 97 to 98 degrees, and the lung sounds are clear. 4. The oxygen saturation level is 98%, and the blood gases are within normal limits.

1

A 10-year-old child has just been diagnosed with hyperthyroidism during a hospital admission. The nurse is providing discharge instructions to both parents. What information should the nurse include? Select all that apply. 1. Place a fan in the child's room for individual temperature regulation. 2. Provide three large meals to provide the calories needed. 3. Encourage the child to take sips of fluid all through the day, including while at school. 4. Decrease the frequency of bathing to prevent dehydration of the skin. 5. Allow the child to eat whatever is desired to maintain adequate caloric intake.

1, 3

What supportive measures would be appropriate for the nurse to use and/or to monitor to prevent contractures and maintain as much neuromuscular function as possible while the child is still paralyzed? Select all that apply. 1. Using neuropathic pain medications with other pain medications 2. Doing active range-of-motion exercises every day 3. Doing isometric exercises whenever the child wants them 4. Using orthotic devices to maintain correct position 5. Doing passive range-of-motion exercises several times daily

1, 4, 5

A male infant was born with fractures of the left shoulder and clavicle and was diagnosed with osteogenesis imperfecta (OI) once his blue sclerae were seen. The newborn is being discharged home and the parents want to know how to care for their child. What information should the nurse share with the parents? 1. Gently lift the newborn by the ankles when changing the diaper. 2. Support the infant during a diaper change by lifting the buttocks. 3. Use two people when changing diapers for the first few months. 4. Put two diapers on the infant to provide extra padding for his lower back.

2

A mother calls the clinic nurse to ask advice regarding her child and possible contact with poison ivy. After hearing a description of the plant, you confirm it is poison ivy. If the contact was in the past 15 minutes, which of the following actions should be recommended to the mother? 1. Wash the child with dishwasher detergent. 2. Flush the skin with cold running water. 3. Have the child bathe in warm water. 4. Have the child shower in hot water.

2

Joey is a 7-year-old boy who comes to the school nurse's office with the complaint of an itchy rash on his face. You, the school nurse, assess the rash to be reddened papules and pustules with a yellowish crust occurring around his mouth and nose. As the school nurse, what would be your first priority?.■ 1. Assess his temperature and lungs. 2. Have the child wash his hands and call his parents so that they can take Joey to see his doctor immediately. 3. Apply calamine lotion to the affected areas. 4. Call the child's parents and have Joey remain in the classroom until they arrive

2

The infant is scheduled for surgery in a few hours to remove the malfunctioning part of the bowel. What teaching from the nurse would best prepare the mother to know what to expect when she first sees her infant after surgery? 1. "Your son will have a colostomy with a bag on his abdomen and an IV." 2. "Your son will have an IV line, an oxygen source, a dressing, and perhaps a colostomy bag." 3. "He will have a colostomy with a bag, a feeding tube, and an oxygen mask." 4. "He will be wearing a diaper and will have an abdominal dressing and soft restraints."

2

Adam, a usually healthy 2-month-old infant, was brought to the pediatrician's office by his mother for excessive vomiting for 2 days. On examination, you note that he is irritable and has not gained any weight since his last checkup. His mother states that he "throws up after every feeding. "Adam's physical examination and diagnostic procedures confirm a diagnosis of gastroesophageal reflux disease (GERD). In discussing treatment of GERD, which is the most appropriate, immediate intervention to discuss with Adam's mother? (Select all that apply.) 1. Thicken feedings with rice cereal. 2. Do not feed more frequently than every 3 hours. 3. Avoid placing the child supine after feedings. 4. Use medications to control Adam's symptoms.

2 and 3

After 10 days in the hospital, Sam is making progress and will be discharged home tomorrow on a sodium- and potassium-restricted diet, until his renal function returns to normal. What are the most appropriate topics to discuss with Sam regarding this diet? 1. Eating fruits and vegetables is the healthiest option. He should avoid fried foods and those high in fat. 2. He should limit intake of protein, such as meat, because his damaged kidneys will not be able to filter out the excess protein. 3. Canned foods should be avoided. 4. None of the above

3

As Sam's condition worsens, he becomes edematous and increasingly hypertensive. The health care provider orders a dose of albumin followed by furosemide (Lasix) intravenously. As the nurse discusses these medications with Sam's parents, what information is pertinent? 1. The albumin is a blood product that will improve Sam's condition by increasing his blood volume, leading to increased renal perfusion. Lasix is then given to promote diuresis. 2. Albumin is used to move fluid from the interstitial space back into the intravascular space. Lasix is then given to promote diuresis. 3. After taking the medications, Sam will have to void. 4. 1 and 3 5. 2 and 3

4

Brian, 16 years of age, has acne vulgaris. Retinoic acid (Retin-A) and benzoyl peroxide are topical medications that he is to begin using. The nurse should explain that significant improvement usually takes how long after initiation of therapy? 1. 1 week 2. 2 weeks 3. 1 month 4. 2 to 3 months

4

Maria is a 10-year-old girl who is brought to the emergency department by her parents because of generalized abdominal pain. She has had slight diarrhea for the past few hours. Her temperature is 37.5° C (99.5° F). Bowel sounds are present. The diagnosis is a possible appendicitis. Several diagnostic tests are ordered. The most appropriate nursing intervention in the preoperative period is: 1. Apply moist heat to abdomen to relieve pain. 2. Administer an enema to ensure total bowel evacuation preoperatively. 3. Perform deep abdominal palpation to assess level of pain. 4. Ensure that diagnostic tests are administered as soon as possible to prevent delay in treatment.

4

Brian is 4 years old and his brother Adam is 5 months old. Both children are brought to the clinic by their mother because of diarrhea and fever. In addition, Brian has vomited twice. The nurse assesses the children and determines that they are mildly dehydrated. The mother asks about giving the children antidiarrheal medications. Based on the nurse's knowledge of these medications, the appropriate response is that they are A. not recommended. B. recommended for children over age 6 months. C. recommended for children over age 1 year. D. recommended for children over age 4 years.

A

Todd is a 3-year-old child who has acute lymphoblastic leukemia. He is being seen in the oncology clinic for chemotherapy. Todd's mother asks the nurse, "What is wrong with my child's blood?" Based on the nurse's knowledge of leukemia and developmental stages, the most appropriate response is to tell the mother that Todd's blood has more: A. platelets. B. red blood cells. C. older-mature white blood cells. D. young-immature white blood cells.

D

Based on the Tara's presentation, what type of physician orders would the nurse anticipate receiving first? 1. Urinalysis and urine culture 2. Blood culture and CBC 3. Lumbar puncture 4. Abdominal x-ray

1

Which of the following statements demonstrates effective learning by Joey's parents regarding his treatment?■ (Impetigo) 1. "I should keep Joey's towels separate from my other children." 2. "Joey should bathe in Aveeno baths at night to help with the itching." 3. "I should wash Joey's linen in hot water and soak his combs in boiling water." 4. "Joey should take his acyclovir until all of the medicine is gone."

1

Sam is a 17-year-old male who was admitted to the hospital 3 days ago after a motor vehicle accident. He has undergone surgery to repair a fractured femur and several large lacerations. In addition, Sam experienced severe abdominal pain caused by blunt force trauma during the accident, but it is now subsiding. However, Sam is experiencing high blood pressure and decreased urinary output. The most appropriate nursing interventions needed to monitor Sam's renal function are 1. strict intake and output records. 2. monitoring abdominal girth for fluid retention. 3. monitoring his dietary intake of sodium and potassium. 4. All of the above.

1

The parents are told to make certain that anyone caring for their child knows about his condition. When he is ready to go to school, school officials should know he has OI, as well. What two reasons should the nurse discuss with the parents as major reasons for letting others know? 1. This alerts caregivers and teachers about the child's brittle bone condition. Because the injuries can occur unusually often, the parents could be suspected of child abuse. 2. This prevents any damage to his self-esteem because of his short stature and limited mobility and allows his classmates to accept him more easily. 3. This is so the caregivers can realign a fracture and prevent complications when providing initial first aid. 4. This provides for opportunities for early socialization of the child so he can get along with children his own age and help teachers adjust to his condition.

1

Jody is a 5-year-old child who was in an automobile accident with her mother. Jody was in the back seat and not wearing a seat belt. She was thrown forward and hit the front seat, resulting in a head injury. Jody has been diagnosed with diabetes insipidus (DI) as a result of the head injury. DI is a common complication of head injury. Select the following symptoms that are associated with DI. 1. Excessive urination 2. Compensatory insatiable thirst 3. Dehydration 4. Electrolyte imbalance 5. Circulatory collapse

1, 2, 3, 4, 5

Brian is 4 years old and his brother Adam is 5 months old. Both children are brought to the clinic by their mother because of diarrhea and fever. In addition, Brian has vomited twice. The nurse assesses the children and determines that they are mildly dehydrated. The mother asks about giving Brian food after he is rehydrated. Which is the most appropriate recommendation? 1. Offer a regular diet. 2. Offer a regular diet except high-protein foods. 3. Give clear liquids for the next 24 hours. 4. Start the BRAT diet (bananas, rice, apples, and tea).

3

Tara is a 4-year-old girl who has been toilet trained for about 9 months. She loves the water, has been enrolled in swimming classes, and likes to take bubble baths. She is brought to the emergency department after having fever up to 102° F for 2 days and abdominal pain. Her mother states that Tara has been complaining of pain since yesterday and that she had two toileting "accidents." Tara's probable diagnosis is urinary tract infection (UTI). Which of the following are factors that place Tara at risk for developing UTIs? 1. Anatomical structure 2. Recent toilet training 3. Submersion in water during bathing or swimming 4. All of the above

4

Which clinical manifestations should lead the nurse to suspect that Maria's appendix has ruptured? 1. Fever 2. Localized pain 3. Increasing anorexia 4. Sudden relief from pain

4

Which of the following medications would you expect Joey's doctor to order?■ (Impetigo) 1. Acyclovir 2. Griseofulvin 3. Vancomycin 4. Penicillin

4

Maria has an appendectomy. The nurse anticipates that she will remain on low intermittent gastric decompression until 1. pain decreases. 2. nausea subsides. 3. infection resolves. 4. bowel motility returns.

4

(Poison Ivy) A full-blown reaction will be evident in approximately: 1. 2 days 2. 5 days 3. 1 week 4. 2 weeks

1

Todd is a 3-year-old child who has acute lymphoblastic leukemia. He is being seen in the oncology clinic for chemotherapy. Todd has some oral ulcers (stomatitis). His parents ask about oral hygiene. The nurse should suggest 1. Avoid brushing teeth until ulcers heal 2. Use frequent mouthwashes with normal saline 3. use frequent mouthwashes with hydrogen peroxide 4. cleanse teeth with lemon glycerin swabs

2

Todd is a 3-year-old child who has acute lymphoblastic leukemia. He is being seen in the oncology clinic for chemotherapy. The chemotherapeutic agents that Todd is receiving usually cause nausea and vomiting. Which is an appropriate nursing intervention related to this? 1. Discourage oral intake of fluids 2. Administer antiemetic before chemotherapy begins 3. Administer antiemetic as soon as symptoms begin 4. Explain to Todd and his parents that nausea and vomiting cannot be prevented

2

Todd is a 3-year-old child who has acute lymphoblastic leukemia. He is being seen in the oncology clinic for chemotherapy. Todd has recently had several upper respiratory tract infections. Which should the nurse recommend to decrease his risk of infection? 1. Dress him warmly 2. Use good handwashing 3. Isolate him from others 4. Keep him inside as much as possible

2

When giving instructions for application of these two topical medications, the nurse should tell Brian to apply: (Acne)■ 1. Benzoyl peroxide and retinoic acid at the same time 2. Benzoyl peroxide in the morning and retinoic acid at bedtime 3. Both medications after cleansing face and expressing comedones 4. Both medications only to lesions, avoiding nonaffected skin

2

(Acne) Instructions for Brian should include: 1. Cleanse face twice daily with an antibacterial soap followed by an astringent. 2. Use sunscreen and wear a hat or visor to minimize sun exposure. 3. Gently express comedones (whiteheads, blackheads) after cleansing face. 4. Avoid foods with a high fat content, such as french fries.

2

A 4-month-old male infant has been seen in the pediatrician's office several times for a distended abdomen, irritability, and constipation. A diagnosis of Hirschsprung disease (HD) is suspected, and further testing is being scheduled. The nurse is obtaining a history about the infant's early months. What question is most critical for the nurse to ask to aid in the diagnosis of HD? 1. "Did your son urinate immediately after delivery?" 2. "When did your son have his first bowel movement?" 3. "Did you breastfeed or bottle-feed your son?" 4. "Did your son experience any colic?"

2

A 13-year-old has just been diagnosed with type 1 diabetes mellitus and is interested in "getting on with my life." He asks how he will know that he is doing a good job if he is "going to be in charge of this thing." What response by the nurse would be most accurate? 1. "Maintain your glucose levels below 154 mg/dL and your hemoglobin A1c at 8% or less." 2. "You're fine as long as you are feeling well and maintaining your everyday schedule as before." 3. "Maintain your glucose levels below 126 mg/dL and your hemoglobin A1c at 7% or less." 4. "Your diabetes is in control once you stop losing the weight and stop getting up at night to urinate."

3

(Poison Ivy) Clothing the child was wearing should be: 1. Burned 2. Placed in a plastic garbage bag and put out with trash 3. Placed in the laundry hamper with other family clothing 4. Washed in hot water and detergent

4

(Poison Ivy) If the child has a severe reaction, which of the following medications may be necessary? 1. Aveeno baths 2. Topical corticosteroid gel 3. Burow solution 4. Oral corticosteroids

4

After using the topical medications for 1 week, Brian calls the nurse to report that his skin is red and peeling. The nurse should recommend that Brian:■ (Acne) 1. Stop using retinoic acid 2. Stop using benzoyl peroxide 3. Stop using both medications 4. Continue using both medications because erythema and peeling are normal at this time

4