ch 42 GI and ch 43 GU
The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition?
"Our son's condition may resolve on its own."
The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac disease. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac disease?
"She loves hot dogs, and we always cut hers up into small pieces."
The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?
"The treatment for the disorder will be a surgical procedure."
The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate?
"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."
The nurse is providing discharge teaching regarding oral fluid rehydration to a mother who brought her child to the clinic because of vomiting over the past 2 days. The child is mildly dehydrated. Which comments by the mother indicated learning occurred?
- "I should not give my child any fluids for 1 to 2 hours after an episode of vomiting." - "Oral rehydration solutions (ORS) are good sources of fluids for rehydration." - "I should be sure my child receives 50 to 100 ml/kg of oral rehydration solution (ORS) over 4 hours."
A child with inflammatory bowel disease is started on an anti-inflammatory medication. Which item(s) would the nurse teach the child and parents about being on this type of medication? Select all that apply.
- Use sunscreen and protective clothing while outside. - Increase folic acid intake. - Drink adequate fluids to avoid crystallization of sulfa in urine. - Administer the medication just after meals to avoid gastrointestinal irritation
The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications?
Assess the popliteal region carefully for skin breakdown.
A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?
Auscultation
The nurse is caring for an 8 year old in skeletal traction for a fractured femur. Which type of traction would be communicated in the shift hand-off?
Balanced suspension traction
A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate?
Creatinine clearance rate
The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?
Deficient knowledge related to diagnosis and condition
When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. Which statement regarding these variations is true?
During adolescence, muscle growth is influenced by increased production of androgenic hormones.
The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child?
Eyes
A nurse prepares a menu for a client with Crohn disease. What is the focus of dietary management for this disease?
High carbohydrate, high protein
Which characteristic is true of cerebral palsy?
It appears at birth or during the first 2 years of life.
The nurse is caring for an 8-year-old child hospitalized with nephrotic syndrome. Which nursing intervention would be appropriate for this child?
Measure the abdominal girth daily. Test the urine regularly for albumin and specific gravity.
A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation?
Muscular wasting results in generalized immobility and difficulty feeding and breathing.
The nurse is planning the discharge instructions for the parents of a 1-month-old infant who has had a circumcision completed. Which information should be included in the education provided?
Report redness or swelling on the penile shaft.
The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention?
Take a stool culture
The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration?
Tenting of the skin
The nurse is observing a child walk down stairs using a swing-through gait. What action by the child is correct?
The child places the crutches on the lower step before placing the good foot down between the crutches.
The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history?
The child recently had an ear infection.
Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis?
The client remains continent throughout the night.
A nurse is discussing with a family the various causes of their child's vulvovaginitis. What would be included in the education?
The use of cleansing towelettes may have caused the vulvovaginitis.
An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:
back with hips up off the bed.
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition?
barium enema
A nurse in the pediatrician's office is providing teaching to a parent of a 24-month-old child who has been diagnosed with muscular dystrophy (MD). The nurse educates the parent regarding their child's risk for developing
cardiomyopathy and respiratory infections
A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?
detect Helicobacter pylori
The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:
epiphysiolysis of the proximal humerus.
A nurse examining a neonate is unable to identify the fetal stomach. The nurse knows that this sign strongly indicates which condition?
esophageal atresia (EA)
A type of traction sometimes used in the treatment of the child with scoliosis is called:
halo traction.
The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess?
leukocyte count
A parent brings the 10-year-old child in to the clinic. The nurse notes: icteric sclera and skin, headache, anorexia, vomiting, and temperature 101.8°F (38.8°C). The parent states the child has had the symptoms since returning to the US from India a few days ago. The nurse will anticipate preparing the child for which test?
liver function tests
The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record?
low serum calcium levels
A nurse is caring for a client who has been diagnosed with bacterial vaginosis. What medication should the nurse anticipate as part of the treatment plan?
metronidazole
The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?
presence of Moro reflex
The nurse is providing care to a child with acute kidney injury. What assessment is priority for the nurse to determine if this child is developing hyperkalemia?
pulse rate and rhythm
A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as:
syndactyly
The nurse is caring for a 10-year-old girl presenting with fever, dysuria, flank pain, urgency, and hematuria. The nurse would expect to help obtain which test first?
urinalysis
A child with liver cirrhosis is admitted to the acute care facility in preparation for a liver transplant. What finding(s) would the nurse document after completing this child's assessment? Select all that apply.
yellow skin and sclera liver palpable palms of hands reddened confused mental status
The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions?
"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup."
The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education?
"Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future."
The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching?
"I should position him on his abdomen with knees bent."
The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?
"I will add the nystatin to her bottle four times per day."
nephrotic syndrome
-massive proteinuria -hypoalbuminemia -edema (anasarca) -hyperlipidemia
A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition?
A 13-year-old boy who is on his school's cross-country team
The nurse is administering cyclophosphamide as ordered for a 12-year-old boy with nephrotic syndrome. Which instruction is most accurate regarding administration?
Administer in the morning; encourage fluids and voiding during and after administration.
The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:
Complete
The nurse is caring for a 6-month-old infant with diarrhea and dehydration. The parent is concerned because the infant has some patches on the tongue. Which feature indicates a geographic tongue?
Some patches are light in color and other patches are dark in color.
The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?
Type II
The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child:
feels increasing severe pain.
A 9-month-old infant presents to the emergency department with vomiting and abdominal pain. While assessing the client, the nurse notes the client screaming intermittently and drawing up legs toward chest a palpable mass in upper right quadrant (above). What does the nurse anticipate in this child's stools?
jellylike, bloody stools intussusception
A parent brings the 2-week-old infant to the office because the infant has been experiencing gastroesophageal reflux over the past week. Which intervention(s) should the nurse recommend to the parent at this point? Select all that apply.
- Feed the infant a formula thickened with rice cereal. - Feed the infant while holding the infant in an upright position. - Keep the infant upright by holding them and/or elevating the head of the crib after feeding.
A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? Select all that apply.
- IV fluid administration - monitor of intake and output - daily weight assessment
The nurse is reinforcing teaching with the caregivers of a child who has been placed in an external fixation device for the treatment of an orthopedic condition. Which statement made by the caregivers indicates an understanding of the external fixation device?
"It will be hard, but we know our child will be in this device for a long time."
The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents?
"Let's meet with the dietitian and plan some meals."
The nurse is caring for a child with gastrointestinal concerns. What statement by the parent would indicate a need for the nurse to further assess the child for constipation?
"My child has such large bowl movements that it clogs the toilet."
A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching?
"My daughter can eat any kind of fruit." some fruit pie fillings and dried fruit may contain gluten.
The nurse is performing discharge teaching for an adolescent diagnosed with peptic ulcer disease. Which statement(s) by the adolescent demonstrates learning has occurred? Select all that apply.
- "I will need to make sure to take all of the antibiotic prescribed." - "I will be starting yoga soon to help with the stress."
The nurse is conducting a neuromuscular assessment on a toddler. What assessment technique(s) is important for the nurse to include in this assessment? Select all that apply.
- Compare muscle strength and tone bilaterally. - Observe for involuntary muscle contractions. - Perform passive range-of-motion on all extremities.
Soft and flat fontanels (fontanelles) indicate mild dehydration.
Pale and slightly dry mucosa indicates mild or moderate dehydration.
The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate?
Prepare the child for admission to the hospital. cholecystitis
In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?
Prepare the infant for surgery.
A group of nursing students are reviewing information about celiac disease. The students demonstrate understanding of this disorder when they identify which classic symptoms? Select all that apply.
steatorrhea constipation diarrhea failure to thrive
What method(s) can a nurse use to evaluate extremity function in an 18-month-old child? Select all that apply.
- Observe the child in developmentally appropriate play. - Elicit from the parent a description of fine and gross motor activities. - Look for symmetric motion in the arms and legs.
The nurse teaches a parent to differentiate between regurgitation and vomiting in the infant. The parent correctly states which characteristic of regurgitation? Select all that apply.
- occurs with feeding - no appearance of distress
What occurs in the gastrointestinal system of the child with Hirschsprung disease?
There is a partial or complete mechanical obstruction in the intestine.
While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication?
Uremia
Which client would be the most likely person to be diagnosed with idiopathic scoliosis that requires treatment?
a young adolescent female
The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:
acute glomerulonephritis.
The nurse is caring for a child with epididymitis. When planning care, which intervention may be included?
scrotal elevation
A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has:
severe dehydration. (+10%)
The nurse is caring for a 19-month-old toddler with a history of diarrhea for 2 days (above). The primary health care provider prescribes oral rehydration over 2 hours followed by discharge home. What will the nurse include in the discharge teaching for this client? Select all that apply.
- monitoring of wet diaper output - encouraging food and fluid intake at home
The nurse is caring for a 6-year-old client diagnosed with acute kidney injury. During assessment, the nurse notes: temperature 99.0°F (37.2°C), urine output less than 0.4 mL/kg/hr, blood pressure 130/88 mm Hg, periorbital edema, and respirations 28 breaths/minute. Which prescription(s) will the nurse anticipate from the primary health care provider? Select all that apply.
furosemide dialysis serum electrolyte levels urinalysis labetalol
