Exam 2 Review

A toddler client is brought to the ED with a history of vomiting and diarrhea for the past three days. Which finding is the nurse most likely to see? a. Shortness of breath b. Slow heart rate c. Sunken eyes d. Tremors

c. Sunken eyes

A toddler client has nausea, vomiting, and diarrhea. Which implementation is best for the nurse to use to maintain an adequate fluid intake? a. Keep the client NPO and give hypotonic solutions IV b. Force fluids and giver hypertonic solutions IV c. Provide gelatin and ice pops to increase fluid intake d. Offer oral rehydration solutions to rehydrate

d. Offer oral rehydration solutions to rehydrate

A toddler client diagnosed with autism is admitted to the pediatric unit with a tracheostomy after swallowing a small toy. The unlicensed assistive personnel reports to the nurse that the child does not respond to questions. Which response by the nurse is best? a. The child is probably frightened due to the hospital environment. b. Ok, I will perform a detailed neuro assessment on the client. c. Thank you for reporting, I will investigate the observation further. d. The inability to respond to questions is a characteristic of autism.

d. The inability to respond to questions is a characteristic of autism.

The nurse teaches about early signs and symptoms of rubeola that may appear before the notable rash. Which are included in the instructions? a. Diarrhea, intestinal cramps, and anorexia b. Runny nose, sneezing, and coughing c. Itching, fever, and cold sores d. Sore throat, ear pain, and swollen lymph nodes

b. Runny nose, sneezing, and coughing

The nurse provides care for an infant client immediately after insertion of a ventroperitoneal shunt. The nurse must intervene if which observation is made? a. The infant's pupils are equally reactive to light. b. The infant is lying on the operative site. c. The suture line is pink. d. Bowel sounds are heard in all four quadrants.

b. The infant is lying on the operative site.

The mother of a child who was recently diagnosed with nephrotic syndrome, asks how she can identify early signs that her child is experiencing a relapse with the condition. You would tell her to monitor the child for the following: SATA A. Weight loss B. Protein in the urine using an OTC kit C. Tea-colored urine D. Swelling in the legs, hands, face, or abdomen

B. D.

You're providing a free educational clinic to new moms about immunizations. You inform the attendees that the Measles, Mumps, and Rubella (MMR) vaccine is given? A. at 6 and 12 months B. 12 months and 4-6 years C. at 4 and 6 months D. at 2 and 12 months

B. 12 months and 4-6 years

At what age does a child starting receiving a yearly flu vaccine? A. 12 months B. 6 months C. 2 months D. 24 months

B. 6 months

As the nurse, you know that it is important to implement a low sodium and potassium diet for a patient with nephrotic syndrome. However, it is important to implant what other type of diet due to another complication associated with this syndrome? A. Low phosphate B. Low fat C. High carbohydrate D. High magnesium

B. Low fat

You're providing care to a 6-year-old male patient who is receiving treatment for nephrotic syndrome. Which assessment finding below requires you to notify the physician immediately? A. Frothy, dark urine B. Redden area on the patients left leg that is swollen and warm C. Elevated lipid level on morning labs D. Urine test results that shows proteinuria

B. Redden area on the patients left leg that is swollen and warm

True or False: One of the main causes of nephrotic syndrome is a post streptococcal infection. True False

False

The nurse in a pediatric clinic is doing health record audits and notices that a preschool client is on a delayed immunization schedule per the parents' request. The client is 5 years old, and it has been 3 weeks since the initial administration of the measles, mumps, and rubella (MMR) vaccine. Which is the best response by the nurse? a. Nothing. This is completely normal and goes along with the catch-up schedule by the CDC. b. Call the parents and harshly explain the dangers of the delayed immunization schedule. c. Call the parents and explain that the child will need to be seen in the next week to receive the second dose of the MMR vaccine to keep on schedule. d. Call Child Protective Services because the child is clearly in an abusive situation.

c. Call the parents and explain that the child will need to be seen in the next week to receive the second dose of the MMR vaccine to keep on schedule.

The nurse knows DTaP vaccine protects against which diseases? a. Diphtheria, typhoid fever, polio b. Diphtheria, typhoid fever, pertussis c. Diphtheria, tetanus, pertussis d. Diphtheria, tetanus, polio

c. Diphtheria, tetanus, pertussis

Which immunizations does the nurse administer to an adolescent client who has never been immunized? a. MMR, Hep A, and DTaP b. Polio, MMR, and DTaP c. MMR, varicella, and HiB d. Tdap, MMR, and polio

d. Tdap, MMR, and polio Tdap (instead of DTaP) vaccine is given to those after the age of 6 years.

Hannah's child is scheduled for surgery due to myelomeningocele; the primary reason for surgical repair is which of the following? A. To prevent hydrocephalus B. To reduce the risk of infection C. To correct the neurologic defect D. To prevent seizure disorders

Correct Answer: B. To reduce the risk of infection Surgical closure decreases the risk of infection stemming from damage to the fragile sac, which can lead to meningitis. Prenatal surgery was proven to be more effective than postnatal surgery in lowering the occurrence of future complications.

A patient is diagnosed nephrotic syndrome. What signs and symptoms below are common in this condition? Select-all-that-apply: A. Hypertension B. Decreased Glomerular Filtration Rate C. Foamy, frothy urine D. Massive Proteinuria E. Hyperlipidemia F. Edema G. Hematuria H. Hypoalbuminemia

The answers are: C, D, E, F, and H. Hypertension, decreased glomerular filtration rate, and hematuria are common findings in ACUTE GLOMERULONEPHRITIS.

True or False: Hypertension occurs in acute glomerulonephritis and is not a common finding with nephrotic syndrome. True False

True

In patients who are experiencing acute glomerulonephritis, the glomerulus is permeable to what substances? A. Red blood cells and protein B. Protein and white blood cells C. Red blood cells, protein, and lipids D. Proteins

A

You're providing education to a group of nursing students about nephrotic syndrome. A student describes the s/s of this condition. Which s/s verbalized by the student require you to re-educate the student about this topic? SATA A. Slight proteinuria B. Hypoalbuminemia C. Edema D. Hyperlipidemia E. Tea-colored urine F. Hypertension

A. E. F.

When should a child receive the first dose of the Hepatitis B vaccine? A. Birth B. 2 months C. 4 months D. 6 months

A. Birth

Match the traction methods to their corresponding description. Traction: Buck's Russell's Bryant's Description: Legs in an extended position. Leg extended, knee flexed. Hips flexed 90 degrees, both legs.

Buck's traction: legs in an extended position Russell's traction: leg extended, knee flexed Bryant's traction: hips flexed 90 degrees, both legs Buck's traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease. Russell's traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Bryant's traction is skin traction with the legs flexed at a 90-degree angle at the hip. Modified Bryant's Traction is used mainly to help reduce congenital hip dislocation. When the child is lying on his back, the traction holds the legs upright and the weight on the traction gently stretches the child's leg. This loosens the ligaments, tendons, and muscles around the child's hip.

A patient is suspected of having nephrotic syndrome due to a health history of Lupus. As the nurse you know that what substance(s) will be present in the urine to confirm this diagnosis? A. Red blood cells and mild protein B. Massive red blood cells and moderate protein C. Massive protein D. Elevated potassium and sodium

C

You're collecting a urine sample on a patient who is experiencing proteinuria due to nephrotic syndrome. As the nurse, you know the urine will appear: A. Tea-colored B. Orange and frothy C. Dark and foamy D. Straw-colored

C. Dark and foamy

Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse in charge detects dry mucous membranes and lethargy. What other findings suggest a fluid volume deficit? A. A sunken fontanel B. Decreased pulse rate C. Increased blood pressure D. Low urine specific gravity

Correct Answer: A. A sunken fontanel In an infant, signs of fluid volume deficit (dehydration) include sunken fontanels, increased pulse rate, and decreased blood pressure. They occur when the body can no longer maintain sufficient intravascular fluid volume. When this happens, the kidneys conserve water to minimize fluid loss, which results in concentrated urine with high specific gravity.

12-year-old Caroline has recurring nephrotic syndrome. Which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care? A. Body image B. Sexual maturation C. Muscle coordination D. Intellectual development

Correct Answer: A. Body image Because of edema associated with nephrotic syndrome, potential self-concept, and body image disturbances related to changes in appearance and social isolation should be considered. Nephrotic syndrome is a condition that causes the kidneys to leak large amounts of protein into the urine. This can lead to a range of problems, including swelling of body tissues and a greater chance of catching infections.

A 1-year-and 2-month-old child weighing 26 lb (11.8 kg) is admitted for traction to treat congenital hip dislocation. When preparing the patient's room, the nurse anticipates using which traction system? A. Bryant's traction B. Buck's extension traction C. Overhead suspension traction D. 90-90 traction

Correct Answer: A. Bryant's traction Bryant's traction is used to treat femoral fractures of congenital hip dislocation in children under age 2 who weigh less than 30 lb (13.6 kg). In Bryant's traction, the child's body and the weights are used as tension to keep the end of the femur (the large bone that goes from the knee to the hip) in the hip socket.

Nurse Chole is evaluating a female child with acute post-streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? A. Increased urine output B. Increased appetite C. Increased energy level D. Decreased diarrhea

Correct Answer: A. Increased urine output Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving. PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema, though it can also present with significant proteinuria.

The nurse is evaluating a female child with acute post streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? A. Increased urine output B. Increased appetite C. Increased energy level D. Decreased diarrhea

Correct Answer: A. Increased urine output Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving. PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema, though it can also present with significant proteinuria.

Niklaus was born with hypospadias; which of the following should be avoided when a child has such condition? A. Surgery B. Circumcision C. Intravenous pyelography (IVP) D. Catheterization

Correct Answer: B. 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 surgical repair.

The 6-year-old son of Mr. and Mrs. Peters is admitted to the healthcare facility with the diagnosis of idiopathic hypopituitarism. His height is measured below the third percentile and weight at the 40th percentile. Which of the following would be the first action of his attending nurse? A. Recommend orthodontic referral for underdeveloped jaw. B. Collaborate with a dietician to access his caloric needs. C. Provide for a tutor for his precocious intellectual ability. D. Place him in a room with a 2-year-old boy.

Correct Answer: B. Collaborate with a dietician to access his caloric needs. Because the child's weight is excessive for his height, he needs a dietary assessment and a weight-loss program. Weight gain typically is out of proportion to growth, resulting in relative obesity. This obesity is truncal in distribution; skull and head circumference growth are typically preserved, producing the impression of a large head.

Will is being assessed by Nurse Lucas for possible intussusception. Which of the following would be least likely to provide valuable information? A. Abdominal palpation B. Family history C. Pain pattern D. Stool inspection

Correct Answer: B. Family history Because intussusception is not believed to have familial tendencies, obtaining a family history would provide the least amount of information. The causes of intussusception are not clearly known. About 90% of cases of intussusception in children arise from an unknown cause. They can include infections, anatomical factors, and altered motility.

The nurse is reviewing the child's record who is scheduled to receive inactivated polio vaccine (IPV). Which of the following would prompt the nurse to withhold the administration? A. History of upper respiratory infections. B. History of an anaphylactic reaction to streptomycin. C. History of recent diarrheal episodes. D. History of redness at the previous injection site.

Correct Answer: B. History of an anaphylactic reaction to streptomycin. Inactivated polio vaccine (IPV) contains a trace amount of streptomycin, neomycin, and polymyxin. The IPV is contraindicated in individuals who have had anaphylaxis following either a previous dose of the vaccine or after taking streptomycin, polymyxin B, or neomycin, as the vaccine does contain trace amounts of these substances.

Tiffany is diagnosed with increased intracranial pressure (ICP); which of the following if stated by her parents would indicate a need for Nurse Charlie to reexplain the purpose for elevating the head of the bed at a 10 to 20-degree angle? A. Help alleviate headache B. Increase intrathoracic pressure C. Maintain neutral position D. Reduce intra-abdominal pressure.

Correct Answer: B. Increase intrathoracic pressure Head elevation decreases, not increases, intrathoracic pressure. In most patients with intracranial hypertension, head and trunk elevation up to 30 degrees is useful in helping to decrease ICP, providing that a safe CPP of at least 70 mmHg or even 80 mmHg is maintained.

Dustin who was diagnosed with Hirschsprung's disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first? A. Administer an antidiarrheal. B. Notify the physician immediately. C. Monitor the child every 30 minutes. D. Nothing. (These findings are common in Hirschsprung's disease.)

Correct Answer: B. Notify the physician immediately. For the child with Hirschsprung's disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly. Further important pointers in the history of patients with suspected HD include clinical features of Hirschsprung's associated enterocolitis (HAEC), multiple episodes of overflow constipation, and soft distended abdomen.

Nurse Kevin is assessing a newborn for developmental dysplasia of the hip (DDH); he would expect to assess which of the following? A. Characteristic limp B. Ortolani's sign C. Symmetrical gluteal folds D. Trendelenburg's signs

Correct Answer: B. Ortolani's sign Ortolani's sign is felt and heard when a newborn's or neonate's hip is flexed and abducted. The hip is held in the way the thumb on the inner aspect and index and ring finger on the greater trochanter. While applying anterior force on the greater trochanter, gently abduct the hip. If the hip is dislocated, one would feel a jerk or clunk. "Hip clicks" are clinically insignificant without instability.

Among toddlers and children up to age five, femur fractures usually result from a low energy fall. In most cases, the orthopedic surgeon realigns the fracture using fluoroscopy or x-ray imaging as a guide and immobilizes the leg in a type of cast called a spica cast. Approximately how many weeks does it take for a fractured femur to heal in a 3-year-old? A. 1-2 weeks B. 2-4 weeks C. 3-8 weeks D. 10-12 weeks

Correct Answer: C. 3-8 weeks In most cases, three to six weeks of early healing is necessary before the child can begin walking on the injured leg. When the bone is completely healed, usually around one year after the injury occurs, the child returns to the hospital to have the nails removed. Following treatment, the orthopedic surgeon continues to monitor the patient for a period of several years to ensure that there is no limb length discrepancy.

Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions? A. Bronchiolitis B. Laryngotracheobronchitis (LTB) C. Epiglottitis D. Pneumonia

Correct Answer: C. Epiglottitis Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis. By the early 1990s, the use of the Hib conjugate vaccine caused a 99% drop in infections caused by Hib. Widespread use of the Hib vaccine has also been shown to significantly decrease rates of epiglottitis, which usually occurs in children.

Buck's traction with a 10 lb. weight is securing a patient's leg while she is waiting for surgery to repair a hip fracture. It is important to check circulation-sensation-movement: A. Every shift B. Every day C. Every 4 hours D. Every 15 minutes

Correct Answer: C. Every 4 hours The patient can lose vascular status without the nurse being aware if left for more than 4 hours, yet checks should not be so frequent that the patient becomes anxious. Vital signs are generally checked q4h, at which time the CSM checks can easily be performed.

Which of the following is not true regarding the varicella vaccine? A. It is administered subcutaneously. B. Children 13 years and older (With no history of chickenpox or have not previously vaccinated) need two doses given at least 28 days apart. C. Give aspirin for any injection-related pain. D. The most common mild side effects are pain, redness, or swelling at the injection site.

Correct Answer: C. Give aspirin for any injection-related pain. Children receiving the varicella vaccine should avoid aspirin or aspirin-containing products because of the risk of Reye's syndrome. After administration of the vaccine, it is recommended to avoid salicylates for five weeks due to the risk of Reye's syndrome and to avoid contact with susceptible high-risk individuals.

Mr. and Ms. Byers' child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following? A. Celiac disease B. Intussusception C. Hirschsprung's disease D. Abdominal-wall defect

Correct Answer: C. Hirschsprung's disease Failure to pass meconium within the first 24 hours after birth may be a sign of Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to weak motility in an intestinal segment. History of the colonic obstruction, which might occur during the early neonatal period till adulthood, along with failure to pass meconium during the first 48 hours of the life, which presents in up to 90% of the affected patients, is highly compatible with the impression of HD.

Spina bifida is one of the possible neural tube defects that can occur during early embryological development. Which of the following definitions most accurately describes meningocele? A. Complete exposure of spinal cord and meninges B. Herniation of the spinal cord and meninges into a sac C. Sac formation containing meninges and spinal fluid D. Spinal cord tumor containing nerve roots

Correct Answer: C. Sac formation containing meninges and spinal fluid. Meningocele is a sac formation containing meninges and cerebrospinal fluid (CSF). Meningocele is the simplest form of open neural tube defects characterized by cystic dilatation of meninges containing cerebrospinal fluid without any neural tissue. A complex meningocele is associated with other spinal anomalies. Meningocele is a typically asymptomatic spinal anomaly and is not associated with acute neurologic conditions.

Sunshine, age 13, has had a lumbar puncture to examine the CSF to determine if bacterial infection exists. The best position to keep her in after the procedure is: A. Prone for two hours to prevent aspiration, should she vomit. B. Semi-Fowler's so she can watch TV for five hours and be entertained. C. Supine for several hours, to prevent a headache. D. On her right side to encourage return of CSF

Correct Answer: C. Supine for several hours, to prevent a headache. Lying flat keeps the patient from having a "spinal headache." Increasing the fluid intake will assist in replenishing the lost fluid during this time. Approximately 10% to 20% of people develop a spinal headache (one that worsens when sitting or standing).

Veronica is a 14-year-old girl who wears a brace for structural scoliosis; which of the following statements indicate effective use of the brace? A. "I sure am glad that I only have to wear this awful thing at night." B. "I'm really glad that I can take this thing off whenever I get tired." C. "I wonder if I can take the brace off when I go to the homecoming dance." D. "I'll look forward to taking this thing off to take my bath every day."

Correct Answer: D. "I'll look forward to taking this thing off to take my bath every day." The brace should be dropped for simply 1 hour of every 24-hour period for hygiene and skincare. It is recommended to wear the Milwaukee brace 23 hours a day. The one hour that the child spends out of the brace should be spent doing exercises. Studies have proven that this protocol is effective for the conservative treatment of adolescent idiopathic scoliosis.

A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect: A. Gross hematuria B. Dysuria C. Nausea and vomiting D. An abdominal mass

Correct Answer: D. An abdominal mass The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Wilms tumor usually presents as an asymptomatic abdominal mass in the majority of children. The mother may have discovered the mass during bathing the infant.

A spica cast was put on Baby Betty after an unfortunate incident to immobilize her hips and thighs. Which of the following is the priority nursing action immediately after application? A. Keep the cast dry and clean. B. Cover the perineal area. C. Elevate the cast. D. Perform neurovascular checks.

Correct Answer: D. Perform neurovascular checks. A neurovascular assessment is always a priority in the assessment of a freshly applied cast to ensure adequate circulation and neurologic function and prevent complications or injury. Neurovascular observations should be conducted hourly for the first 24 hours then 2-4 hourly for the next 48 hours depending on the condition. Document findings on appropriate limb observation flowsheet.

Stephen was diagnosed with minimal-change nephrotic syndrome; which of the following signs and symptoms are characteristics of the said disorder? A. Hypertension, edema, hematuria B. Hypertension, edema, proteinuria C. Gross hematuria, fever, proteinuria D. Poor appetite, edema, proteinuria

Correct Answer: D. Poor appetite, edema, proteinuria Clinical manifestations of nephrotic syndrome include loss of appetite due to edema of the intestinal mucosa, proteinuria, and edema. The classic NS presentation is edema, in the early phase is located in the face in the morning on waking with puffiness of the eyelids and the impression of the folds of sheets on the skin and ankles at the end of the day.

A 6-year-old child is scheduled to have measles, mumps, and rubella (MMR) vaccine. Which of the following routes will you expect the nurse to administer the vaccine? A. Intramuscularly in the vastus lateralis muscle. B. Intramuscularly in the deltoid muscle. C. Subcutaneously in the gluteal area. D. Subcutaneously in the outer aspect of the upper arm.

Correct Answer: D. Subcutaneously in the outer aspect of the upper arm. (MMR) the vaccine is administered subcutaneously in the outer aspect of the upper arm. The dosage for both MMR and MMRV is 0.5 mL. Both vaccines are administered by the subcutaneous route.

You have learned that in babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. Which of the following is the most common form of DDH? A. Acetabular dysplasia B. Dislocation C. Preluxation D. Subluxation

Correct Answer: D. Subluxation DDH is a group of congenital abnormalities of the hip joints, which includes subluxation, dislocation, and preluxation. Of the types of congenital hip abnormalities, subluxation is the most common. In mild cases of DDH, the head of the femur is simply loose in the socket. During a physical examination, the bone can be moved within the socket, but it will not dislocate.

When administering an I.M. injection to an infant, the nurse in charge should use which site? A. Deltoid B. Dorsogluteal C. Ventrogluteal D. Vastus lateralis

Correct Answer: D. Vastus lateralis The recommended injection site for an infant is the vastus lateralis or rectus femoris muscles. Skeletal muscle can accommodate larger volumes of medication than subcutaneous tissue, and absorption is faster because muscle tissue is highly vascular. Muscle has fewer pain-sensing nerves than subcutaneous tissue and is less sensitive to irritating and viscous medications, so pain is lessened.

True or False: The appendix is found on the left lower side of the abdomen and is connected to the cecum of the large intestine.

False The appendix is found on the RIGHT (not left) lower side of the abdomen and is connected to the cecum of the large intestine.

Your patient is 4 days post-opt from an appendectomy. Which assessment finding requires further evaluation? A. The patient reports their last bowel movement was the day before surgery. B. The patient reports incisional pain. C. The patient coughs and deep breathes while splinting the abdominal incision. D. Options A and C

The answer is A. If the patient has not had a bowel movement 2-3 days after surgery it requires further evaluation such as listening to bowel sounds and asking the patient if they are passing gas. If the patient has no bowel sounds or does NOT report passing gas, the doctor should be notified. Options B and C are normal findings.

A patient is recovering after having an appendectomy. The patient is 48 hours post-opt from surgery and is tolerating full liquids. The physician orders for the patient to try solid foods. What types of foods should the patient incorporate in their diet? A. Foods high in fiber B. Foods low in fiber C. Foods high in carbohydrates D. Foods low in protein

The answer is A. It is best for the patient to follow a diet high in fiber to prevent straining during bowel movements.

A mother calls the pediatric clinic to ask when her daughter will receive the Varicella vaccine. Your answer to her question is: A. at 2, 4, and 6 months B. at 12 months and 4-6 years C. at 6 and 12 months D. at 4 months and 4-6 years

The answer is B. The child will receive the Varicella vaccine at 12 months and 4-6 years of age.

A 12 month old receives a series of vaccinations which includes the Hepatitis A vaccine. When should the child receive the 2nd dose of this vaccine? A. in 3 months B. at the 18 month visit C. when the child is 4-6 years old D. in 2 months

The answer is B. The first dose of HepA is given at 12 months and then the second dose is given 6 months from that dose, which would be at the 18 month visit.

You're providing education to a group of nursing students about the care of a patient with appendicitis. Which statement by a nursing student requires re-education about your teaching? A. "After an appendectomy the patient may have a nasogastric tube to remove stomach fluids and swallowed air." B. "Non-pharmacological techniques for a patient with appendicitis include application of heat to the abdomen and the side-lying position." C. "The nurse should monitor the patient for signs and symptoms of peritonitis which includes increased heart rate, respirations, temperature, abdominal distention, and intense abdominal pain." D. "It is normal for some patients to have shoulder pain after a laparoscopic appendectomy."

The answer is B. This statement by the nursing student requires re-education because heat should NEVER be applied to abdomen if appendicitis is suspected or known. Heat application can increase the risk of appendix perforation. Ice application is recommended, if warranted. However, the side-lying position can help relieve the patient's pain and is recommended. All the other options are correct.

A patient is scheduled for appendectomy at noon. While performing your morning assessment, you note that the patient has a fever of 103.8 'F and rates abdominal pain 9 on 1-10. In addition, the abdomen is distended and the patient states, "I was feeling better last night but it seems the pain has become worst." The patient is having tachycardia and tachypnea. Based on the scenario, what do you suspect the patient is experiencing? A. Pulmonary embolism B. Colon Fistulae C. Peritonitis D. Hemorrhage

The answer is C. Based on the patient's presenting symptoms, the patient is most likely experiencing peritonitis because the appendix has ruptured. The key clues in this scenario are the classic signs and symptoms of peritonitis (tachycardia, tachypnea, high temperature, and abdominal pain/distension) along with the patient's statement that they were feeling better last night (hence probably the time the appendix ruptured) which periodically relieved the pain at the appendix but allowed for the contents of the appendix to leak into the peritoneal cavity....hence causing peritonitis.

An 18 year old patient is admitted with appendicitis. Which statement by the patient requires immediate nursing intervention? A. "The pain hurts so much it is making me nauseous." B. "I have no appetite." C. "The pain seems to be gone now." D. "If I position myself on my right side, it makes the pain less intense."

The answer is C. It is important that the nurse monitors the patient's pain level. If the patient reports that the pain has suddenly decreased or is gone, this is a warning sign that the appendix may have perforated (ruptured). If the appendix has ruptured, the sudden decrease in pain will be followed by more pain due to peritonitis (which is life- threatening). Therefore, the nurse should notify the doctor immediately.

A 23 year old patient is admitted with suspected appendicitis. The patient states he is having pain around the umbilicus that extends into the lower part of his abdomen. In addition, he says that the pain is worst on the right lower quadrant. The patient points to his abdomen at a location which is about a one-third distance between the anterior superior iliac spine and umbilicus. This area is known as what? A. Rovsing's Point B. Hamman's Point C. McBurney's Point D. Murphy's Point

The answer is C. This is known as McBurney's Point and is a classic sign and symptom in patients with appendicitis.

A parent has a question about the Rotavirus vaccine and when it is administered. As the nurse you know that ________ doses are given, and the last dose is given at ________? A. 2; 6 months B. 3; 4 months C. 4; 4-6 years D. 3; 6 months

The answer is D. THREE doses are GIVEN and the LAST dose is given at 6 months.

A 4 year old is scheduled for routine immunizations. As the nurse you know the physician will most likely order what vaccinations? A. DTaP (diphtheria, Tetanus, Pertussis) B. Polio C. Hepatitis B D. RV (Rotavirus) E. MMR (Measles, Mumps, Rubella) F. Hib (Haempophilus Influenzae Type B) G. Varicella

The answers are A, B, E, and G. The immunizations ordered at 4-6 years of age include: DTaP, Polio, MMR, and Varicella.

A 5 year-old male patient is experiencing acute glomerulonephritis. What signs and symptoms may you observe with this condition? A. Swelling in the face B. Hyperlipidemia C. Tea-colored urine D. Elevated BUN and creatinine level E. >3 Grams of protein loss in the urine per day

The answers are A, C, and D. Hyperlipidemia and >3 Grams of protein loss in the urine per day is common in NEPHROTIC SYNDROME not acute glomerulonephritis.

Select the most common type of medications that may be ordered by a physician to treat nephrotic syndrome: A. Cardiac glycosides B. Corticosteroids C. Antibiotics D. Antihypertensives E. Diuretics F. Anticholinergics

The answers are B and E. Corticosteroids are commonly ordered for treatment of nephrotic syndrome. These medications will help reduce swelling and decrease the amount of protein lost in the urine. In addition, diuretics will help remove extra fluid in the body. Diuretics are sometimes used with the administration of IV albumin to help replenish the system with albumin.

During a routine pediatric visit, a 2 month old patient will need which of the following vaccines? A. MMR (Measles, Mumps, Rubella) B. Hepatitis A C. Hepatitis B D. DTaP (Diphtheria, Tetanus, Pertussis) E. Hib (Haemophilus Influenzae Type B) F. Varicella G. Polio H. RV (Rotavirus) I. PCV (Pneumococcal Conjugate Vaccine)

The answers are C, D, E, G, H, and I. At 2 months the patient should receive: DTaP, Hepatitis B, Hib, Polio, RV, and PCV.

Select all the following options that are NOT causes of appendicitis: A. Fecalith B. Routine usage of NSAIDs C. Infection due to Helicobacter pylori D. Lymph node enlargement due to viral or bacterial infection E. Diet low in fiber

The answers are: B, C, and E. These options are NOT causes of appendicitis. Routine usage of NSAIDS and infection due H. pylori are causes of peptic ulcers. While a diet low in fiber is thought to be the cause of diverticulosis. Fecalith and lymph node enlargement due to viral or bacterial infection (such as mononucleosis etc.) can cause appendicitis.

Thinking back to the scenario in question 3, what other signs and symptoms are associated with appendicitis. SELECT-ALL-THAT-APPLY: A. Increased red blood Cells B. Patient has the desire to be positioned in the prone position to relieve pain C. Umbilical pain that extends in the right lower quadrant D. Abdominal rebound tenderness E. Abdominal Flaccidity

The answers are: C and D. These are classic signs and symptoms found in patients with appendicitis. Option A is wrong because the patient may have increased WHITE blood cells (not red). Option B is wrong because the patient may have the desire to be in the fetal position (side-lying with the knees bent) to relieve the pain. The prone position would increase the pain. Option E is wrong because the patient would have abdominal RIGIDITY (not flaccidity).

The nurse plans care for an infant client diagnosed with a myelomeningocele. Which principle of nursing care is most important to apply when caring for this infant? a. Asepsis b. Exercise c. Hygiene d. Rest

a. Asepsis

A 6 month old client is in the emergency room and the parent reports watery diarrhea over the past 36 hours. Which signs and symptoms should be reported to the health care provider (HCP) immediately? Select all that apply. a. Increased specific gravity b. Sodium of 144 mEq/L c. Sunken fontanels d. Cracked, dry lips e. Absence of tearing

a. Increased specific gravity c. Sunken fontanels d. Cracked, dry lips e. Absence of tearing

The nurse evaluates the parent's knowledge of the infant client's immunization schedule. Which statement by the parent indicates a correct understanding of the immunization schedule? a. My child will receive 4 Haemophilus influenzae type b (Hib) vaccines as past of the immunization schedule. b. My child needs 2 hepatitis vaccines, one at 1 month and the other at 4 months. c. I'm going to let my child get chickenpox and measles rather than have all those painful vaccines. d. I'm glad the baby can be vaccinated against chickenpox before age 6 months old, so there's no way to catch it from older siblings.

a. My child will receive 4 Haemophilus influenzae type b (Hib) vaccines as past of the immunization schedule.

The nurse is presenting during a parenting class for developmentally disabled children. Which statement made by parents of a toddler diagnosed with down syndrome indicates that further teaching is necessary? a. My child's development will become more rapid in time. b. We will notice our child's motor skills are always slow. c. Repetitive play is a good way to teach our child. d. My child responds to affection in a positive way.

a. My child's development will become more rapid in time.

The newborn nursery nurse provides care for a client diagnosed with hip dysplasia. The nurse anticipates which treatment to be prescribed for the client? a. Pavlik harness b. Double diapering c. Placing a small pillow between the legs d. Bracing the affected leg

a. Pavlik harness

The nurse performs assessments on infants at the health department. The nurse identifies which finding as an early indication of cerebral palsy? a. The 4-month-old lacks head control. b. The 7-month-old infant sits with support. c. The 8-month-old infant is unable to crawl. d. The 3-month-old infant smiles at the parent.

a. The 4-month-old lacks head control.

The nurse prepares to administer the inactivated polio vaccine to a 4-month-old infant. For which assessment finding does the nurse delay administering the vaccine? a. The infant has otitis media with a fever. b. The infant has mild rhinitis and is afebrile. c. The infant is teething and irritable. d. The infant received the vaccine at 2 months of age.

a. The infant has otitis media with a fever.

A parent of an infant born with a clubfoot asks the nurse how the deformity is usually treated. Which statement by the nurse is appropriate? a. A series of braces is used until the foot is gradually moved back into place, then the foot is casted. b. A series of casts will be applied and changed every few days to weeks until the foot is positioned correctly, then the foot is braced. c. The infant undergoes massage to stretch the tendons of the affected foot, then is placed in the first cast around 6 months of age. d. The infant will undergo several surgical procedures, then will be casted for several months.

b. A series of casts will be applied and changed every few days to weeks until the foot is positioned correctly, then the foot is braced.

During a well child check-up for a 6-month-old client, the parent reports the client received the first DTaP at 2-months of age, and has received no other vaccinations. Which action by the nurse is most appropriate? a. Repeat first DTaP, starting the schedule again. b. Give second DTaP. c. Give MMR d. Give two DTaP vaccinations today

b. Give second DTaP.

The office nurse receives a phone call from a parent of an infant client who received the DTaP vaccine 3 days ago. The nurse is most concerned if the parent makes which statement? a. There is redness at the injection site. b. My baby is crying continuously. c. My baby's temperature is 101F. d. My baby seems to be eating less.

b. My baby is crying continuously.