Exam 2: NCLEX Questions (Includes GU & Renal)

Which of the following indicates that a child with heart failure is carefully following the prescribed medical regimen? 1. Elevation in red blood cell (RBC) count 2. Normal weight for age 3. Pulse rate less than 50 beats/minute 4. Daily use of an antibiotic

2. Normal weight for age Adequate weight for height demonstrates adequate nutritional intake and lack of edema. An elevated RBC count demonstrates polycythemia. A pulse rate less than 50 beats/minute, bradycardia, probably indicates digoxin toxicity. Daily use of an antibiotic is not indicated in heart failure.

A boy who weighs 44 lb has been given an order for amoxicillin 500 mg BID. The drug text notes that the daily dose of amoxicillin is 50 mg/kg/day in two divided doses. What dose in milligrams is safest for this child?

500 mg First, calculate the child's weight in kg: 44/2.2 = 20 kg. Then, calculate the appropriate daily dose according to the drug text: 50 mg/kg/day = 50 mg × 20 kg = 1,000 mg/day. The abbreviation b.i.d. means twice daily; therefore 1,000 divided by 2 equals 500 mg.

While assessing a child with coarctation of aorta, the nurse would expect to find which of the following? 1. Absent or diminished femoral pulses 2. Cyanotic ("tet") episodes 3. Squatting posture 4. Severe cyanosis at birth

1. Absent or diminished femoral pulses Absent or diminished femoral pulse is a classic characteristic of coarctation of aorta. Tet episodes and squatting are characteristic of tetralogy of Fallot. Severe cyanosis at birth is seen in such defects as transposition of the great vessels.

Which of the following should be avoided if the child has hypospadias? 1. Circumcision 2. Catheterization 3. Surgery 4. Intravenous pyelography (IVP)

1. Circumcision Hypospadias refers to a condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface (underside) of the penile shaft. The ventral foreskin is lacking, and the distal portion gives an appearance of a hood. Early recognition is important so that circumcision is avoided; the foreskin is used for the surgical repair. Catheterization may be used to ensure urinary elimination. Surgery is the procedure of choice to improve the child's ability to stand when urinating, improve the appearance of the penis, and preserve sexual adequacy. IVP is contraindicated if the child has an allergy to iodine or shellfish.

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? Select all that apply. 1. Pallor 2. Edema 3. Anorexia 4. Proteinuria 5. Weight loss 6. Decreased serum lipids

1. Pallor 2. Edema 3. Anorexia 4. Proteinuria Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? Select all that apply. 1. Place the infant in a private room. 2. Ensure that the infant's head is in a flexed position. 3. Wear a mask at all times when in contact with the infant. 4. Place the infant in a tent that delivers warm humidified air. 5. Position the infant on the side, with the head lower than the chest. 6. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

1. Place the infant in a private room. 6. Ensure that nurses caring for the infant with RSV do not care for other high-risk children. RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of contact and standard precautions during care (wearing gloves and a gown) reduces nosocomial transmission of RSV. A mask is unnecessary. In addition, it is important to ensure that nurses caring for a child with RSV do not care for other high-risk children to prevent the transmission of the infection. An infant with RSV should be isolated in a private room or in a room with another infant with RSV infection. The infant should be positioned with the head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. Cool humidified oxygen is delivered to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea.

The clinic nurse reads the results of a tuberculin skin test (TST) on a 3-year-old child. The results indicate an area of induration measuring 10 mm. The nurse should interpret these results as which finding? 1. Positive 2. Negative 3. Inconclusive 4. Definitive and requiring a repeat test

1. Positive Induration measuring 10 mm or more is considered to be a positive result in children younger than 4 years of age and in children with chronic illness or at high risk for exposure to tuberculosis. A reaction of 5 mm or more is considered to be a positive result for the highest risk groups, such as a child with an immunosuppressive condition or a child with human immunodeficiency virus (HIV) infection. A reaction of 15 mm or more is positive in children 4 years or older without any risk factors.

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? 1. Restrict fluids as prescribed. 2. Care for the arteriovenous fistula. 3. Encourage foods high in potassium. 4. Administer analgesics as prescribed.

1. Restrict fluids as prescribed. Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis).

Which of the following represents an effective nursing intervention to reduce cardiac demands and decrease cardiac workload? 1. Scheduling care to provide for uninterrupted rest periods 2. Developing and implementing a consistent care plan 3. Feeding the infant over long periods 4. Allowing the infant to have her way to avoid conflict

1. Scheduling care to provide for uninterrupted rest periods Organizing nursing care to provide for uninterrupted periods of sleep reduces cardiac demand. Developing a consistent care plan can be important, but it is not related to decreasing cardiac demands or workload. Feeding time should be restricted to a maximum of 45 minutes or discontinued sooner if the infant tires. In an attempt to get her own way, the child may cry. Excessive crying should be limited; however, appropriate limit setting should still be observed.

The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output? 1. Weighing the diapers 2. Inserting a urinary catheter 3. Comparing intake with output 4. Measuring the amount of water added to formula

1. Weighing the diapers Heart failure is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. The most appropriate method for assessing urine output in an infant receiving diuretic therapy is to weigh the diapers. Comparing intake with output would not provide an accurate measure of urine output. Measuring the amount of water added to formula is unrelated to the amount of output. Although urinary catheter drainage is most accurate in determining output, it is not the most appropriate method in an infant and places the infant at risk for infection.

Children with Kawasaki's disease may develop: 1. aneurysm formation 2. mitral valve disease 3. sepsis 4. meningitis

1. aneurysm formation Without treatment, 20% to 25% of children can develop aneurysm formation.

Obese children are at risk for: (choose all that apply) 1. bone problems 2. cardiovascular disease 3. autoimmune disorders 4. type 1 diabetes 5. respiratory problems 6. psychological problems

1. bone problems 2. cardiovascular disease 5. respiratory problems 6. psychological problems Obese children are at greater risk for bone and joint problems, sleep apnea (respiratory problem), social and psychological problems, and cardiovascular disease. Long-term effects may include obesity as an adult, heart disease, type 2 diabetes, stroke, certain types of cancer, and osteoarthritis.

The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instruction? 1. "A balance of rest and exercise is important." 2. "I can apply lotion or powder to the incision if it is itchy." 3. "Activities in which my child could fall need to be avoided for 2 to 4 weeks." 4. "Large crowds of people need to be avoided for at least 2 weeks after surgery."

2. "I can apply lotion or powder to the incision if it is itchy." The mother should be instructed that lotions and powders should not be applied to the incision site after cardiac surgery. Lotions and powders can irritate the surrounding skin, which could lead to skin breakdown and subsequent infection of the incision site. Options 1, 3, and 4 are accurate instructions regarding home care after cardiac surgery.

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis? 1. "I'm so glad they didn't find any protein in his urine." 2. "I noticed his urine was the color of coca-cola lately." 3. "His health care provider said his kidneys are working well." 4. "The nurse who admitted my child said his blood pressure was low."

2. "I noticed his urine was the color of coca-cola lately." Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common due to fluid volume overload secondary to the kidneys not working properly.

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention? 1. Cover the bladder with petroleum jelly gauze. 2. Cover the bladder with a nonadhering plastic wrap. 3. Apply sterile distilled water dressings over the bladder mucosa. 4. Keep the bladder tissue dry by covering it with dry sterile gauze.

2. Cover the bladder with a nonadhering plastic wrap. In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The use of petroleum jelly gauze should be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucosa when removed.

A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? 1. Warm, dry skin 2. Decreased wheezing 3. Pulse rate of 90 beats/minute 4. Respirations of 18 breaths/minute

2. Decreased wheezing Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving. Warm, dry skin indicates an improvement in the child's condition because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats/minute. The normal respiratory rate in a 10-year-old is 16 to 20 breaths/minute.

In a child with asthma, beta adrenergic agonists, such as albuterol, are administered primarily to do which of the following? 1. Decrease postnasal drip 2. Dilate the bronchioles 3. Reduce airway inflammation 4. Reduce secondary infections

2. Dilate the bronchioles Beta adrenergic agonists, such as albuterol, are highly effective bronchodilators and are used to dilate the narrow airways associated with asthma. Decongestants may be given to decrease postnasal drip. Corticosteroids may be used for their anti-inflammatory effect; antibiotics are used to prevent secondary infection.

Immunization of children with the Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions? 1. Laryngotracheobronchitis (LTB) 2. Epiglottitis 3. Pneumonia 4. Bronchiolitis

2. Epiglottitis Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis. Acute LTB is of viral origin. The most common bacterial organisms causing pneumonia in children are pneumococci, streptococci, and staphylococci. Bronchiolitis is usually caused by respiratory syncytial virus.

Which of the following respiratory conditions is always considered a medical emergency? 1. Laryngotracheobronchitis (LTB) 2. Epiglottitis 3. Asthma 4. Cystic fibrosis (CF)

2. Epiglottitis Epiglottitis, acute and severe inflammation of the epiglottis, is always considered an acute medical emergency because it can lead to acute, life-threatening airway obstruction. Acute LTB requires close observation for airway obstruction, but this condition is not always an emergency. Asthma is a chronic disease; however, status asthmaticus and acute attacks require prompt treatment. CF is a chronic disease and is not considered an emergency.

Which of the following would the nurse expect to see as a cardinal sign or symptom of digoxin toxicity in a child with heart failure who is receiving digoxin? 1. Respiratory distress 2. Extreme bradycardia 3. Constipation 4. Headache

2. Extreme bradycardia Extreme bradycardia is a cardinal sign of digoxin toxicity. Respiratory distress, constipation, and headache are not related to digoxin toxicity.

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension 2. Generalized edema 3. Increased urinary output 4. Frank, bright red blood in the urine

2. Generalized edema Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

Secondary vesicoureteral reflux usually results from which of the following? 1. Congenital defects 2. Infection 3. Acidic urine 4. Hydronephrosis

2. Infection Infection is the most common cause of secondary vesicoureteral reflux. Congenital defects cause primary vesicoureteral reflux. Acidic urine is normal and helps to prevent infection. Hydronephrosis may result from vesicoureteral reflux.

When developing a teaching plan to prevent urinary tract infection, which of the following should be included? (Select all that apply.) 1. Wearing underwear made of synthetic material such as nylon 2. Maintaining adequate fluid intake 3. Keeping urine alkaline by avoiding acidic beverages 4. Avoiding urination before and after intercourse 5. Avoiding bubble baths and tight clothing 6. Emptying bladder with each urination

2. Maintaining adequate fluid intake 5. Avoiding bubble baths and tight clothing 6. Emptying bladder with each urination Fluid intake helps dilute urine and minimize infection potential, bubble baths and tight clothing may act as irritants, and emptying the bladder fully with each urination prevents stasis. Children and teens should wear cotton underwear, keep their urine acidic, and void before and after intercourse (if sexually active).

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriate nursing action? 1. Initiate strict enteric precautions. 2. Move the infant to a room with another child with RSV. 3. Leave the infant in the present room because RSV is not contagious. 4. Inform the staff that they must wear a mask, gloves, and a gown when caring for the child.

2. Move the infant to a room with another child with RSV. RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of contact and standard precautions during care is necessary. Using good hand-washing technique and wearing gloves and gowns are also necessary. Masks are not required. An infant with RSV is isolated in a single room or placed in a room with another child with RSV. Enteric precautions are unnecessary.

When developing a teaching plan for the parents of a child with pulmonic stenosis (PS), the nurse would keep in mind that this disorder involves which of the following? 1. Return of blood to the heart without entry into the left atrium 2. Obstruction of blood flow from the right ventricle 3. Obstruction of blood from the left ventricle 4. A single vessel arising from both ventricles

2. Obstruction of blood flow from the right ventricle PS refers to an obstruction of blood flow from the right ventricle. Total anomalous pulmonary venous communications involve the return of blood to the heart without entry into the left atrium and obstruction of blood flow from the left ventricle. Truncus arteriosus involves a single vessel arising from both ventricles.

When developing a care plan for the child diagnosed with cystic fibrosis (CF), which of the following must the nurse keep in mind? 1. CF is an autosomal dominant hereditary disorder. 2. Pulmonary secretions are abnormally thick. 3. Obstruction of the endocrine glands occurs. 4. Elevated levels of potassium are found in the sweat.

2. Pulmonary secretions are abnormally thick. CF is characterized by abnormally thick pulmonary secretions. It is a chronic, inherited disorder, specifically an autosomal recessive hereditary disorder affecting the exocrine, not endocrine, glands. The thick mucus obstructs the exocrine glands. Diagnosis of CF is based on elevated chloride levels found in sweat.

Ribavirin (Virazole) may be used to treat the severe form of which of the following? 1. Bronchiolitis 2. Respiratory syncytial virus (RSV) 3. Otitis media 4. Cystic fibrosis (CF)

2. Respiratory syncytial virus (RSV) Ribavirin is an antiviral medication used for treating severe RSV infection and for children with RSV who are compromised (such as children with bronchopulmonary dysplasia or heart disease). The drug is not used to treat bronchiolitis, otitis media, or CF.

An acute, severe prolonged asthma attack that is unresponsive to usual treatment is referred to as which of the following? 1. Intrinsic asthma 2. Status asthmaticus 3. Reactive airway disease 4. Extrinsic asthma

2. Status asthmaticus Status asthmaticus is an acute, prolonged, severe asthma attack that is unresponsive to usual treatment. Typically, the child requires hospitalization. Intrinsic is a term used to denote internal precipitating factors, such as viruses. Reactive airway disease is another general term for asthma. Extrinsic is a term used to denote external precipitating factors, such as allergens.

Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation? 1. Patent ductus arteriosus (PDA) 2. Tetralogy of Fallot 3. Coarctation of aorta 4. Aortic stenosis (AS)

2. Tetralogy of Fallot Tetralogy of Fallot consists of four major anomalies: ventricular septal defect, right ventricular hypertrophy, pulmonic stenosis (PS), and aorta overriding the ventricular septal defect. PS impedes the flow of blood to the lungs, causing increased pressure in the right ventricle, forcing deoxygenated blood through the septal defect to the left ventricle. As a result of this decreased pulmonary blood flow, deoxygenated blood is shunted into the systemic circulation. The increased workload on the right ventricle causes hypertrophy. The overriding aorta receives blood from both the right and left ventricles. This is the definition of defect with decreased pulmonary blood flow where unoxygenated blood is shunted into the systemic circulation. Tetralogy of Fallot is the only one in this category. With PDA, blood flows from the aorta through the PDA and back to the pulmonary artery and lungs (shunting of oxygenated blood to the pulmonic system), causing increased left ventricular workload and increased pulmonary vascular congestion. Coarctation of aorta and AS are obstructive defects where obstruction, not shunting, is the problem.

The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indication that the child may be experiencing airway obstruction? 1. The child exhibits nasal flaring and bradycardia. 2. The child is leaning forward, with the chin thrust out. 3. The child has a low-grade fever and complains of a sore throat. 4. The child is leaning backward, supporting himself or herself with the hands and arms.

2. The child is leaning forward, with the chin thrust out. Epiglottitis is a bacterial form of croup. A primary concern is that it can progress to acute respiratory distress. Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, the use of accessory muscles for breathing, and the presence of stridor. Option 4 is an incorrect position. Options 1 and 3 are incorrect because epiglottitis causes tachycardia and a high fever.

Which of the following are defects associated with tetralogy of Fallot? 1. Coarctation of aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus 2. Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy 3. Tricuspid valve atresia, atrial septal defect, ventricular septal defect, and hypoplastic right ventricle 4. Aorta exits from the right ventricle and pulmonary artery exits from the left ventricle, with two noncommunicating circulations

2. Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy The defects associated with tetralogy of Fallot include ventricular septal defect, overriding aorta, PS, and right ventricular hypertrophy. Coarctation of aorta and aortic and mitral valve stenosis are defects associated with tricuspid atresia. Severe coarctation of aorta, severe aortic valvular stenosis or atresia, and severe mitral valve stenosis or atresia are defects associated with hypoplastic left heart syndrome. Also, the left ventricle, aortic valve, mitral valve, and ascending aorta usually are small or hypoplastic. The aorta exiting from the right ventricle and the pulmonary artery exiting from the left ventricle with no communication between the systemic and pulmonic circulations describes the defects associated with transposition of the great vessels.

A nurse is assigned to work with a 4-year-old child with cystic fibrosis. To enable this child to function at her fullest capacity, the nurse will: 1. promote independence with feeding, toilet training, dressing, and gross motor skills. 2. reassure child that the illness and its treatments are not punishments for her behavior. 3. foster child's ability to maintain educational needs and encourage physical activity. 4. encourage increasing responsibility for self-care, while still promoting peer acceptance.

2. reassure child that the illness and its treatments are not punishments for her behavior. Cystic fibrosis is a chronic illness, and a 4-year-old child would be in the preschool stage when children experience magical thinking and believe that their illness and/or its treatment is punishment for some wrongdoing on their part.

The mother of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make? 1. "The child may be allergic to antibiotics." 2. "The child is too young to receive antibiotics." 3. "Antibiotics are not indicated unless a bacterial infection is present." 4. "The child still has the maternal antibodies from birth and does not need antibiotics."

3. "Antibiotics are not indicated unless a bacterial infection is present." Laryngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi and is the most common type of croup. It can be viral or bacterial. Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present. Options 1, 2, and 4 are incorrect. In addition, no supporting data in the question indicate that the child may be allergic to antibiotics.

Which of the following statements by the family of a child with asthma indicates a need for additional home care teaching? 1. "We need to identify what things trigger his attacks." 2. "He is to use his bronchodilator inhaler before the steroid inhaler." 3. "We'll make sure that he avoids exercise to prevent attacks." 4. "He should increase his fluid intake regularly to thin secretions."

3. "We'll make sure that he avoids exercise to prevent attacks." Additional teaching is needed if the family states that the child with asthma should avoid exercise to prevent attacks. Children with asthma should be encouraged to exercise as tolerated. Identifying triggers, using a bronchodilator inhaler before a steroid inhaler, and increasing fluid intake are appropriate measures to be included in a home care teaching program for the child with asthma and his family.

Which of the following instructions should be included in the teaching plan for parents of a young child with otitis media? 1. Cleaning the inside of the ear canals with cotton swabs 2. Placing the child in the supine position to bottle-feed 3. Avoiding contact with people who have upper respiratory tract infections 4. Giving prescribed amoxicillin (Amoxil) on an empty stomach

3. Avoiding contact with people who have upper respiratory tract infections Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection. Cotton swabs can cause injuries such as tympanic perforation. They may be used to clean the outer ear, but they should never be inserted into the ear canal. A bottle-fed child should be fed in an upright position because feeding the child in the supine position may actually precipitate otitis by allowing formula to pool in the pharyngeal cavity. Amoxicillin, when prescribed, should be given with food to prevent stomach upset.

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which should the nurse most likely expect to note? 1. Hematuria 2. Proteinuria 3. Bacteriuria 4. Glucosuria

3. Bacteriuria Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic facilitates entry of bacteria into the urine. Options 1, 2, and 4 are not characteristically noted in this condition.

When caring for a very-low-birth-weight neonate, the nurse carefully monitors inspiratory pressure and oxygen (O2) concentration to prevent which of the following? 1. Respiratory distress syndrome (RDS) 2. Respiratory syncytial virus (RSV) 3. Bronchopulmonary dysplasia (BPD) 4. Meconium aspiration syndrome

3. Bronchopulmonary dysplasia (BPD) Close monitoring of inspiratory pressure and O2 concentration is necessary to prevent BPD, which is related to the use of high inspiratory pressures and O2 concentrations especially in very-low- birth-weight and extremely low-birth-weight neonates with lung disorders. RDS, a disorder caused by lack of surfactant, usually is found in premature neonates. RSV is a group of viruses that cause respiratory tract infections, such as bronchiolitis and pneumonia. Meconium aspiration syndrome is a respiratory disorder created by the aspiration of meconium in the perinatal period.

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1. Cracked lips 2. Normal appearance 3. Conjunctival hyperemia 4. Desquamation of the skin

3. Conjunctival hyperemia Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an acute systemic inflammatory illness. In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal, but signs of inflammation may be present.

The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? 1. Pallor 2. Hyperactivity 3. Exercise intolerance 4. Gastrointestinal disturbances

3. Exercise intolerance Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. A child with aortic stenosis shows signs of exercise intolerance, chest pain, and dizziness when standing for long periods. Pallor may be noted, but is not specific to this type of disorder alone. Options 2 and 4 are not related to this disorder.

When caring for a child with feeding disorder of infancy or early childhood, which of the following is the most appropriate nursing diagnosis? 1. Ineffective infant feeding pattern 2. Ineffective breathing pattern 3. Impaired parenting 4. Risk for injury

3. Impaired parenting Commonly, nonorganic failure to thrive (NFTT) is a result of parental deprivation, parents' inadequate nutritional information, or a disturbance in the parent-child attachment. Thus, impaired parenting is the most appropriate nursing diagnosis. Implementation focuses on promoting normal growth and development and fostering appropriate parenting behaviors. Feeding problems may be seen as a result of NFTT, but these are related to the underlying problem of impaired parenting. Because the cause is not related to a disease, ineffective breathing pattern is inappropriate. The child may be at risk for injury from imbalanced nutrition, but again this is the result of the underlying impaired parenting.

Which of the following signs and symptoms are characteristic of minimal-change nephrotic syndrome? 1. Gross hematuria, proteinuria, fever 2. Hypertension, edema, hematuria 3. Poor appetite, proteinuria, edema 4. Hypertension, edema, proteinuria

3. Poor appetite, proteinuria, edema Clinical manifestations of nephrotic syndrome include loss of appetite due to edema of intestinal mucosa, proteinuria, and edema. Gross hematuria is not associated with nephrotic syndrome. Fever would occur only if infection also existed. Hypertension alone or accompanied by hematuria is associated with glomerulonephritis.

When performing a procedure related to a genitourinary (GU) problem, the nurse would anticipate that which of the following age groups would find it especially stressful? 1. Infants 2. Toddlers 3. Preschoolers 4. School-age children

3. Preschoolers In general, preschoolers have more fears because of their fantasies, contributing to fears of the simplest procedures. Castration fears also are prominent at this age and may be heightened by procedures related to GU problems. Typically, GU procedures do not create greater stress in infants, toddlers, and school-age children.

Which of the following nursing interventions would be appropriate to promote optimal nutrition in an infant with heart failure? 1. Offering formula that is high in sodium and calories 2. Providing large feedings evenly spaced every 4 hours 3. Replacing regular nipples with easy-to-suck ones 4. Allowing the infant to feed for at least 1 hour

3. Replacing regular nipples with easy-to-suck ones Because the infant may tire easily with regular nipples and thus would not be able to suck adequately, the nurse should replace regular nipples with easy-to-suck ones. Typically, the infant receives a low-sodium, high-calorie diet. Also to prevent tiring, small frequent feedings lasting no more than 45 minutes, rather than large evenly spaced feedings or ones lasting longer than 1 hour, should be given.

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF? 1. Pallor 2. Cough 3. Tachycardia 4. Slow and shallow breathing

3. Tachycardia HF is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. The early signs of HF include tachycardia, tachypnea, profuse scalp sweating, fatigue and irritability, sudden weight gain, and respiratory distress. A cough may occur in HF as a result of mucosal swelling and irritation, but is not an early sign. Pallor may be noted in an infant with HF, but is not an early sign.

The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan? 1. "Caution should be used when straddling the infant on a hip." 2. "Vital signs should be taken daily to check for bladder infection." 3. "Catheterization will be necessary when the infant does not void." 4. "Circumcision has been delayed to save tissue for surgical repair."

4. "Circumcision has been delayed to save tissue for surgical repair." Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant should not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. Options 1, 2, and 3 are unrelated to this disorder.

Which question should the nurse ask the parents of a child suspected of having glomerulonephritis? 1. "Did your child fall off a bike onto the handlebars?" 2. "Has the child had persistent nausea and vomiting?" 3. "Has the child been itching or had a rash anytime in the last week?" 4. "Has the child had a sore throat or a throat infection in the last few weeks?"

4. "Has the child had a sore throat or a throat infection in the last few weeks?" Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The assessment data in options 1, 2, and 3 are unrelated to a diagnosis of glomerulonephritis.

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? 1. "I will not mix the medication with food." 2. "I will take my child's pulse before administering the medication." 3. "If more than 1 dose is missed, I will call the health care provider." 4. "If my child vomits after medication administration, I will repeat the dose."

4. "If my child vomits after medication administration, I will repeat the dose." Digoxin is a cardiac glycoside. The parents need to be instructed that if the child vomits after digoxin is administered, they are not to repeat the dose. Options 1, 2, and 3 are accurate instructions regarding the administration of this medication. In addition, the parents should be instructed that if a dose is missed and is not identified until 4 hours later, the dose should not be administered.

A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). She asks the nurse how to position her new infant for sleep. In which position should the nurse tell the parent to place the infant? 1. Side or prone 2. Back or prone 3. Stomach with the face turned 4. Back rather than on the stomach

4. Back rather than on the stomach SIDS is the unexpected death of an apparently healthy infant younger than 1 year for whom an investigation of the death and a thorough autopsy fail to show an adequate cause of death. Several theories are proposed regarding the cause, but the exact cause is unknown. Nurses should encourage parents to place the infant on the back (supine) for sleep. Infants in the prone position (on the stomach) may be unable to move their heads to the side, increasing the risk of suffocation. The infant may have the ability to turn to a prone position from the side-lying position.

The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent? 1. "The immunization schedule will need to be altered." 2. "The child should not receive any hepatitis vaccines." 3. "The child will receive all of the immunizations except for the polio series." 4. "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."

4. "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination." Cystic fibrosis is a chronic multisystem disorder (autosomal recessive trait disorder) characterized by exocrine gland dysfunction. The mucus produced by the exocrine glands is abnormally thick, tenacious, and copious, causing obstruction of the small passageways of the affected organs, particularly in the respiratory, gastrointestinal, and reproductive systems. Adequately protecting children with cystic fibrosis from communicable diseases by immunization is essential. In addition to the basic series of immunizations, a yearly influenza immunization is recommended for children with cystic fibrosis. Options 1, 2, and 3 are incorrect.

Which of the following infants is least likely to develop sudden infant death syndrome (SIDS)? 1. An infant who was premature 2. A sibling of an infant who died of SIDS 3. An infant with prenatal drug exposure 4. An infant who sleeps on his back

4. An infant who sleeps on his back Infants who sleep on their back are least likely to develop SIDS. However, SIDS has been associated with infants who sleep on their abdomens. Being premature, having a sibling who died of SIDS, and being prenatally exposed to drugs all place the infant at high risk for developing SIDS.

For a child with recurring nephrotic syndrome, which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care? 1. Muscle coordination 2. Sexual maturation 3. Intellectual development 4. Body image

4. Body image Because of the edema associated with nephrotic syndrome, potential self-concept and body image disturbances related to changes in appearance and social isolation should be considered. Muscle coordination, sexual maturation, and intellectual function are not affected.

Which of the following would the nurse expect to assess in an older child with pneumococcal pneumonia? 1. Bulging fontanel 2. Mild cough 3. Slight fever 4. Chest pain

4. Chest pain Older children with pneumococcal pneumonia may complain of chest pain. A bulging fontanel may be seen in infants with meningitis or increased intracranial pressure. A mild cough and slight fever are more commonly assessed with viral pneumonia.

What is the most likely underlying pathophysiology of primary enuresis? 1. Urinary tract infection 2. Psychogenic stress 3. Vesicoureteral reflux 4. Delayed bladder maturation

4. Delayed bladder maturation The most likely cause of PE is delayed or incomplete maturation of the bladder. UTIs may cause either primary or secondary enuresis, but they are not the leading cause of PE. Psychogenic stress may cause either primary or secondary enuresis, but it is not the leading cause of PE. Vesicoureteral reflux may cause either primary or secondary enuresis, but it is not the leading cause of PE.

Which of the following instructions would be included in a sexually active adolescent's preventive teaching plan about urinary tract infections? 1. Wiping back to front 2. Wearing nylon underwear 3. Avoiding urinating before intercourse 4. Drinking acidic juices

4. Drinking acidic juices Drinking acidic juices, such as cranberry juice, helps keep the urine at its desired acid pH and reduces the chance of infection. The client should wipe from front to back, wear cotton underwear, and void before and after intercourse.

Which of the following would the nurse expect when assessing a child with cystitis? 1. High fever 2. Flank pain 3. Costovertebral tenderness 4. Dysuria

4. Dysuria Dysuria is a symptom of a lower urinary tract infection (UTI) such as cystitis. High fever, flank pain, and costovertebral tenderness are signs and symptoms of pyelonephritis, an upper UTI.

The mother of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen is not effective. Which instruction should the nurse provide to the mother? 1. Increase the dose of ibuprofen. 2. Increase the frequency of ibuprofen. 3. Encourage the child to lie on the left side. 4. Encourage the child to lie on the right side.

4. Encourage the child to lie on the right side. Pneumonia is an inflammation of the pulmonary parenchyma or alveoli, or both, caused by a virus, mycoplasmal agents, bacteria, or aspiration of foreign substances. Splinting of the affected side by lying on that side may decrease discomfort. It would be inappropriate to advise the mother to increase the dose or frequency of the ibuprofen. Lying on the left side would not be helpful in alleviating discomfort.

Which of the following organisms is the most common cause of urinary tract infection (UTI) in children? 1. Staphylococcus 2. Klebsiella 3. Pseudomonas 4. Escherichia coli

4. Escherichia coli E. coli is the most common organism associated with the development of UTI. Although Staphylococcus, Klebsiella, and Pseudomonas species may cause UTIs, the incidence of UTIs related to each is less than that for E. coli.

When teaching parents about known antecedent infections in acute glomerulonephritis, which of the following should the nurse cover? 1. Herpes simplex 2. Scabies 3. Varicella 4. Impetigo

4. Impetigo Impetigo, a bacterial infection of the skin, may be caused by streptococci and may precede acute glomerulonephritis. Although most streptococcal infections do not cause acute glomerulonephritis, when they do, a latent period of 10 to 14 days occurs between the infection, usually of the skin (impetigo) or upper respiratory tract, and the onset of clinical manifestations. Herpes, scabies, and varicella are not associated with acute glomerulonephritis.

A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the most appropriate nursing action? 1. Tell the mother that the child must stay in the tent. 2. Place a toy in the tent to make the child feel more comfortable. 3. Call the health care provider and obtain a prescription for a mild sedative. 4. Let the mother hold the child and direct the cool mist over the child's face.

4. Let the mother hold the child and direct the cool mist over the child's face. Laryngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi and is the most common type of croup. Cool mist therapy may be prescribed to liquefy secretions and to assist in breathing. If the use of a tent or hood is causing distress, treatment may be more effective if the child is held by the parent and a cool mist is directed toward the child's face (blow-by). A mild sedative would not be administered to the child. Crying would increase hypoxia and aggravate laryngospasm, which may cause airway obstruction. Options 1 and 2 would not alleviate the child's fear.

A 7-year-old child is seen in a clinic, and the health care provider documents a diagnosis of primary nocturnal enuresis. The nurse should provide which information to the parents? 1. Primary nocturnal enuresis does not respond to treatment. 2. Primary nocturnal enuresis is caused by a psychiatric problem. 3. Primary nocturnal enuresis requires surgical intervention to improve the problem. 4. Primary nocturnal enuresis is usually outgrown without therapeutic intervention.

4. Primary nocturnal enuresis is usually outgrown without therapeutic intervention. Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.

A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen to the infant? 1. During sleep 2. When changing the infant's diapers 3. When the mother is holding the infant 4. When drawing blood for electrolyte level testing

4. When drawing blood for electrolyte level testing Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. Crying exhausts the limited energy supply, increases the workload of the heart, and increases the oxygen demands. Oxygen administration may be prescribed for stressful periods, especially during bouts of crying or invasive procedures. Options 1, 2, and 3 are not likely to produce crying in the infant.