Exam 2 - possible questions
A nurse is providing discharge teaching to the parents of a 6-month-old infant who is postoperative following hypospadias repair with a stent placement. Which of the following instructions should the nurse include in the teaching?
Allow the stent to drain directly into your infant's diaper-- this will prevent kinking or twisting that can interfere with urine flow
Providing teaching to the parents of a preschooler who has heart failure and who is beginning to take digoxin twice daily. Appropriate instructions to include?
"Brush the child's teeth after giving the medication."
A nurse is reviewing the dietary choices of an adolescent who has iron deficiency anemia. The nurse should identify that which of the following menu items has the highest amount of iron?
1/2 cup of raisins
A nurse is admitting a child who has Wilms' tumor. Which of the following actions should the nurse take?
Put a "no abdominal palpation" sign over the child's bed
A nurse is caring for a child who has enuresis. Which is a complication of it a)UTI b) emotional problems c)urosepsis d)progressive kideny dx
b) emotional problems
A nurse is caring for a child who has a diagnosis of iron deficiency anemia. Which of the following instructions would be appropriate for the nurse to give to the parents?
"Give the iron between meals with orange juice."
A nurse is caring for an infant who is receiving IV fluids for the treatment of tetralogy of fallot and begins to have a hypercyanotic spell. Which of the following actions should the nurse take?
Place the infant in a knee-chest position-- this will decrease the return of desaturated venous blood from the legs and to direct more blood into the pulmonary artery by increasing systemic vascular resistance
A nurse is reviewing the laboratory report of a 2-year-old child who has diarrhea and has been vomiting for 24 hr. Which of the following findings should the nurse report to the provider?
Potassium 2.5 mEq/L
A nurse is creating a plan of care for a school-age child who has heart disease and has developed heart failure. Which of the following interventions should the nurse include in the plan?
Provide small, frequent meals to the child-- the metabolic rate for a child with heart failure is high because of poor cardiac function and helps conserve energy
A nurse is providing dietary teaching to the parent of a school-age child who has celiac disease. The nurse should recommend that the paretn offer which of the following foods to the child?
Rice pudding
A nurse is providing nutritional teaching to an adolescent client who has celiac disease. Which of the following breakfast foods should the nurse recommend?
Scrambled eggs
A nurse is caring for a school-age child who is receiving chemotherapy and is severely immunocompromised. Which of the following actions should the nurse take?
Screen the child's visitors for indications of infection-- potential for an overwhelming infection
nurse is caring for a 7-year-old child diagnosed with glomerulonephritis. The child has decreased urinary output and a blood pressure of 160/78 mm Hg. The child is receiving hydralazine (Apresoline). Which of the following lunch choices should the nurse recognize as most appropriate?
Grilled chicken on a roll, pear slices, and 4 oz of apple juice
A nurse is reviewing the lab report of a school-age child who is experiencing fatigue. Which of the following findings should the nurse recognize as an indication of anemia?
Hematocrit 28%
A nurse is assessing a child with a UTI. Which are manifestation for a UTI. a) night sweats b)swelling of the face c) pallor d)pale-colored urine d)fatigue
b)swelling of the face c) pallor d)fatigue
A nurse is planaing care for achild with a UTI. which should be included a) admin antidiuretic b)restrict fluid c)evaluate the child's self esteem d)encourage frequent voiding
d)encourage frequent voiding
A nurse is caring for a child who had watery diarrhea in the past 3 days. Which of the following is an appropriate action for the nurse to take? a) Offer chicken broth b) Initiate oral rehydration therapy c)Start hypertonic IV solution d) Keep NPO until diarrhea
b) Initiate oral rehydration therapy
A nurse is providing teaching to the mother of an infant who has a prescription for digoxin. Which of the following instruction should the nurse include a) Do no offer your baby fluids after giving he medication b)Digoxin increases your baby's heart rate c)Give the correct dose of medication at regularly scheduled times d)If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount.
c)Give the correct dose of medication at regularly scheduled times
A nurse is assessing a 6-month-old infant following a cardiac catheterization. Which of the following findings should the nurse report to the provider?
BP 86/40 mm Hg
A nurse is assessing an infant who has a ventricular septal defect. Which of the following findings should the nurse expect?
Loud, harsh murmur-- due to the left-to-right shunting of blood
A nurse is planning care for an adolescent who has sickle cell anemia and is experiencing a vasoocclusive crisis. Which of the following interventions should the nurse include in the plan?
Maintain the child on bed rest
A nurse is caring for a school-age child who has acute rheumatic fever. Which of the following actions should the nurse take?
Maintain the child on bed rest-- limiting activity with assist with prevention of cardiac damage
A nurse is creating a plan of care for a child who has leukopenia secondary to chemotherapy. Which of the following interventions should the nurse include in the plan?
Monitor the child for increased temperature
A nurse is assessing a child who has a ventricular septal defect. Which of the following finding should the nurse expect?
Murmur at the left sternal border
A nurse is providing discharge teaching to the parents of a child who has nephrotic syndrome. Which of the following instructions should the nurse include in the teaching?
Keep the child away from people who have an infection
A nurse is caring for a male infant who has an PSAGN. Which of the following finding should the nurse expect a)frothy urine b)periorbital edema c)ill appearance d)decrease Cr e)HTN
b)periorbital edema c)ill appearance e)HTN
A nurse is teaching about clinical manifestations of tracheomalacia to a parent of an infant who had tracheoesphageal fistula repair as a newborn. Which of the following findings should the nurse include in the teaching?
Barking cough
nurse is admitting a child who has a possible diagnosis of leukemia. Which of the following tests is the most appropriate for the nurse to consider when confirming a diagnosis of leukemia?
Bone marrow aspiration
A nurse is caring for a child who is admitted with swollen, painful joints and is diagnosed with rheumatic fever. When educating the child's parent about rheumatic fever, which of the following statements by the nurse would be appropriate?
"It is preceded by a streptococcal infection."
A nurse is providing discharge teaching to the parent of an 18-month-old toddler who has dehydration as a result of acute diarrhea. Statement by the parent that indicates and understanding of the teaching?
"I will monitor my child's # of wet diapers"
nurse receives the following laboratory values on a 2-month-old child who has cyanotic heart disease. The results are a hemoglobin of 17 g/dL and a hematocrit of 51%. Which of the following statements by the nurse reflects the most appropriate interpretation of this information?
"The infant's body is compensating for tissue hypoxia by increasing RBC production."
A nurse in a provider's office is caring for a school-age child who has varicella. The parent asks the nurse when her child will no longer be contagious. Appropriate response by the nurse?
"When your child's lesions are crusted, 6 days after they appear."
A nurse in the ED is caring for an adolescent who has severe abdominal pain due to appendicitis. Which of the following locations should the nurse identify as McBurney's point? (Hotspot)
A. the lower R. quadrant of the abdomen between the umbilicus and the anterior iliac crest.
A nurse is caring for a child who is receiving chemotherapy with anorexia and nausea. Which of the following interventions should the nurse recognize as the most appropriate for the child experiencing these symptoms?
Allow the client to eat whatever the client wants, at any time.
nurse is caring for a child who has epistaxis. Which of the following actions would be the most appropriate for the nurse to take?
Apply a cold cloth to bridge of nose.
nurse is caring for a 10-year-old child who is postoperative abdominal surgery and was medicated 6 hr ago. When assessing the child, the nurse finds the child quiet and not interacting with family. Which of the following is an appropriate nursing action?
Assess the child's need for pain medication.
A nurse is creating a plan of care for a preschooler who has Wilm's tumor and is scheduled for surgery. Which of the following interventions should the nurse include?
Avoid palpating the abdomen when bathing the child before surgery
A nurse is caring for a 12-month-old infant following surgical repair of a cleft palate. The nurse should plan to feed the infant using which of the following instruments?
Cup
A nurse is caring for a school-age child who has primary nephrotic syndrome and is taking prednisone. Following 1 wk of tx, which of the following clinical manifestations indicates to the nurse that the medication is effective?
Decreased edema
A nurse is caring for a 6-year-old child who is receiving chemotherapy. The child has a platelet count of 20,000/mm3. Which of the following should the nurse recognize as the appropriate intervention for a child with this platelet count?
Encourage quiet play.
A nurse is admitting a 4-month-old infant who has heart failure. Which of the following findings is the nurse's priority?
Episodes of vomiting-- this can indicate digoxin toxicity which requires immediate intervention
A nurse is caring for a 3 year old child who is scheduled for a nephrectomy. When preparing preoperatively, which of the following actions should the nurse recognize as appropriate?
Explain the procedure to the child in simple sentences just before administering the preoperative sedation.
A school nurse is assessing a school-age child who has erythema infectiosum (fifth disease). Which of the following findings should the nurse expect?
Facial rash-- predominantly on the child's cheeks, the rash lasts from 1 to 4 days
A nurse is reviewing the laboratory report of a 6-year-old child who is receiving chemotherapy. Which of the following laboratory values should the nurse report to the provider?
Hgb 8.5 g/dL-- child getting chemo is at risk for anemia due to chemo effects on the blood forming cells of the bone marrow.
A clinic nurse is providing teaching to the parent of a 1-month-old infant who has gastroesophageal reflux. Which of the following statements by the parent indicates an understanding of the teaching?
I will add rice cereal to my baby's feedings
A nurse is providing discharge teaching to the parent of a school-age child who has leukemia and is receiving chemotherapy. Which of the following statements by the parent indicates an understanding of the teaching?
I will inspect my child's mouth every day for sores
A nurse is planning care for a school-age child who is in the oliguric phase of acute kidney injury (AKI) and has a sodium level of 129 mEq/L. Which of the following interventions should the nurse include in the plan?
Initiate seizure precautions for the child-- hyponatremia increases the child's risk of seizures
A home health nurse is developing a plan of care for the parents of a toddler who has hemophilia. Which of the following instructions should the nurse include in the plan?
Inspect the toddler's toys for sharp edges
A nurse is providing education to a parent whose child has had a colostomy. Which of the following is an appropriate method to determine understanding of the teaching?
Observe the parents while they perform the procedure.
A nurse is caring for a toddler who is experiencing acute diarrhea and has moderate dehydration. Which of the following nutritional items should the nurse offer to the toddler?
Oral rehydration solution-- this will replace electrolytes and water
A nurse is caring for a school-age child who has peripheral edema. Following assessments that confirm peripheral edema?
Palpate the dorsum of the child's feet
A nurse is caring for an 8-year-old child who has acute glomerulonephritis. Which of the following findings should the nurse expect?
Periorbital edema
A nurse on the pediatric unit is caring for four clients who all have assessments ordered in the morning. Which of the following values should the nurse report to a client's primary care provider immediately?
Sickle cell anemia and a urine specific gravity of 1.030
A nurse is caring for a 6-week-old infant following a pyloromyotomy. Which of the following forms of feeding should the the nurse anticipate for the infant 6 hr after the procedure?
Small, frequent bottle feedings of electrolyte solution
A nurse is reviewing the lab report of an infant who is receiving tx for severe dehydration. The nurse should identify that which of the following lab values indicates effectiveness of the current tx?
Sodium 140 mEq/L
A nurse is assessing a toddler who has gastroenteritis and is exhibiting manifestations of dehydration. Which of the following findings should the nurse address first?
Tachypnea-- results when the kidneys are unable to excrete hydrogen ions and produce bicarbonate leading to metabolic acidosis
A nurse is caring for a child who has frequent urinary tract infections. When educating the parent on the prevention of urinary tract infections, which of the following instructions should the nurse include in the teaching?
Teach the child to wipe her perineum from front to back after urinating.
A nurse is assessing a pt. who has a new diagnosis of celiac disease. Expected clinical manifestations?
Steatorrhea
A nurse is caring for an infant following surgical repair of a cleft lip and palate. Which of the following actions should the nurse take?
Suction the infant gently with a bulb syringe PRN
A nurse in an ED is assessing a 3-month-old infant who has rotavirus and is experiencing acute vomiting and diarrhea. Manifestations that indicate moderate to severe dehydration?
Sunken anterior fontanel
A nurse is assessing a 6-month-old infant who was recently admitted with acute vomiting and diarrhea. Which of the following findings indicates the infant has moderate dehydration?
Tachypnea
A nurse is providing teaching about immunizations to the parents of a severely immunocompromised child who has HIV. Which of the following statements should the nurse include in the teaching?
The pneumococcal and influenza vaccines are recommended for your child
A nurse is preparing to abotain an antistreptolysin O (ASO) titer from a child who has acute glomerulonephritis. The child's parent asks the nurse to explain the purpose of the test. Which of the following responses should the nurse make?
The test shows us if your child had a recent strep infection
A nurse is caring for four children who have congenital heart disease. Based on the pathophysiology of the disorders, which of the following should the nurse recognize would present with cyanosis?
Transposition of great vessels
A nurse is assessing a toddler who has leukemia and is receiving his first round of chemotherapy. Which of the following findings is the priority for the nurse to report to the provider?
Urticaria-- greatest risk is anaphylactic reaction
A nurse is admitting an infant who has intussusception. Which of the following findings should the nurse expect? Select all that apply
Vomiting-- due to the obstruction that occurs Lethargy-- due to episodes of severe pain
A nurse is teaching a school-age child and his parent about postoperative care following cardiac catheterization. Which of the following instructions should the nurse include?
Wait 3 days before taking a bath-- reduces the risk of infection
A nurse is assessing a 2-month-old infant who has a ventricular septal defect. Which of the following findings should the nurse report to the provider?
Weight gain of 1.8 kg (4lb)
A nurse is caring for a child with possible rheumatic fever. Which of the following finding should the nurse expect? a) Erythema marginatunm b)continuous joint pain of the digits c)Tender, subcutaneous nodules d)decreased ESR e)Elevated C-reactive protein
a) Erythema marginatunm e)Elevated C-reactive protein
A nurse is assessing a child who has rotavirus infection. Which of the following are expected findings. ( all that apply) a) Fever b) Vomiting c)Watery stools d)Bloody stools e) confusion
a) Fever b) Vomiting c)Watery stools
A nurse is teaching a parent of an infant about GERD. Which of the following should the nurse include in the teaching a) Offer frequent feedings b)thicken formula with rice cereal c)use a bottle with a one-way valve d)position baby uprights after feedings e)use a wide-based nipple for feedings
a) Offer frequent feedings b)thicken formula with rice cereal d)position baby uprights after feedings
A nurse is assessing an infant who has a suspected UTI. Which are anticipated finding? a) increase in hunger b)irritability c)decrease in urination d) vomiting e)fever
b)irritability d) vomiting e)fever
A nurse is caring for an infant who has a hydrocele. Which action should the nurse take. a)prepare the child for surgery b) explain the parents that the issue will self-resolve c)retract the foreskin and cleanse several times a day d)refer the family for a genetic consulting
b) explain the parents that the issue will self-resolve
A nurse is reviewing the laboratory results of a child who has experienced diarrhea for the past 24 hr. Which of the following values for urine specific gravity should the nurse expect?
1.035
A nurse is assessing an infant who has hypoertrophic pyloric stenosis. Which of the following findings should the nurse excpect. ( all that apply) a)Projectile vomiting b)dry mucus membrane c)currant jelly stools d)sausage-shaped abd mass e)constant hunger
a)Projectile vomiting b)dry mucus membrane e)constant hunger
A nurse is assessing an infant who has coarctation of the aorta. Which of the following finding should the nurse expect? ( all that apply) a)Weak femoral pulses b)Cool skin of lower extremities c)severe cyanosis d)clubbing of the fingers e)heart failure
a)Weak femoral pulses b)Cool skin of lower extremities e)heart failure
A nurse is caring for a male infant who has an epispadias. Which of the following finding should the nurse expect a)bladder exstrophy b)inability to retract foreskin c)widened pubic symphysis d)broad spade-like penis e) pain
a)bladder exstrophy c)widened pubic symphysis d)broad spade-like penis
A nurse is a caring for a 2-year-old who is scheduled for cardiac cath. Which of the following actions should the nurse take? a)Place on NPO for 12 hours prior b)Check for iodine/shelfish allergy c)Elevate the affected extremity after the cath d)Limit fluid intake after the cath
b)Check for iodine/shelfish allergy
A nurse is assessing an infant who had heart failure. Which of the following findings should the nurse expect a)Bradycardia b)Cool extremities c)Peripheral edema d)Increased urinary output e)Nasal flaring
b)Cool extremities c)Peripheral edema e)Nasal flaring
A nurse is teaching a parent of a child who has UTI. Which should be included? a)wear nylon underpants b)avoid bubble baths c) empty bladder completely with each void d)provide info about manifestations of infection e)wipe perineal area back to front
b)avoid bubble baths c) empty bladder completely with each void d)provide info about manifestations of infection
A nurse is assessing a child who has nephrotic syndrome. Which finding shouldthe nurse expect a)Dipstick protein of 1+ b)edema in the ankles c)hyperlipidemia d)weight loss e)anorexia
b)edema in the ankles c)hyperlipidemia e)anorexia
A nurse is caring for an infant who is postop after cleftlip and cleft palate repair. Which action should the nurse take? a) remove the packing in the mouth b)place the infant in an upright position c)offer a pacifier with sucrose d)Assess the mouth with a tongue blade
b)place the infant in an upright position
A nurse is caring for a child who has a possible intussusception. The parents of the child ask the nurse how the diagnosis is made. Which of the following responses should the nurse make?
An abdominal ultrasound will confirm the pocket in the intestine
A nurse is caring for a child who has Hirschsprung's dx. Which action should the nurse take a)Encourage a high-fiber, lop=protein, low-calorie diet b)prepare the family for surgery c)place an NG tube for decompression d)initiate bed rest
b)prepare the family for surgery
charge nurse is assigning rooms for admissions. An 8 year old child who is admitted with sickle cell anemia and is dehydrated. Which of the following is an appropriate room assignment for this child?
10-year-old male; postoperative appendectomy
nurse is caring for a child who has tetralogy of Fallot preoperatively. Which of following laboratory values should the nurse expect to find?
Hematocrit of 58%
A nurse is reviewing the laboratory report of a toddler who is receiving chemotherapy for leukemia. Which of the following laboratory values should the nurse report to the provider?
Hgb 6 g/dL
A nurse is caring for a child who has acute glomerulonephritis. Which of the following actions should the nurse recognize as appropriate in the care of this child?
Monitoring blood pressure every 4 hr