PEDS 3
During a follow-up visit, the parents of a 5-month-old infant diagnosed with congenital heart disease tell the nurse, "We're just so tired and emotionally spent. All these tests and examinations are overwhelming. We just want to have a normal life. We're so focused on the baby that it seems like our 3-year-old is lost in the shuffle." Which nursing diagnosis would the nurse identify as most appropriate? A) Fear related to infant's cardiac condition and need for ongoing care B) Interrupted family processes related to demands of caring for the ill child C) Risk for delayed growth and development related to necessary treatments D) Deficient knowledge related to the care of a child with congenital heart disease
B) Interrupted family processes related to demands of caring for the ill child
The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response would alert the nurse to a confirmed risk factor for this condition? A) "He just got over a head cold with laryngitis." B) "She has been very healthy up to now." C) "My child has not been sick at all." D) "My child is just 18 months old."
A) "He just got over a head cold with laryngitis."
The nurse teaches the parents of a preschool girl about ways to prevent urinary tract infections. The nurse determines the parents understood the teaching if they state: A) "we will tell our daughter to use the restroom as soon as she needs to go, and not hold her urine. B) "we will buy nylon underpants for our daughter." C) "we will encourage our daughter to daily take a bubble bath and/or wash her private area thoroughly with antibacterial soap." D) "we will limit our daughter's fluid intake."
A) "we will tell our daughter to use the restroom as soon as she needs to go, and not hold her urine.
An infant who develops jaundice at 6 to 8 weeks of age should be evaluated for: A) biliary atresia B) hirschsprungs disease C) ABO blood-type incompatibility with the mother D) cystic fibrosis
A) biliary atresia
The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which information would the nurse include in her teaching plan? A) Parents should establish norms and standards that signify acceptance or rejection. B) Continuous peer relationships provide the most important social interaction for school-age children. C) Teachers are the most influential people in the development of the school-age child's social network. D) A characteristic of school-age children is their formation of groups with no rules and values involved.
B) Continuous peer relationships provide the most important social interaction for school-age children.
An infant is admitted to the hospital with an unrepaired congenital heart defect. The physician's orders are to maintain the infant's oxygen saturation between 80% and 85%. The nurse realizes this is indicative of: A) left sided heart failure B) a right to left shunt C) right sided heart failure D) a left to right shunt
B) a right to left shunt
The goals of treatment for gastroschisis include all of the following EXCEPT: A) Preventing hypothermia. B) Maintaining perfusion to abdominal contents. C) Protecting from trauma. D) Cover the abdominal contents with a clean dressing.
D) Cover the abdominal contents with a clean dressing.
The nurse assesses a child who has undergone a cardiac catheterization and finds the bandage and bed soaked with blood. The BEST, FIRST nursing action is to: A) Place the child in Trendelenburg position B) Notify the physician C) Remove the bandage and assess the site D) Apply pressure slightly above the catheterization site and call for help
D) Apply pressure slightly above the catheterization site and call for help
A parent tells the nurse she has heard a lot about autism but is not sure what it is. The nurse informs the parent that the diagnostic criteria for autism includes delayed or abnormal functioning in the following areas with onset before age 3 years: A) Focus, and impulsivity B) Play, and gross motor development C) Growth less than fifth percentile, and fine motor development D) Language development, and social interaction
D) Language development, and social interaction
An infant with a cyanotic congenital heart defect has a hypercyanotic spell. The nurse's FIRST action should be: A) Begin cardiopulmonary resuscitation B) Auscultate the breath sounds and heart tones C) Notify the physician D) Lift up the infant's trunk while flexing the hips and knees (knee-chest position)
D) Lift up the infant's trunk while flexing the hips and knees (knee-chest position)
A child comes to the emergency department with acute diarrhea and mild dehydration. The nurse anticipates an order for: A) A clear liquid diet including fruit juice and jello B) Antidiarrheal medications such as diphenoxylate (Lomotil) C) Antibiotics D) Oral rehydration solution (ORS)
D) Oral rehydration solution (ORS)
After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states: A) "An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss." B) "An infant's skin is thinner than an adult's, so substances placed on the skin are absorbed more readily." C) "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." D) "The infant's epidermis is loosely connected to the dermis, increasing the risk for breakdown."
C) "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented."
Please match the types of inflammatory skin conditions with the definitions. A) Diaper dermatitis B) Contact dermatiti C) Atopic dermatitis D) Erythema Multiforme
A) An acute hypersensitivity reaction caused by the skin coming in contact with soiled diapers. B) an acute hypersensitivity reaction characterized by a cell-mediated response to an antigenic substance exposure. C) a chronic disorder characterized by extreme itching and inflamed, reddened, and swollen skin. D) Stevens-Johnson and toxic epidermal necrolysis are extreme forms.
A child has been diagnosed with hydronephrosis. The nurse teaches the parents that hydronephrosis results from: A) An obstruction preventing urine from flowing out of the kidney B) Red blood cells becoming trapped and breaking apart inside the kidneys C) The bladder forming outside of the abdominal wall D) Excess production of urine
A) An obstruction preventing urine from flowing out of the kidney
After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow? A) Atrial septal defect B) Transposition of the great vessels C) Tetralogy of Fallot D) Hypoplastic left heart syndrome
A) Atrial septal defect
Please match the cardiac defects with the hemodynamic characteristics: A) Tetralogy of Fallot B) Ventricular Septal Defect C) Coarctation of the Aorta D) Truncus Arteriosus
A) Decreased Pulmonary Blood Flow B) Increased Pulmonary Blood Flow C) Obstructive Defect D) Mixed Defect
The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find? A) Decreased blood urea nitrogen (BUN) B) Hypoalbuminemia C) Hyperlipidemia D) Hypoproteinemia
A) Decreased blood urea nitrogen (BUN)
The nurse plans care for a child with Kawasaki disease based on the knowledge that: A) IV Gamma globulin (IVIG) and aspirin are administered during the initial acute phase B) Early treatment is required to avoid permanent joint damage C) Ibuprofen is the treatment of choice for the associated fever and inflammation D) The child's fever usually resolves within 24-48 hours after starting antibiotics
A) IV Gamma globulin (IVIG) and aspirin are administered during the initial acute phase
The nurse is caring for an infant with suspected pyloric stenosis. The nurse observes for: A) Projectile vomiting B) Diarrhea and hyperactive bowel sounds C) Abdominal rigidity and decreased bowel sounds D) Distention of abdomen and constipation
A) Projectile vomiting
An 8-year-old with Celiac disease is in the hospital. The nurse offers the child a breakfast of: A) Scrambled eggs B) Waffles C) Raisin bran D) Toasted rye bread with jelly
A) Scrambled eggs
When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess? A) Strawberry tongue B) Hirsutism or striae C) Café au lait spots D) Malar rash
A) Strawberry tongue
Which finding would lead the nurse to suspect that a child is experiencing moderate dehydration? A) Sunken fontanels B) Dusky extremities C) Tenting of skin D) Hypotension
A) Sunken fontanels
Teasing and bullying can be common during the school-age years. The nurse recognizes that: A) Teasing and bullying can have a lasting effect on a child B) It is impossible to predict who might bully other children C) It is impossible to predict who might be victimized by a bully D) Teasing and bullying occur most often inside the school classroom
A) Teasing and bullying can have a lasting effect on a child
A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. In order to minimize reflux, the nurse recommends: A) Thicken the formula with a small amount of rice cereal B) Give larger, less frequent feedings C) Give continuous nasogastric tube feedings D) The parents request a prescription for a proton pump inhibitor such as lansoprazole
A) Thicken the formula with a small amount of rice cereal
A 6-year-old child tells the nurse the bruises on her back are from her father hitting her. She asks the nurse not to tell anyone else. The nurse should: A) Call the child's physician to see if there has been any concern about abuse in the past B) Call child protective services (CPS) as soon as possible and follow up with a written report to CPS C) Not report the conversation since it was meant to be confidential D) Ask the child to tell the physician or the hospital social worker
B) Call child protective services (CPS) as soon as possible and follow up with a written report to CPS
A 3-year-old child with a broken arm is brought to the Emergency Department by her parents. The mother tells the admitting nurse the child fell off her tricycle. The father tells the physician the child fell down the stairs. The parents are appropriately concerned about their child and the child obviously loves her parents. The child is quiet and not talkative. She is the youngest of four children. The nurse reviews the child's chart and identifies that non-accidental trauma (abuse) must be considered. The nurse bases this on: A) The child being quiet and not talkative B) Conflicting reports of the accident from the parents C) The child being the youngest of four children D) The unlikely diagnosis of a 3-year-old with a fractured arm
B) Conflicting reports of the accident from the parents
An 8-month-old infant has a coarctation of the aorta which has not been surgically corrected. The nurse takes vital signs and finds the blood pressure to be 100/60 in the right upper extremity and 80/50 in the right lower extremity. The nurse's BEST response is to: A) Administer oxygen B) Document the blood pressures. This is an expected finding C) Retake the blood pressure on the left side D) Call the physician STAT
B) Document the blood pressures. This is an expected finding
An infant is diagnosed with a patent ductus arteriosus. The nurse carefully assesses for: A) Cyanosis from shunting of unoxygenated blood into the systemic circulation B) Respiratory distress and moist breath sounds C) Increased blood pressure in the upper extremities D) Edema in the hands, feet, and periorbital areas
B) Respiratory distress and moist breath sounds
The parents of a child with cognitive impairments ask the nurse to recommend appropriate toys. The nurse suggests the most important consideration when selecting toys for their child is: A) Encouraging and improving motor skills B) Safety C) Toys designed for the child's chronologic age D) Teaching useful skills
B) Safety
An infant with short bowel syndrome is being discharged home with total parenteral nutrition (TPN) and gastrostomy feedings. The nurse includes in the discharge teaching: A) Do not let the infant suck on a pacifier or take any foods or fluids by mouth B) Signs of central venous catheter infection C) How to secure the IV line under the diaper to prevent it becoming dislodged D) How to calculate the child's caloric needs based on weight
B) Signs of central venous catheter infection
A child is diagnosed with celiac disease. Based on knowledge of the disorder, the nurse teaches the child and family about a gluten free diet including: A) The child will need to limit protein B) The child will not be able to eat wheat, barley, or rye C) Once the GI tract has healed the child will be able to go back to an unrestricted diet D) The child will need to eliminate all dairy and lactose containing foods
B) The child will not be able to eat wheat, barley, or rye
An infant has been diagnosed with an inguinal hernia. The bedside nurse is doing a physical assessment of the infant. Which assessment finding would be concerning? A) The infant having a fontanel that's soft and flat. B) The nurse not being able to manually reduce the hernia. C) The infant being irritable from being NPO for surgery. D) The infant having a protrusion in the inguinal area.
B) The nurse not being able to manually reduce the hernia.
The nurse plans care for a child with glomerulonephritis based on the knowledge that the most important nursing interventions are to assess for and prevent or restore alterations in: A) decreased activity B) fluid volume excess C) growth and development affected by hospitalization D) pain and discomfort
B) fluid volume excess
A child is having vomiting and diarrhea with poor oral intake. The nurse assesses the child for dehydration. Assessment findings consistent with moderate to severe dehydration are: A) weight loss of approximately 1 pound in a 40 pound 4 year old B) increased pulse and respirations with cool, pale skin and sunken eyes C) a bulging fontanel in an infant D) 5 to 6 voids in a 24 hour period
B) increased pulse and respirations with cool, pale skin and sunken eyes
A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse advises the father to: A) apply warm compresses B) take the child to the emergency department C) apply a thin layer of corticosteroid cream D) remove the stinger
B) take the child to the emergency department
The mother of a 7-year-old girl tells the school nurse that her child is deathly afraid of going to school. What would be the best intervention the nurse could suggest in this situation? A) Investigate a new school for the child to attend that the child will not be afraid of. B)Return the child to school and investigate the cause of the fear. C) Tell the child that privileges will be taken away if she does not return to school. D) Have the child stay home from school until any issues causing this fear are resolved.
B)Return the child to school and investigate the cause of the fear.
The nurse plans care for a newborn with a cleft lip and palate before surgical repair. The nurse includes in the plan: A) Attempt oral feedings but if formula comes out of the infant's nose do not feed the infant by mouth B) Feed with pedialyte or glucose water only C) Feed the infant in an upright position using special bottles with a one-way valve D) Tube feedings and give nothing by mouth
C) Feed the infant in an upright position using special bottles with a one-way valve
The nurse is planning care for a neonate with a suspected tracheoesophageal fistula. The nurse includes all of the following interventions in the plan of care, but knows the most important nursing intervention prior to surgery is: A) Record accurate I and O B) Administer ordered IV antibiotics on time C) Give nothing by mouth D) Monitor lab results
C) Give nothing by mouth
The nurse assesses a child with systemic venous congestion from heart failure. The nurse is especially alert for manifestations of: A) Decreased blood pressure and compensatory tachycardia B) Pale, cool extremities C) Hepatosplenomegally and peripheral edema D) Tachypnea with crackles on auscultation
C) Hepatosplenomegally and peripheral edema
The radiology report states a child has invagination (telescoping) of one segment of bowel within another. The nurse knows this is diagnostic for: A) Gastroschisis B) Inguinal hernia C) Intussusception D) Meckel's diverticulum
C) Intussusception
A 9-year-old has been diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). As the nurse in the clinic, you recognize all of the following behavior management techniques can be beneficial with a child with ADHD EXCEPT: A) Establish a daily routine. B) Set limits and hold child responsible for behavior. C) Negotiate about the limits set. D) Providing consistent caregivers.
C) Negotiate about the limits set.
The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which best exemplifies a school-ager working toward accomplishing this developmental task? A) The child becomes aware of the opposite sex. B) The child performs his bedtime preparations autonomously. C) The child signs up for after-school activities. D) The child is developing a conscience.
C) The child signs up for after-school activities.
A child with a congenital heart defect is on daily doses of lanoxin (Digoxin) and furosemide (Lasix). The nurse encourages the family to include bananas, oranges, and leafy vegetables in the child's diet. These foods are recommended because: A) They improve iron absorption B) They contain essential vitamins C) They are high in potassium D) They reduce the risk for constipation
C) They are high in potassium
A child is being admitted to the hospital with minimal-change nephrotic syndrome. The nurse prepares the family to expect: A) antihypertensive medication B) low protein diet C) corticosteroids D) antibiotics
C) corticosteroids
A child has been diagnosed with Hirschsprung disease. The nurse prepares the family to expect: A) To administer daily enemas B) A low-fiber diet C) Total parental nutrition (TPN) D) Surgical removal of the affected section of bowel
D) Surgical removal of the affected section of bowel
A 16-year-old female with severe acne has been started on isotretinoin (Accutane). The nurse determines the teen understood the teaching about the medication if the teen states: A) "I will complete the entire bottle before discontinuing the medication." B) "I will ensure I do not get pregnant while taking this medication." C) "I will increase my fluid intake while on this medication." D) "If I need a mild pain medication I will take acetaminophen (Tylenol) instead of ibuprofen while on this medication."
B) "I will ensure I do not get pregnant while taking this medication."
The nurse recommends to the parent of a child with cognitive impairment that the child should be referred for stimulation and educational programs: A) As soon as the child has the ability to communicate B) As young as possible C) At 5 or 6 years of age when the child begins school D) At 3 years of age when schools are required to provide services
B) As young as possible
The structural defects of Tetralogy of Fallot are: MARK ALL THAT APPLY A) Overriding aortic arch B) Ventricular septal defect C) Right ventricular hypertrophy D) Pulmonary stenosis E) Aortic stenosis
A;B;C;D A) Overriding aortic arch B) Ventricular septal defect C) Right ventricular hypertrophy D) Pulmonary stenosis
Nursing interventions for a child after a cardiac catheterization include: MARK ALL THAT APPLY A) Monitor the cardiac rhythm on the EKG B) Remove the dressing after 5 minutes C) Check pulse distal to the catheterization site and compare to the opposite side D) Assess the temperature and color of the catheterized extremity distal to the catheterization site E) Encourage ambulation as soon as the child is alert after the procedure
A;C;D;E A) Monitor the cardiac rhythm on the EKG C) Check pulse distal to the catheterization site and compare to the opposite side D) Assess the temperature and color of the catheterized extremity distal to the catheterization site E) Encourage ambulation as soon as the child is alert after the procedure
The nurse expects a 13 year old child to have completed the following developmental stages: SELECT ALL THAT APPLY A) industry B) identity C) initiative D) trust E) autonomy
A;C;D;E industry initiative trust autonomy
