peds exam 3

perform a straight catheterization

The doctor orders a clean-catch urine specimen on an infant who is not toilet trained. The best means of collecting this urine would be to:

Beta-adrenergic blocker

A child demonstrated a sudden onset of thyrotoxicosis. The nurse anticipates that, besides antithyroid therapy, the child is likely also to receive which of the following types of drugs?

Edema

A child has been admitted to the hospital with a diagnosis of "rule out nephrosis." The nurse would assess the child for:

Antistreptolysin-O (ASO) titer

A child has been admitted to the unit with acute glomerulonephritis. The test that would confirm this diagnosis is:

Gentamicin

A child has been diagnosed with acute renal failure secondary to an infectious organism. The nurse would question the medical order for:

the antibiotics have been administered for 24 hours.

A child has just been diagnosed with bacterial meningitis. The parent asks the nurse how long the child will be in isolation. The nurse's reply will be based on a protocol that isolation continues until:

"We're going to skip his dietary restrictions one day a week to allow us both some relaxation."

A child has recurrent nephrotic syndrome. The mother reports to the nurse that she is overwhelmed with the care of her child. After the nurse discusses options with the mother, which statement by the mother indicates continued coping difficulties?

swelling and redness of the involved joint(s)

A child is admitted to the hospital unit with a diagnosis of "rule out acute onset of Legg-Calve-Perthes (LCP) disease." The symptom that would not be as- sociated with LCP is:

Positive blood cultures

A child is admitted to the hospital with a diagnosis of "rule out osteomyelitis." Which of the following serum laboratory values noted by the nurse supports this diagnosis?

Pre-collagen type 1

A child is admitted with osteogenesis imperfecta (OI). In reviewing laboratory findings, the nurse would expect to find abnormal levels of:

keeping head of bed at a 30-degree angle, providing supplemental oxygen, administering IV osmotic diuretics as ordered.

A child is being treated for intracranial pressure (ICP). Appropriate actions to decrease ICP would include: (Select all that apply.)

flush any remaining dye from the urinary tract

A child returning to the unit after an intravenous pyelogram (IVP) has an order to drink extra fluids. When the mother asks the purpose of these fluids, the nurse responds that increased fluid intake will:

drink a glass of orange juice

A 10-year-old diabetic client tells the school nurse that he has some early signs of hypoglycemia. The nurse recommends that the child:

the appendix has ruptured.

A 10-year-old boy has been admitted with a diagnosis of "rule out appendicitis." While the nurse is con- ducting a routine assessment, the boy states, "It doesn't hurt anymore." The nurse suspects that:

In the emergency room or soon after arriving on the unit.

A 10-year-old boy receives a blow to his head with a hard baseball and is admitted to the hospital for observation. If the child were to develop an epidural hematoma, he would most likely display symptoms:

Increasing hoarseness

A 10-year-old client presents with weakness in legs and history of the flu. The medical diagnosis is Guillain-Barre syndrome. It would be imperative for the nurse to inform the physician after observing which of the following?

Exercise induced hypoglycemia

A 10-year-old girl comes to the office of the school nurse after recess. This is the child's first day back in school after hospitalization, where she was diagnosed with diabetes. The child reports she took the dose of insulin as instructed and that it was the same as she took while hospitalized. The nurse notices that she is nervous with hand tremors present. She is pale, sweaty, and complaining of sleepiness. The school nurse would suspect?

"You have a different type of diabetes where the pill won't work.

A 12-year-old boy was just diagnosed with Type 1 diabetes mellitus. As the nurse teaches him about insulin injections, he asks why he can't take the diabetic pills that his aunt takes. What would be the best response by the nurse?

Sitting in a wheelchair

A 12-year-old male is admitted to the adolescent unit with a diagnosis of slipped capitol femoral epiphysis. Which of the following activities should not be al- lowed by the nurse prior to surgical correction?

"All of your hormone levels are normal, so no medication is needed at this time. If you want to talk about it, I would be happy to discuss it with you."

A 13-year-old boy is being evaluated for delayed puberty. He has had an examination with a pediatric endocrinologist who states that the child has a constitutional delay. An appropriate communication to the child by the nurse that reinforces the physician's explanation of the diagnosis would be:

Exercises to increase pelvic tilt should be done several times per day while in the brace

A 14-year-old adolescent has just been fitted for a Milwaukee brace. Which of the following should the nurse include in teaching about this brace?

Apply an ice bag

A 14-year-old boy is brought into the Emergency Department with a diagnosis of rule out appendicitis. He is complaining of right lower quadrant pain. The nurse's most appropriate action to assist in managing his pain would be to:

low-sodium diet

A 14-year-old is being treated for renal failure. The nurse would ensure that the child follows a:

Obtunded

A 15-year-old client is seen in the emergency department following a head injury from football. During the first few hours after admission, he sleeps unless awakened, but he can be aroused easily and is oriented. In charting assessment findings, the nurse would describe this level of consciousness as:

Disturbed body image related to treatment of scoliosis.

A 15-year-old who has a diagnosis of scoliosis is being seen in the outpatient clinic. The nurse is planning care for this adolescent and develops the following nursing diagnoses. Which nursing diagnosis should take highest priority?

Protruding tongue, hypotonia

A 2-month-old infant arrives at the pediatric clinic. Upon assessment, the baby exhibits the following characteristics. Which characteristic does the nurse relate to a diagnosis of congenital hypothyroidism? (Select all that apply.)

No response to painful stimuli

A 2-year-old child is admitted to the neurosurgical unit following a head injury. The nurse is using the Glasgow Coma Scale to measure neurological functioning. Which of the following assessment findings indicate the lowest level of functioning for this child?

Ability to maintain airway

A 3-month-old infant has been admitted with a diagnosis of encephalitis. The first nursing priority would be to assess:

Increase frequency of feedings and keep them small

A 3-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. The mother wants to know what she can do differently to decrease the reflux. Which intervention should the nurse suggest to minimize reflux?

Allow the child to assume a position of comfort, keep the lights bright to monitor skin color, monitor the child for seizures

A 3-year-old child is admitted to the hospital unit with a diagnosis of viral meningitis. The nurse should take which of the following actions in the care of this child? (Select all that apply.)

Difficulty climbing stairs

A 3-year-old child is suspected of having Duchenne's muscular dystrophy. Which of the following assessment findings by the nurse would support this diagnosis? Difficulty climbing stairs

"Your child has a deficiency in melanin because of decreased tyrosine. You will always have to take special care of his skin."

A 4-month-old infant has been diagnosed with phenylketonuria (PKU). The child has eczema and sensitivity to sunlight. The mother asks the nurse why her child's skin is so sensitive. An appropriate explanation by the nurse would be:

elevated heart rate, urine specific gravity of 1.038, slow capillary refill

A 4-month-old infant is admitted to the nursing unit with moderate dehydration. Which of the following symptoms does the nurse suspect led to the diagnosis of moderate dehydration in this child? (Select all that apply.)

Early morning headache

A 4-year-old child is being evaluated for hydrocephalus. The nurse notes which of the following as an early sign of hydrocephalus in this child?

Risk for injury related to disease state

A 4-year-old child with osteogenesis imperfecta (OI) is admitted to the hospital unit for an unrelated condition. The nurse determines that which nursing diagnosis has the highest priority for this child?

allis sign, asymmetric thigh and gluteal folds

A 5-month-old infant is being assessed for develop- mental dysplasia of the hip. The nurse concludes that positive signs and symptoms that indicate this disorder include: (Select all that apply.)

position the infant at a 30- to 45-degree angle after feedings.

A 6-week-old infant is brought into the pediatrician's office with a history of frequent vomiting after feedings and failure to gain weight. The diagnosis of gastroesophageal reflux is made and discharge instructions are begun. While planning discharge teaching on feeding techniques with the parents, the nurse should include instructions to:

Child describing feeling of the affected hand being "asleep"

A 6-year-old child has a cast applied for a fractured radius. The nurse completes an orthopedic assessment on this child. Which of the following symptoms requires immediate attention and should be reported to the physician?

"Elbow restraints are used postoperatively to keep children's hands away from the surgical site."

A child who underwent cleft palate repair has just returned from surgery with elbow restraints in place. The parents question why their child must have the restraints. The nurse would give which of the following as the best explanation to the parents?

Meningeal irritation

A child with a history of a seizure was admitted 2 hours ago. The history indicates fever, chills, and vomiting for the past 24 hours. In report, the nurse is told that the child has a positive Brudzinski's sign. The nurse infers this is most likely caused

Innervation to the anal sphincter predisposes the child to being incontinent.

A child with a myelomeningocele is started on a bowel management plan. The child's mother questions why this is being done. The nurse's response will be based on the understanding that lack of:

Hepatitis B can be prevented by receiving the HBV vaccine

A high school experiences an outbreak of hepatitis B. In teaching the high school students about hepatitis B, the school nurse would explain:

"I worry about my daughter maintaining control since children with diabetes have more complications than adults do."

A mother attends the pediatric clinic with her 10- year-old daughter who has diabetes mellitus (DM). After completing the diabetic teaching, the nurse evaluates the mother's knowledge. Which statement by the mother indicates a satisfactory understanding of diabetes?

prolonged jaundice at birth, described as a "good baby", constipation.

A mother of a 4-month-old tells the nurse that her child has been diagnosed with hypothyroidism. The mother asks the nurse what symptoms led to the diagnosis. The nurse explains that which of the following symptoms are consistent with this diagnosis? (Select all that apply.)

With autosomal recessive inheritance, each baby has 25% chance of having the disease

A new mother of an infant diagnosed with phenylketonuria (PKU) meets with the nurse who informs her that PKU follows autosomal recessive inheritance. The mother states that this is a relief since she now knows her next baby will not have the disease. What additional information does the mother need?

There is a calf muscle atrophy of the affected limb.

A newborn is being admitted to the newborn nursery. The nurse would assess the infant for congenital defects. In addition to the abnormal position of the foot, the nurse would note which of the following if clubfoot is present?

Epispadias, bilateral inguinal hernias

A newborn is found to have exstrophy of the bladder. The nurse should evaluate the infant for: (Select all that apply.)

Increased intracranial pressure.

A nurse is assessing a new admission. The 6-month-old infant displays irritability, bulging fontanels, and setting-sun eyes. The nurse would suspect:

Pain in the hip of a preadolescent child

A nurse performs triage in a pediatric orthopedic clinic. Which of the following should the nurse recognize as a symptom of slipped capitol femoral epiphysis?

give the crushed medication in a syringe or in the nipple mixed with a small amount of formula

A teenage mother arrives at the clinic with her new baby who has recently been diagnosed with congenital hypothyroidism. When instructing the mother about administering levothyroxine medication, the nurse would include the information that she should:

Group-A beta-hemolytic streptococcus infections can be followed by the complication of acute glomerulonephritis.

A urinalysis is ordered for a child with a throat culture positive for group-A-beta-hemolytic streptococcus (strep throat). The mother asks why this test is being ordered. The nurse explains:

The spasticity of their muscles increases their caloric need.

A young child has just been diagnosed with spastic cerebral palsy. The nurse is teaching the parents how to meet the dietary needs of their child. The nurse would explain that children with cerebral palsy frequently have special dietary needs or feeding challenges because:

Back pain

An adolescent diagnosed with idiopathic structural scoliosis describes all of the following symptoms. Which one would the nurse conclude is not associated with this diagnosis?

logrolling every 2 hours, nasogastric intubation, use of an incentive spirometer every 2 hours while awake

An adolescent is returning to the hospital unit after surgical spinal fusion for scoliosis. The nurse would include which of the following in the immediate postoperative care of this client? (Select all that apply.)

Lethargy

After being diagnosed with Graves' disease, a teenager begins taking propylthiouracil (PTU) for treatment of the disease. What symptom would indicate to the nurse that the dose may be too high?

Protect the child from harm from the environment

An 18-month-old child is observed having a seizure. The nurse motes that the child's jaws are clamped. The priority nursing responsibility at this time would be:

The suture line could be interrupted.

An 18-month-old child with a history of cleft lip and palate has been admitted for palate surgery. The nurse would provide which explanation about why a toothbrush should not be used immediately after surgery?

Obstructed flow of cerebrospinal fluid.

An 8-year-old client with a ventriculoperitoneal shunt was admitted for shunt malfunction. He presents with symptoms of increased intracranial pressure. The mechanism of the development of his symptoms is most probably related to:

Check the blood glucose twice a day and the glycosolated hemoglobin every 3 months.

An adolescent with diabetes has had several episodes demonstrating lack of diabetic control. The nurse is reviewing techniques for checking the control of diabetes. The nurse states to the adolescent, "The best way to maintain control of your disease is to:

abdominal girth every 4 hours

An appropriate nursing assessment of an infant suspected of having necrotizing enterocolitis would be:

Risk for infection

An appropriate nursing diagnosis for a toddler with unrepaired exstrophy of the bladder would be:

"The straps of the harness should be placed next to the skin.", "The harness should be worn for 6 hours a day.", "It will take a long time for my child to walk and crawl."

An infant is placed in a Pavlik harness for develop- mental dysplasia of the hip. The nurse has completed parent teaching, but the parents seem to be over- whelmed by the condition and make several statements indicating a lack of understanding. The statements that indicate more teaching is needed are: (Select all that apply.)

Monitoring rectal temperature every 4 hours

An infant returns from initial surgery for Hirschsprung's disease. All of the following are routine postoperative nursing interventions. Because of the type of surgery this child had, the nurse would exclude which of them?

There is an immediate rise in the TSH after birth

An infant was born 24 hours ago. The nurse has been instructed to collect blood by heel stick for neonatal screening for congenital hypothyroidism before the baby is discharged. The nurse questions the order with the pediatrician because 24 to 48 hours after birth is not the optimal time to collect this specimen for what reason?

Allow the toddler to assist with cleaning off his fingers before blood glucose monitoring, allow the toddler to choose food selections from options offered.

Considering a child's developmental level in diabetic care is essential. The nurse should include which in- formation in teaching the parents of a recently diagnosed toddler with diabetes? (Select all that apply.)

Who was tested immediately after birth.

Four newborns have blood drawn for the Guthrie test for phenylketonuria. The nurse would question the results of the baby:

Cover the sac with moistened sterile gauze

Immediately after the delivery of an infant with an omphalocele, the nurse would take which of the following actions?

Mental retardation.

Mothers in the waiting room of the endocrine clinic are discussing their children's illnesses. The nurse determines that the mothers of children with phenyl- ketonuria (PKU) and congenital hypothyroidism recognize a common goal in the early treatment of their children when they state they are hoping to avoid:

Weekly changes with manipulation

Parents of an unborn infant have just learned that, based on ultrasound, their infant has clubfoot. They ask the nurse how clubfoot is treated. Which of the following treatments should the nurse discuss with the parents?

Promote descent of the testes

The newborn has been diagnosed with cryptorchidism. The physician has ordered human chorionic gonadotropin (HCG) to be administered to the baby. The mother asks the nurse why the baby is receiving this drug. The nurse's best explanation would be that the drug will:

nephrotic syndrome, urinary tract infection

The nurse admits children with the following dis- eases to the unit. The nurse determines that the children with which diseases are at risk for the development of acute renal failure (ARF)? (Select all that apply.)

throughout life

The nurse has completed discharge teaching on the dietary regimen of a child with celiac disease. The nurse recognizes that client education has been successful when the mother states that the child must comply with the gluten-free diet:

Baked chicken, green beans, and a slice of cornbread

The nurse has taught dietary restrictions to a 7-year- old child who has celiac disease. After teaching, the child is allowed to choose a meal from the hospital menu. The nurse evaluates that teaching was effective when the child chooses which of the following?

slowly increase the volume offered according to the physician's orders.

The nurse instructs the parents about postoperative feeding following their infant's pyloromyotomy. The nurse evaluates that the parents understand the instructions when the parents state they will:

Withhold the dose and report this to the physician since a sore throat is a common side effect

The nurse is administering propylthiouracil (PTU) to a 12-year-old recently diagnosed with Grave's dis- ease. The child has been receiving the drug 3 times a day for 3 weeks. She suddenly complains of a severe sore throat. What would be the appropriate nursing action?

Provide client/parent education for specimen collection before the specimen is obtained.

The nurse is admitting a 12-year-old girl to the hospital prior to surgery. The physician has ordered a urinalysis. In order to obtain accurate urinalysis data, the nurse should:

Subtracting the weight of a dry diaper from a wet diaper and record this amount

The nurse is caring for a toddler who is not toilet trained. The doctor has ordered intake and output measurement. The nurse will most accurately measure the urine by:

the obstruction is above the bile duct

The nurse is caring for an infant vomiting secondary to pyloric stenosis. The mother questions why the vomitus of this child appears different from that of her other children when they have the flu. The nurse would explain that the emesis of an infant with pyloric stenosis does not contain bile because:

Tell family members to wash their hands frequently

The nurse is developing a teaching plan for the parents of an infant diagnosed with hepatitis A. Which of the following instructions would be included to re- duce the risk for transmission of this disease?

"My child should sleep for at least 8 hours without arousing after we get home."

The nurse is providing discharge instructions for a child who has suffered a head injury within the last four hours. The nurse determines there is a need for additional teaching when the mother states:

while golfing after school at 3pm

The nurse is teaching a 15-year-old client about the different types of insulin. The client takes NPH insulin at 8:00 A.M. The nurse interprets that the adolescent understands this type of insulin when the child states that the most likely time for an insulin reaction would be:

wheat, oats, barley

The nurse is teaching the parents of a child with celiac disease about the dietary restrictions. The nurse would explain that the most appropriate diet for their child is a diet that is free of which of the following? (Select all that apply.)

"I should try to get her to drink a lot of water and juices", "I will buy her underwear made with cotton", "If I notice her starting to wet the bed again, I need to have her checked for another urinary tract infection."

The nurse is teaching the parents of a preschooler information about urinary tract infections (UTIs) and means of reducing their recurrence. Statements from the parents that indicate an understanding of ways to prevent UTIs include: (Select all that apply.)

Opisthotonos

The nurse observes a client with a neck and back arched and extremities severely extended. The mother asks why the child is doing that. The nurse explains that this posturing is called:

Access to the spinal fluid is facilitated

The nurse places a young child scheduled for a lumbar puncture in a side-lying position with the head flexed and knees drawn up to the chest. The mother asks why the child has to be positioned this way. The nurse explains the rationale for the positioning is that:

A large bowl of dry cereal with strawberries and apple juice

The nurse was working with a group of parents of children with phenylketonuria. The nurse has completed family teaching on the dietary restrictions. The parents are given sample menus to choose a meal for their child. Which menu choice indicates understanding of the dietary instructions?

observing the child for evidence of hypertension, providing fun activities for the child on bedrest, monitoring the urine for hematuria.

The nurse would include which of the following in the care of a child with acute glomerulonephritis? (Select all that apply.)

Administer ordered antibiotics on schedule

The nurse would place highest priority on which nursing activity in managing a young child diagnosed with urinary tract infection (UTI)?

Keep track of possible loss or gain of fluid retained in body tissues

The parents of a child diagnosed with upper urinary tract infection (UTI) ask the nurse why the child need a daily weight. In formulating a response, the nurse includes that it is important because a daily weight will:

Strict bedrest

The physician has written the following orders for a child with Duchenne muscular dystrophy hospitalized for a respiratory infection. The nurse should question the order for:

Positive tonic neck reflex

Upon performing a physical assessment of a 7-month-old child, the nurse notes the following findings. The nurse concludes that which finding is abnormal and could suggest cerebral palsy (CP)?

Proteinuria

When reviewing a urinalysis report of a client with acute glomerulonephritis, the nurse expects to note which of the following?

Assessing temperature every 4 hours

Which of the following nursing care measures takes highest priority in caring for a child in skeletal traction?

Dry mucous membranes

Which of the following signs would the nurse recognize as an indication of moderate dehydration in a preschooler?

"My child will need to be home schooled to protect him from injury."

Which of the following statements made by a parent of a child with osteogenesis imferfecta (OI) needs clarification by the nurse?

"I can stop the antibiotics when I see that my child is afebrile for one week."

Which of the following statements made by the parent of a child being discharged with osteomyelitis re- quires further teaching by the nurse?

infection

While a child is receiving prednisone (Deltasone) for treatment of nephrotic syndrome, the nurse determines that it is important to assess the child for:

bile-stained vomitus, poor weight gain since birth, alternating constipation and diarrhea

While gathering admission data on a 16-month-old child, the nurse notes all the following abnormal findings. Which finding is related to a diagnosis of Hirschsprung's disease? (Select all that apply.)

Diaphragmatic hernia

While performing a newborn assessment, the nurse notes the infant is having difficulty breathing, with nasal flaring, cyanosis, retractions, and an absence of breath sounds on the left side. The nurse auscultates the apical pulse on the right side of the chest. The nurse notifies the physician immediately because of suspected:

Parents must bring the child back to the clinic on a regular basis to have more medicine added to the pump

the nurse is providing client education for a family whose child has cerebral palsy and is receiving baclofen epidural therapy to control spasticity. Which of the following is most important for the nurse to include in the discussion?