Pediatric Questions for Exam 6

52. After doing well for a period of time, a child with leukemia develops an overwhelming infection. The child's death is imminent. Which statement offers the nurse the BEST guide in making plans to assist the parents in dealing with their child's imminent death? A. Knowing that the prognosis is poor helps prepare parents for the death of children B. Parents are especially grieved when a child does well at first by then declines quickly C. Parent's trust in health care personnel is most often destroyed by a death that is considered untimely D. It is more difficult for parents to accept the death of an older child than that of a toddler

B. It has been found that parents are more grieved when optimism is followed by defeat

A nurse is assessing an infant who has 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, C, E

37. Which foods should the nurse encourage a parent to offer to a child with iron-deficiency anemia? A. Cereal, milk, yellow vegetables B. Potato, peas, chicken C. Macaroni, cheese, and ham D. pudding, green vegetables, and rice

B. Rationale Potatoes, peas, chicken, green vegetables, and fortified cereals contain significant amounts of iron and therefore recommended.

40. A child with Hemophilia presents with a burning sensation in the knee and reluctance to move the body part. The nurse collaborates with the care team to provide factor replacement and implements which intervention? A. Administers an aspirin-containing component B. Institutes RICE C. Begins physical therapy with an active range of motion D. Initiates skin traction immobilization

B

38. What is the most appropriate method to use when drawing blood from a child with hemophilia? A. Use finger punctures for lab draws B. Prepare to administer platelets C. Apply heat to the extremity before venipunctures D. Schedule all labs to be drawn at one time

D. Rationale Coordinating labs to minimize sticks reduces trauma and the ris of bleeding.

48. Which beverage should the nurse plan to give a child with leukemia to relieve nausea? A. Orange juice B. Weak Tea C. Plain water D. Carbonated soda

D. Carbonated beverages ordinarily are best tolerated when a child feels nauseated

A nurse is preparing to administer iron dextran IM to a school-age child who has iron deficiency anemia. Which of the following actions by the nurse is appropriate? A. Administer the dose in the deltoid muscle B. Use the Z-track method when administering the dose. C. Avoid injecting more than 2 mL with each dose D. Massage the injection site for 1 min after administering the dose

B

5. What instructions should the nurse include in the discharge teaching for a 3-month-old infant with a cardiac defect who is to receive digoxin? SATA A. Give medication at regular intervals B. Mix the medication with a small volume of breast milk or formula C. Repeat the dose one time if the child vomits immediately after administration D. Notify HCP of poor feeding or vomiting E. Makeup missed doses as soon as realized F. Notify HCP if more than 2 consecutive doses are missed

1, 4, 6 Rationale: To achieve optimal therapeutic levels, digoxin should be given at regular intervals without variation, usually every 12 hours. Vomiting and poor feeding are signs of toxicity. If more than 2 consecutive doses are missed, intervention may be needed to assure therapeutic levels. The medication should not be mixed with any other fluid as refusal may result in inaccurate intake of the medication. Taking makeup doses, or taking the medications at times other than scheduled, may adversely affect serum levels

A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? SATA A. Weak femoral pulses B. Cool skin of lower extremities C. Severe cyanosis D. Clubbing of the fingers E. Low blood pressure

A, B, E

34. Which action indicates that the parents of a 12-month-old with iron deficiency anemia understand how to administer iron supplements? SATA A. Administering iron supplements in combination with fruit juice B. Scheduling iron supplements with meals C. Verbalizing the need to report dark stools D. Brushing the child's teeth after administering the iron supplements E. Decreasing the dietary intake of foods fortified with iron

A, D Rationale Parent teaching concerning a child with iron-deficiency anemia should include directions about giving iron combined with fruit juice, in divided doses, between meals, and with a dropper for a 12 month-old or through a straw for older toddlers. Iron stains teeth, so brushing the teeth and administering liquid iron through a dropper or straw are necessary to prevent staining the teeth. Iron should not be given with milk, antacids, or tea and should be administered on an empty stomach. Iron will cause the stool to become black or green, which is normal and does not need to be reported.

A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following findings should the nurse expect? SATA A. Erythema marginatum (rash) B. Continuous joint pain of the digits C. Tender, subcutaneous nodules D. Decreased erythrocyte sedimentation rate E. Elevated C-reactive protein

A, E

49. Which medication prescription to help relieve pain in a child with leukemia should the nurse question? A. Hydromorphone B. Tylenol with codeine C. Ibuprofen D. Hydrocodone

C Rationale Ibuprofen prolongs bleeding time and is contraindicated in clients with Leukemia

9. A child diagnoses with Tetralogy of Fallot becomes upset, cries, and thrashes around when a blood specimen is obtained. The child becomes cyanotic, and the respiratory rate increases to 44 breaths/min. Which action should the nurse do FIRST? A. Obtain a prescription for sedation for the child B. Assess for an irregular heart rate and rhythm C. Explain to the child that it will only hurt for a short time D. Place the child in a knee-to-chest position

D

36. Which statement by the parent of a toddler MOST suggests that the child is at risk for iron deficiency anemia? A. "He drinks over 4 glasses of milk per day." B. "He must drink over 10 oz of apple juice per day." C. "He refuses to eat more than 2 different kinds of vegetables." D. "He does not like meat, but he will eat small amounts of it."

A Rationale Milk is a poor source of iron. Toddlers should have between two and three servings of milk per day.

21. A school-age client with rheumatic fever is on long-term aspirin therapy. Which client statement most indicates that the client is experiencing a serious adverse reaction to aspirin? A. "I hear ringing in my ears." B. "I put lotion on my itchy skin." C. "My stomach hurts after I take that medication." D. "These pills make me cough."

A. Rationale Tinnitus is an adverse effect of prolonged aspirin therapy, and the child should be examined by an HCP for hearing loss. Itchy skin commonly accompanies the rash associated with rheumatic fever, and the nurse encourages lotion use

The nurse creates a teaching plan for the family of a child with hemophilia who receives recombinant antihemophilic factor. Which problem is MOST important for the nurse to teach the family to report immediately? A. Yellowing of the skin B. Constipation C. Abdominal distention D. Hives

D Rationale Administration of antihemolytic factor is a biosynthetic preparation of factor VIII that carries the risk for severe allergic reaction

31. The nurse admits a 1-year-old child to the hospital with the diagnosis of sickle cell crisis. The nurse explains to the parents which condition leads to local tissue damage during a sickle cell crisis? A. autoimmune reaction complicated by hypoxia B. Lack of oxygen in the red blood cells C. Obstruction to circulation D. Elevated serum bilirubin concentration

C Rationale: Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis.

28. A 16-month-old child diagnosed with Kawasaki disease is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. What should the nurse do FIRST? A. Apply lotion to the hands and feet B. Offer foods the toddler likes C. Engage the child in quiet activities D. Encourage the parents to get some rest

C. Rationale One of the characteristics of children with KD is irritability. They are often inconsolable. Engaging the child in quiet activities help calm the child and reduce the workload of the heart.

26. When Developing the plan of care for a newly admitted 2-year-old child with the diagnosis of Kawasaki disease, which intervention should be the priority? A. Taking vital signs q6h B. Monitoring intake and output every hour C. minimizing skin discomfort D. Providing passive range-of-motion exercises

B Rationale Cardiac status must be monitored carefully in the initial phase of KD because the child is at high risk for congestive heart failure. Therefore, the nurse needs to assess the child frequently for signs of CHF, which would include respiratory distress and decreased urine output. VS would be obtained more often than every 6 hours

7. Which signs and symptoms would lead the nurse to suspect a child has Tetralogy of Fallot (TOF)? SATA A. Murmur B. Hx of squatting C. Bounding pulses D. Cyanosis E. Faint pulse F. Tachypnea

A, B, D, F Rationale: TOF is a heart condition with 4 defects: pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and an overriding aorta. A systolic murmur, cyanosis, tachypnea are all symptoms of TOF. Toddlers with uncorrected defects instinctively squat (knee-chest position) to decrease the return of systemic venous blood to the heart.

22. A school-age child has been put on an activity restriction during the active phase of rheumatic fever. Which outcome indicates that the activity restriction has been effective? A. The joints are free from permanent injury B. The resting heart rate is between 60-100 bpm C. The child exhibits a decrease in chorea movements D. The subcutaneous nodules over the joints are no longer palpable

B Rationale During the acute phase of rheumatic fever, the heart is inflamed and every effort is made to reduce the work of the heart. Bed rest with limited activity is necessary to prevent heart failure. Therefore, the most reliable indicator that activity restriction has been effective is a resting heart rate between 60 and 100 bpm. No permanent damage to the joints occurs with rheumatic fever. The chorea movements associated with rheumatic fever are self-limiting and usually disappear in 1-3 mos.

A nurse is caring for a 2 year old child who has a heart defect and is scheduled for cardiac catheterization. Which of the following actions should the nurse take? A. place on NPO status for 12 hours prior to the procedure B. Check for iodine or shellfish allergies prior to the procedure C. Elevate the affected extremity following the procedure D. Limit fluid intake following the procedure

B

A nurse is caring for an infant whose screening test reveals a potential diagnosis of sickle cell disease. Which of the following tests should be performed to distinguish if the infant has the trait or the disease? A. Sickle solubility test B. Hemoglobin electrophoresis C. CBC D. Transcranial doppler

B

45. After the nurse teaches the parent of a child newly diagnoses with leukemia about the disease, which description if given by the parent, best indicates an understanding of the nature of leukemia? A. "leukemia is an infection resulting in increased white blood cell production." B. "Leukemia is a type of cancer characterized by an increase in immature white blood cells." C. "Leukemia is an inflammation associated with enlargement of the lymph nodes." D. "Leukemia is an allergic disorder involving increased circulating antibodies in the blood."

B Rationale Leukemia is a neoplastic or cancerous disorder of blood-forming tissues that is characterized by a proliferation of immature white blood cells.

The mother tells the nurse that she will be afraid to allow her child with hemophilia to participate in sports because of the danger of injury and bleeding. After explaining that physical fitness is important for children with hemophilia, which activity should the nurse suggest as ideal? A. Snow skiing B. Swimming C. Basketball D. Gymnastics

B Rationale Swimming is the ideal activity for a child with hemophilia because it is a noncontact sport.

47. The nurse teaches the family of a child with leukemia about preventing infections. How should the nurse explain to the parents why their child is at risk for infections? A. "Abnormal platelets lead to bruising and bleeding." B. "There are an insufficient number of circulating white blood cells." C. The number of red blood cells is inadequate for carrying oxygen." D. "Immature white blood cells are incapable of handling an infectious process."

D Rationale In leukemia, although there is an increased number of immature white blood cells, they are unable to combat infection

A nurse is providing teaching to the parent of a child who has a new prescription for liquid oral iron supplements. Which of the following statements by the parent indicates an understanding of the teaching? A. "I should take my child to the emergency department if his stools become dark." B. "My child should avoid eating citrus fruits while taking the supplements." C. "I should give the iron with milk to help prevent an upset stomach." D. "My child should take the supplement through a straw."

D Rationale The child should take the supplement through a straw to prevent or minimize staining the teeth

12. Which intervention is the highest priority for the therapeutic management of a child with congestive heart failure caused by pulmonary stenosis? A. educating the family about the signs and symptoms of infection B. Administering enoxaparin to improve left ventricular contractility C. Assessing heart rate and blood pressure q2h D. Administrating furosemide to decrease systemic venous congestion

D Rationale: Pulmonary stenosis can cause right-sided CHF, resulting in venous congestion. Removing accumulated fluid is a primary goal of treatment in right-sided heart failure. Furosemide is used to reduce venous congestion. It is important to educate the family about signs and symptoms of CHF, but treating the the client's CHF is the priority. Enoxaparin is an anticoagulant and will not help improve left ventricular contractility.

39. A diagnosis of hemophilia A is confirmed in an infant. Which instruction should the nurse provide the parents as the infant becomes more mobile and starts to crawl? A. Administer one-half of a children's aspirin for a temp higher than 101 F B. Sew thick padding into the elbows and knees of the child's clothing C. Check the color of the child's urine every day D. Expect the eruption of the primary teeth to produce moderate to severe bleeding

B. Rationale As the hemophilic infant begins to acquire motor skills, fals and bumps increase that risk of bleeding

43. An adolescent client is admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which signs and symptoms require the MOST urgent nursing interventions? A. Fatigue and anorexia B. Fever and petechiae C. Swollen neck lymph glands and lethargy D. Enlarged liver and spleen.

B Rationale Fever and Petechiae associated with acute lymphoblastic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding.

The nurse is teaching the parents of a child with sickle cell disease. Which information should the nurse give the family on how to prevent a sickle cell crisis? A. Exercise in cool temperature B. Drink at least 2 quarts of fluid a day C. Avoid contact sports D. Take anti-inflammatory medications before exercising

B. Rationale: Increasing fluid intake and being well hydrated will help prevent cell stasis of red blood cells and promotes obstruction and increases the chance of sickling with hypoxia and pain to the part that is involved .

25. Which action should the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? A. Maintain the joints in an extended position B. Applying gentle traction to the child's affected joints C. Support proper alignment with rolled pillows D. Use a bed cradle to keep linens off joints

D Rationale For a child with arthritis associated with rheumatic fever, the joints are usually so tender that even the weight of bed linens can cause pain. Use of a bed cradle is recommended to help remove the weight of the linens on painful joints. Joints need to be maintained in good alignment, not positioned in extension, to ensure that they remain functional.

27. A school-age child has been diagnosed with Kawasaki disease. What teaching should the nurse provide the family about the pharmacological management of Kawasaki disease? A. Inactivated vaccines are permissible while receiving IV immunoglobulin for Kawasaki disease B. The benefits of taking aspirin for Kawasaki disease outweigh the risk for Reye syndrome C. Corticosteroids are often needed to control inflammation in Kawasaki disease D. Platelet infusions are needed with Kawasaki disease to prevent internal bleeding

B Rationale Vasculitis in Kawasaki disease can lead to life-threatening complications such as myocardial infarction and aneurysms. High doses of aspirin or NSAIDs are frequently prescribed to control fever, inflammation, and platelet aggregation.

20 The nurse discusses the treatment plan for an adolescent with rheumatic fever with the family. Which teaching about the therapeutic management of rheumatic fever? A. "Antibiotics will be prescribed for at least 5 years to prevent disease reoccurrence." B. "Anticonvulsants will be needed for a lifetime if our child develops involuntary movements." C. "Corticosteroids may be prescribed if nonsteroidal anti-inflammatory meds are not effective. " D. "Diuretics may be needed if our child develops CHF."

B Rationale: Phenobarbital or diazepam may be needed to treat involuntary movements, but there are typically no residual effects from chorea that require lifetime treatment. Clients who have a second episode of rheumatic fever are at extreme risk of heart valve damage.

19. The nurse plans the care for a child with rheumatic fever in the acute phase. What is the most important action for the nurse to teach the parents to monitor the child's progress? A. Listening to bilateral breath sounds B. Monitoring the child's pulse C. Observing closely for abnormal movements D. Recording the child's I&O

B Rationale: Tachycardia is associated with inflammation of the heart in rheumatic fever. Improvements In pulse rate are decreasing. The nurse should teach the parents to monitor the child's pulse. Preferably the pulse is taken apically for a full minute. The pulse may be prescribed during sleep and wake times to determine activity tolerance.

35. During a health history, the nurse learns that a pediatric client seldom eats foods high in iron. Which physical assessment findings would suggest that the child has developed iron-deficiency anemia? SATA A. Decreased heart rate B. Pale skin C. Swollen tongue D. Systolic murmur E. yellow sclera

B, C, D Rationale: Pale skin is one of the most common physical findings associated with iron deficiency anemia. Lower levels of myoglobin lead to soreness and swelling of the tongue. Low levels of hemoglobin force the heart to work harder to pump blood. Anemia presents as an elevated heart rate, not decreased. Yellowed sclera is consistent with hemolytic anemia

A nurse is providing teaching to the caregiver of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include? A. "Do not offer your baby fluids after giving the 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 the correct amount is received."

C