Peds Exam 3 Practice Questions
prepare to administer analgesics via the intravenous route Pain management is vital to the care of a child with areas with deep partial-thickness (deep second-degree) burns. The nurse would assure the tracheal tube is taped in a very secure manner, because edema will make reintubation (if the tube is inadvertently dislodged) difficult. IV fluids would be warmed, to prevent hypothermia.
The nurse is caring for a child who experienced deep partial-thickness (deep second-degree) burns to the front of the body after falling into a campfire approximately 25 minutes prior. What action would the nurse include in the plan of care for the child?
Apply topical antifungal cream Red lesions in diaper area indicate diaper candidiasis.
The nurse is caring for an infant on the pediatric unit who has a very red rash in the diaper area, with red lesions scattered on the abdomen and thighs. What is the priority nursing intervention?
The nurse follows contact precautions Impetigo is highly contagious and can spread quickly. The nurse should follow contact (skin and wound) precautions, including wearing a cover gown and gloves.
The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing action is priority?
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?
Thick, fissured tongue
The nurse is educating the parents of a neonate with Down syndrome regarding nutrition. Which provides the biggest challenge in feeding the neonate?
Administering intravenous calcium gluconate as ordered. Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany.
The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority?
"We should be sure to administer the medication on an empty stomach so the medication will be absorbed better." "If the medication doesn't seem to be working, we can stop giving it to our child at any time." Corticosteroids should be administered with foods to prevent GI upset and damage to the mucosa. The medications must be tapered before discontinuing in order to prevent acute adrenal insufficiency.
The nurse is providing discharge instructions for a client taking a corticosteroid. Which statements by the parents alert the nurse that clarification of instructions is needed?
Administer subcutaneous glucagon. If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level.
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to take?
"Our child will start puberty again when the medication stops." Treatment for central precocious puberty involves administering a gonadotropin-releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages. This analog can be given by depot injection every 3 to 4 weeks, a daily subcutaneous injection, or an intranasal spray two or three times per day. With GnRH analog treatment, secondary sexual development stabilizes or regresses.
After teaching the parents of a child with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching?
The child's toes are pointed downward, his head and neck are arched backwards, and his arms and legs are extended. The child's heart rate is 56 beats per minute. The child's pupils are fixed and dilated.
The young boy was involved in a motor vehicle accident and was admitted to the pediatric intensive care unit with changes in level of consciousness and a high-pitched cry. Which are late signs of increased intracranial pressure? Select all that apply.
"Kids can usually be managed with an oral agent, meal planning, and exercise." Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increased activity.
A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?
growth hormone The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin.
The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone?
cellulitis Cellulitis is characterized by reddened or lilac-colored, swollen skin that pits when pressed by the fingertips.
The nurse is caring for a child brought to a pediatric clinic for swelling in the lower extremities. The skin is reddened with undefined borders and pits slightly when pressed. Based on the assessment findings, which of the following would the nurse suspect?
low serum calcium levels With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.
The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record?
A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force
The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation?
The boy rises from the floor by walking his hands up his legs Gowers' sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken. The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and "walk" hands up his legs to stand.
The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this?
Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Desmopressin acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.
A child has been prescribed desmopressin acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse?
Administering antitoxin intravenously Monitoring for airway obstruction Adhering to droplet precautions Ensuring complete bed rest
The nurse is caring for a child newly diagnosed with diphtheria. Which nursing interventions would the nurse include in the child's plan of care? Select all that apply.
Screening for HIV No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test.
The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting?
hypertension Symptoms of increased intracranial pressure include slowing of both pulse and respirations, increasing blood pressure, and the development of hypothermia.
The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP?
increased head circumference (bulging fontanel) pulse rate of 60 beats/min and regular (low HR) vomiting parent states, "My infant does not act right."
The nurse is caring for a hospitalized infant at risk for developing increased intracranial pressure. Which assessment finding(s) would the nurse communicate to the health care provider for further intervention? Select all that apply.
"We will be sure to keep the area safe and turn our child on the side during seizure activity." "We should time the seizure and write down what happens during the seizure."
The nurse is providing discharge teaching to the parents of a child recently diagnosed with a seizure disorder. The nurse determines learning has occurred with which statement(s) by the parents? Select all that apply.
Perform a jaw-thrust technique to assess the patency of the airway The nurse would first evaluate the airway, assessing its patency. Position the airway in a manner that promotes good air flow.
The parents of a preschool child are distraught as they carry their limp child into the emergency room. The parents report the child fell approximately 10 feet from a large slide and hit his head "hard enough to knock him out." What is the nurse's next action?
"Baby powder should not be used on newborns because of the risk of aspiration upon application." The use of baby powders containing talc or known as "talcum powder" can cause accidental aspiration, pneumonia, and death. Aspiration is predominantly caused when the baby receives a "puff of smoke" when the powder is shaken from the container directly onto the baby's skin. In addition, the use of talcum powder is abrasive and is considered to contribute to the pathogenesis of diaper dermatitis.
The nurse is caring for a mother and newborn on a postpartum unit. The mother asks if it OK to use baby powder on newborns. Which response by the nurse would be most appropriate?
Assist with log-rolling the children every 2 hours.
The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel?
maculopapular rash that began on the face and has spread to the rest of the body fever upper respiratory infection symptoms
The nurse is obtaining a health history and assessment for a child being admitted who is suspected of having measles. What signs and symptoms does the nurse expect to find during the assessment? Select all that apply.
This medication must be given by injection. Somatropin is administered by injection. It is best given at the hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions.
The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication?
impetigo Impetigo is a superficial bacterial skin infection. Impetigo in the newborn is usually bullous (blister-like, fluid filled); in the older child, the lesions are nonbullous and have a honey-colored, crusted appearance.
The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children that involves honey-colored crusted lesions. The nurse most likely is referring to:
"A hot bath will soothe my child's itching when it is severe." Hot baths should be avoided, use Warm baths. Pat dry, fragrance free moisturizer, cotton clothing.
The nurse is teaching about skin care for atopic dermatitis. Which statement by the parent indicates that further teaching may be necessary?
"Your child most likely has cradle cap (seborrhea). You can care for it by cleansing the hair and scalp daily with baby shampoo and applying baby oil." Infantile seborrheic dermatitis, better known as cradle cap, usually responds well to cleansing the scalp with a mild shampoo. The thick, scaling lesions on the child's scalp can be treated by applying baby oil, mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft brush to lift the scales then shampooed again. A fine-toothed comb helps rid the hair of scale debris.
The parent of a 1-week-old infant is concerned with white scales that have begun to flake off the infant's scalp. The parent asks the nurse what to do to treat this. How should the nurse bestrespond?
Graves disease Symptoms of Graves disease include an increased rate of growth; weight loss despite an excellent appetite; hyperactivity; warm, moist skin; tachycardia; fine tremors; an enlarged thyroid gland or goiter; and ophthalmic changes including exophthalmos.
During an assessment of an adolescent child, the nurse notes that the child has a protuberant tongue, fatigued appearance, poor muscle tone, and exophthalmos. What medical diagnosis would the nurse expect the child to have?
assessing the child's airway and breathing and noting any wheezing or stridor Urticaria is a type I hypersensitivity reaction. Therefore, the priority nursing assessment is to carefully assess airway and breathing, as hypersensitivity reactions may affect respiratory status.
The nurse is caring for a child with urticaria. What is the priority action?
Place heating pads and warmed blankets on the trunk of the body initially With moderate hypothermia, the trunk of the client should be warmed first.
A child arrives at the emergency department with moderate hypothermia and frostbite. Which action would be most appropriate for the nurse to perform?
Gowers sign A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness.
The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?
The involved extremity is adducted, prone, and internally rotated Erb palsy is an upper brachial plexus injury and the involved extremity usually presents as adducted, prone, and internally rotated.
The nurse is conducting a physical examination of a child with a brachial plexus injury. Which finding would lead the nurse to be highly suspicious of Erb palsy?
second-degree frostbite Second-degree frostbite demonstrates blistering with erythema and edema. First-degree frostbite results in superficial white plaques with surrounding erythema. In third-degree frostbite, the nurse would note hemorrhagic blisters that would progress to tissue necrosis and sloughing when the fourth degree is reached.
The nurse is examining a child for indications of frostbite and notes blistering with erythema and edema. The nurse notes which degree of frostbite?
Use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula.
A young mother brings her new baby, diagnosed with congenital hypothyroidism, to the clinic so she can learn how to administer levothyroxine. The nurse should include which of the following instructions?
Administer immunosuppressive medications as ordered. Monitor the client for signs and symptoms of graft versus host disease. Provide oral care at least every shift, but more often as needed. Perform meticulous hand hygiene and ensure all visitors follow these precautions. The client who has had a bone marrow transplant is at high risk for bone marrow rejection and must receive immunosuppressive medications as scheduled to prevent rejection. Protective isolation, not contact precautions, are followed to prevent infection in this immunocompromised client, as does hand hygiene. Oral hygiene prevents infections from beginning in the mouth. Graft versus host disease is an allergic reaction that can occur; early recognition is vital.
The nurse is completing a care plan for a child who has recently had a bone marrow transplant. Which nursing interventions should the nurse include in the care plan? Select all that apply.
Urine output An infant with diabetes insipidus has a decrease in antidiuretic hormone. Strict fluid precautions will not alter urine formation. This assessment is important because the infant will be at great risk for dehydration and electrolyte imbalance.
An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions?
The parents lay the neonate in an elevated infant seat. Postoperatively, the neonate is to be kept flat to prevent a rapid decrease in intracranial pressure.
The nurse is providing instruction to the parents of a neonate following ventriculoperitoneal shunting (VP shunt) related to hydrocephalus. For which parent action would the nurse provide additional teaching?
8.5% The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%.
A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result?
Oriented to person, place, and time Disorientation Obtundation Stupor Coma
A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression.
tetanus For any burn, check the child's tetanus immunization status on admission and ensure that tetanus toxoid is given if the child's immunizations are not up to date, because anaerobic and aerobic bacteria can grow at the interface between burned and healthy tissue.
A child is admitted to the acute care facility with a burn injury. The nurse would check the child's immunization status, specifically for which of the following?
Second-degree or partial-thickness burn A burn that encompasses the epidermis and the underlying dermis is a second-degree burn. A first-degree burn would only involve the epidermis, and a third-degree burn would involve nerve endings as well as destruction of the epidermis and dermis. A fourth-degree burn would extend even deeper into the fat layer.
A young child has just been admitted to the emergency department with a burn that encompasses the epidermis and the underlying dermis. From which type of burn does this child suffer?
The tongue has a white or red "strawberry" appearance
An 11-year-old girl arrives at the doctor's office with fever, a sore throat, chills, and malaise. A throat culture indicates scarlet fever. Which other symptom should the nurse notice in this client that clearly indicates scarlet fever?
Bathe with a product that is oatmeal-based
An adolescent experiencing contact dermatitis reports experiencing pruritis. What intervention will the nurse recommend to relieve the itching?
Staphylococcus aureus Staphylococcus aureus is the most common cause of impetigo in infants. Group A beta hemolytic strep is seen in older children.
An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants?
Weighing on the same scale each day
In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care?
Baclofen pump A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally
Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer?
Apply ice to the affected area Spider bites can cause serious illness if untreated. Bites of black widow spiders, brown recluse spiders, and scorpions demand medical attention. Applying ice to the affected area until medical care is obtained can slow absorption of the poison.
The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a health care provider. What is the most appropriate action for the nurse to do with this child?
secondary bacterial infections The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions.
The most common complication of varicella is:
Encourage rest and relaxation. Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to antipyretics and analgesics
The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided?
hyperactive and irritable
The nurse is admitting to the nursery a newborn of a mother who continued to drink alcohol during her pregnancy. Which finding does the nurse predict to encounter on the newborn's assessment?
idiopathic scoliosis
The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?
fluid balance
The nurse is caring for a child who has received significant partial-thickness burns to the lower body. What is the priority assessment in the first 24 hours after injury?
Vomiting The GI system is the first to be overwhelmed by excessive histamine release.
The nurse is providing care to a child with a latex allergy. The nurse notifies all care providers of the allergy and assesses for which early sign of an anaphylactic reaction?
head trauma A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma.
The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?
latex A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex.
The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?
Developmental dysplasia of the hip (DDH)
The parent has brought a 2-year-old to the public clinic for immunizations. The nurse documents the following characteristics: A duck waddle gait Shortened extremity Asymmetry of the gluteal folds Protruding abdomen The nurse then refers the toddler to the health care provider for potential diagnosis of which?
Group B streptococcus In infants under the 3 months of age the most causative agents are group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen, a full septic work-up is done. Neonates have the poorest outcomes from sepsis.
What is the leading cause of neonatal sepsis and death?
Give the child 4 oz of orange juice
When monitoring the blood glucose level of a 12-year-old child with type 2 DM, your reading is 50 mg/dL. Which is the most appropriate action?
"Herpes zoster is a reactivation of a previous varicella zoster infection."
When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate?
missing clitoris
Which clinical manifestation should a nurse recognize as most significant when assessing a client who is suspected of having female circumcision?
The nurse will administer oxygen The major complication of pertussis (whooping cough) is pneumonia and respiratory complications. Oxygen, bed rest, and monitoring for airway obstruction are nursing interventions. The highest priority is administering oxygen to maintain adequate oxygenation of cells.
he nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child?
Regular insulin Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.
A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer?
Repeat the full dose immediately.
A child is receiving desmopressin (DDAVP) for the treatment of central diabetes insipidus. The child sneezes immediately after receiving the morning dose. Which is the best action made by the nurse?
"Please take your child straight to the emergency department." A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately.
A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse?
"Your infant had a long period of jaundice from birth." "Your infant's motor activity has been decreased." "Your infant has had ongoing constipation."
A 2-month-old infant is diagnosed with hypothyroidism. When educating the parents, the nurse explains which as signs suggesting hypothyroidism? Select all that apply.
Functional status related to eating and mobility
A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history?
Administer intravenous antibiotics. Institute contact isolation precautions. Obtain blood cultures.
A nurse is providing care to a child admitted to the hospital with a diagnosis of severe periorbital cellulitis. Which intervention(s) should the nurse expect to implement? Select all that apply.
Zidovudine
A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. What would the nurse expect to administer?
a fasting blood glucose greater than 126 mg/dl
A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?
back with hips up off the bed Bryant traction is used to reduce fractures or with developmental dysplasia of the hip (DDH) in children younger than 2 years of age. In this type of traction, both legs are extended vertically with the child's weight serving as the counterbalance. For there to be traction, the infant's hips must be off the bed.
An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:
Abdominal mass
The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present?
Periorbital edema Periorbital edema and edema in the ankles are the initial presenting symptoms. As the swelling advances, the edema becomes generalized with a pendulous abdomen full of fluid. Edema in the scrotum also appears. Edema in the hands, sacrum and facial puffiness can be a progression of the disease.
The nurse is triaging clients as they come in to an urgent care facility. Which assessment finding is clinically significant for early nephrotic syndrome?
Penicillin to prevent acute glomerulonephritis A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to treat the beta-hemolytic group A streptococcal infection and to prevent the complication of developing acute glomerulonephritis and rheumatic fever.
When the health care provider looks in a child's mouth during a sick-visit examination, the parent exclaims: "The tongue is bright strawberry red! It was not like that yesterday." The health care provider would most likely prescribe which medication based on the probable diagnosis?
It appears at birth or during the first 2 years of life Cerebral palsy is an irreversible, nonprogressive disorder that results from damage to the developing brain during the prenatal, perinatal, or postnatal period. Although some children with cerebral palsy are intellectually disabled, many have normal intelligence.
Which characteristic is true of cerebral palsy?
significant level of alpha-fetoprotein present in amniotic fluid Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects.
Which diagnostic measure is most accurate in detecting neural tube defects?
short, palpebral fissures Infants with fetal alcohol spectrum disorder are usually born with microcephaly. Their facial features include short, palpebral fissures and a thin upper lip
Which facial change is characteristic in a neonate with fetal alcohol spectrum disorder?
hypocalcemia ypoparathyroidism results in low production of PTH, which in turn leads to hypocalcemia and hyperphosphatemia.
A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse mostlikely expect to address?
penicillin V Penicillin V is the antibiotic of choice. In those sensitive to penicillin, erythromycin may be used
A child is diagnosed with scarlet fever. History reveals that the child has no known drug allergies. When preparing the child's plan of care, the nurse would anticipate administering which agent as the drug of choice?
"You look funny. Well, both of you do. I see two of you." The caregiver should notify the health care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep.
A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement?
adolescence Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.
A group of students is reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?
void during the procedure At the start of the voiding cystourethrogram, a catheter is inserted into the bladder. The contrast medium is inserted through the catheter into the bladder. Fluoroscopy is performed to demonstrate the filling of the bladder and the collapsing of the bladder upon emptying. The assessment of emptying requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed. No anesthetic is required for this procedure.
A 4-year-old child with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing the child for this procedure, the nurse would want to prepare the child to:
Position for adequate airway clearance
A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. He has an ineffective cough. Lung auscultation reveals diminished breath sounds. What is the priority nursing intervention?
acute glomerulonephritis Scarlet fever infection is the result of group A streptococci. It generally starts with a throat infection (strep throat). The bacteria produce a toxin that causes the rash over the body. Because this is a streptococci-based infection, the child will need to be monitored for the development of rheumatic fever or glomerulonephritis following the illness
A chief danger of scarlet fever is that children may develop:
His ability to void and have an erection in adulthood may be impaired and surgery is needed.
A male newborn is born with hypospadias. The nurse doing the newborn physical assessment notes that the penis is also curved downward. What information would the nurse provide the parents for this infant
"My child wears out his clothes before he outgrows them." Poor growth, short stature. Higher weight to height ratio.
During a well-child examination which of the following comments made by the parent would indicate the possibility of a growth hormone deficiency?
Cartilage During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?
Administration of levothyroxine indefinitely
Prior to discharging an infant with congenital hypothyroidism to home with the parents, what should the nurse emphasize regarding the care that this child will need going forward?
hypovolemic shock In severe burns the increased capillary permeability results in vasodilation. This increases hydrostatic pressure in the capillaries, causing water and electrolytes to leak out of the vasculature and resulting in edema. Around 48 to 72 hours, the capillary permeability returns to normal causing severe diuresis. Hypovolemic shock is the major manifestation in the first 48 hours in massive burns. As extracellular fluid pours into the burned area, it collects in enormous quantities, dehydrating the body.
The nurse is caring for a child with a severe burn. The treatment for this child during the first 48 hours will be most likely be related to
upright positioning The nurse should emphasize that the child's position should be arranged to promote maximum chest expansion. This is usually in the upright position.
The nurse is caring for a 10-year-old child with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion?
diazepam Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting.
The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered?
tinea capitis
The nurse is caring for a 10-year-old male in a pediatric clinic with presenting symptoms of small circular patches of hair loss on the scalp. Which skin condition does the child most likely have?
Encourage the child to wear a medical alert bracelet for penicillin.
When providing discharge instructions to a child who was admitted to the hospital following stridor, wheezing, and urticaria after taking penicillin, which nursing action is priority?
prone right side lying left side lying
A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply.
antifungal
The nurse is educating a parent about the treatment for a child's tinea cruris. What medication class would the nurse include in the teaching plan?
bananas The nurse should instruct children and their families to avoid foods with a known cross-reactivity to latex, such as bananas.
The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food?
Eggs Shrimp Peanuts Foods that should be avoided in children younger than 1 year of age include cow's milk, eggs, peanuts, tree nuts, sesame seeds, and fish and shellfish (i.e., shrimp).
A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which foods would the nurse most likely include? Select all that apply
Mumps Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling.
A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease?
"Watch for changes in his behavior or eating patterns." Changes in behavior or in eating patterns can suggest a problem with his shunt, such as infection or blockage.
The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?
Trichomonas
The nurse is reviewing the causative organisms noted on laboratory reports. Which organism is transmitted solely by sexual contact?
Encourage high fluid intake. Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms?
By 6 months of age HIV appears to progress more rapidly in untreated infants and children who contract it through placental transmission. These children usually are HIV positive by 6 months old and develop clinical signs by 1 to 3 years old. If a mother is treated for HIV during pregnancy, the infant will also receive HIV medication for 6 weeks after birth. The infant will need to be tested at 1 month of age and at 4 months of age. This testing will determine the absence of HIV in the infant.
A nurse instructor is teaching pregnant women how HIV can spread from mother to fetus without treatment. For the untreated child who contracts HIV through placental transmission, when will the child test positive for HIV?
Draws up the short-acting insulin before the intermediate-acting insulin. Stores the insulin vial at room temperature. Gives the injection at a 45-degree angle.
A nurse is making a home visit to a 12-year-old child with type 1 diabetes and is reviewing insulin administration. The nurse determines that the teaching was successful when the child performs which actions? Select all that apply
Encourage high fluid intake
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms?
DI can be managed with vasopressin given as lifelong treatment. Vasopressin is the drug of choice for this lifelong disease. In DI, antidiuretic hormone is undersecreted.
A nurse on the pediatric floor is taking care of a 12-year-old child with diabetes insipidus (DI). Which fact would the nurse understand about this disease?
Incubation Prodrome Illness Convalescence
A nursing instructor has presented a class on the stages of an infectious disease to a group of students and asks the students to place the stages in their proper sequence from beginning to end. Place the stages in their proper sequence.
Low-grade fever Macular rash Papular rash Vesicle formation Crusting
A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.
a chemical burn According to the American Burn Association, chemical burns warrant referral to a burn unit. A partial-thickness or second-degree burn greater than 10% of the body surface area would warrant a referral to a burn unit. A superficial or first-degree burn on the chest or hands does not warrant a referral to a burn unit.
The nurse is caring for a 2-year-old boy with a burn. What finding would warrant referral to a burn unit?
Type II According to the Salter-Harris classification, a type II fracture is partially through the physis extending into the metaphysis.
The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?
stocking-glove pattern on hands or feet A stocking-glove pattern on the hands or feet or a circumferential ring appearing around the extremity points to the caregiver forcefully holding the child under extremely hot water.
The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a burn induced by child abuse (child maltreatment)?
"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be." Bracing is the primary treatment for scoliosis. The braces used today are designed by computer-aided techniques and fit under the arms rather than extending to the neck. Braces must be worn 23 hours a day. Surgical intervention is only performed in severe cases.
The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?
eye opening verbal response motor response
The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply.
0815 The onset of rapid acting insulins like lispro (Humalog) is within 15 minutes. The onset of short-acting insulin is 30 to 60 minutes. The onset of intermediate-acting insulin is 1-3 hours, and long-acting insulin's onset is 1-2 hours.
The nurse is preparing to administer the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline?
intraventricular hemorrhage (IVH)
A preterm newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanel (fontanelle), cyanosis, and increased head circumference. These signs indicate the newborn has which complication
"Your child may return to school when all of the lesions have crusted over."
A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent?
MRSA
A varsity high-school wrestler presents with a "rug burn" type of rash on his shoulder that is not healing as expected, despite use of triple antibiotic cream. Two other wrestlers on his team have a similar abrasion. What infection should the nurse be most concerned about, based on the history?
The VCUG will rule out vesicoureteral reflux
A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents?
urinalysis Urinalysis is ordered to reveal preliminary information about the urinary tract. The test evaluates color, pH, specific gravity, and odor of urine. Urinalysis also assesses for presence of protein, glucose, ketones, blood, leukocyte esterase, red blood cell count, white blood cell count, bacteria, crystals, and casts.
The nurse is caring for a 10-year-old girl presenting with fever, dysuria, flank pain, urgency, and hematuria. The nurse would expect to help obtain which test first?
Blood glucose level at 1630 NPH lasts 10-16 hours, peaks at 2-4 hours.
The nurse is caring for a 14-year-old boy with type 1 DM. He takes NPH insulin every morning at 7:30 AM. Which assessment data will the nurse use to evaluate the therapeutic effectiveness of the medication?
onset of a streptococcus infection last week
The nurse is caring for a client newly diagnosed with acute glomerulonephritis? When receiving the pediatric client's history, which is anticipated?
heredity Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait.
Through which mechanism is Duchenne muscular dystrophy acquired?
change in level of consciousness
A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure?
cognitive impairment A newborn with congenital hypothyroidism is lethargic, hypotonic and irritable. Delayed growth is seen as well as decreased mental responsiveness. The newborn has an enlarged tongue and poor sucking ability. Without treatment with the thyroid hormone, the newborn will develop a cognitive impairment and failure to thrive
A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely?
Dehydration If there is a complete blockage of cortisol formation, aldosterone production will also be deficient. Without adequate aldosterone, salt is not retained by the body, so fluid is not retained. Almost immediately after birth, affected infants begin to have vomiting, diarrhea, anorexia, loss of weight, and extreme dehydration. If these symptoms remain untreated, the extreme loss of salt and fluid can lead to collapse and death as early as 48 to 72 hours after birth. The salt-losing form must be detected before an infant reaches an irreversible point of salt depletion.
A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client?
A simple blood test to diagnose hypothyroidism is required in most states.
A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer?
Administer diphenhydramine As nerve endings heal they cause intense itching that can be relieved with the use of medications (e.g., diphenhydramine hydrochloride, loratadine) and by applying soothing lotions such as Nivea or Eucerin.
A nurse is caring for a child with second- and third-degree (partial- and full-thickness) burns over 15% of the body. The child reports severe itching in and around the burn sites. Which action would be most appropriate for the nurse to perform?
removing any fur or woolen items from the child's wardrobe encasing the mattress and pillow in sturdy plastic installing air conditioning in the home Allergies are associated with environmental allergens to which the child is hypersensitive. It is important to identify and eliminate the allergen as best as possible. Measures to control environmental allergens include replacing stuffed furniture (can hide dust mites) with wooden furniture; removing any fur or woolen items from the child's wardrobe; encasing the mattress and pillow in sturdy plastic. It is best to install air conditioning instead of opening the windows. Open windows allow environmental allergens to enter the house. Most air conditioning systems include a filter. The windows in the house should remain closed.
A nurse is preparing a teaching plan about environmental control measures for the parents of a child with an allergy. Which recommendation(s) will the nurse include? Select all that apply.
creatine kinase Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring.
The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?
Edema with wet blistering skin Partial-thickness or second-degree burns are very painful and edematous and have a wet appearance or the presence of blisters. Third-degree (full-thickness) burns appear red, edematous, leathery, dry, or waxy and may display red or charred skin (eschar).
The nurse is caring for a child with a second-degree (partial-thickness) burn. What assessment findings would the nurse expect to observe?
"Treatment will begin immediately." Developmental dysplasia of the hip (DDH) is a congenital newborn condition that requires immediate intervention. The development of the acetabulum of the hip is defective, and it may or may not be dislocated. Treatment of the defect and dislocated hips involves positioning the hip into a flexed, abducted (externally rotated) position to attempt to press the femur into the acetabulum. This involves splints and halters as the first line of treatment. Treatment should not be delayed. Surgery and casts are typically not used as the first line of treatment
The nurse is caring for a newborn client newly diagnosed with developmental dysplasia of the hip (DDH). Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis?
During follow-up visits the child demonstrates normal growth and development. 21-OH enzyme deficiency results in blocking the production of adrenal mineralocorticoids and glucocorticoids.
The nurse is caring for a newborn with 21-OH enzyme deficiency congenital adrenal hyperplasia (CAH). The nurse identifies one goal of the plan of care as being the understanding of the importance of maintaining hormone supplementation. Which outcome criteron demonstrates this goal has been met?
Spica cast The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.
The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?
insulin When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.
The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease?
pulse rate and rhythm Hyperkalemia occurs when the potassium levels rise above normal laboratory values. Although it varies among laboratories, a normal potassium range is generally between 3.5 and 5 mEq/l (3.5 and 5 mmol/l). When the potassium levels rise, the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping.
The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia?
A young child's bones commonly bend instead of break when an injury occurs. The infant and a young child's bones are more flexible and more porous with a lower mineral count than adults. The structural differences of a young child's bone allow for greater shock absorption thus, bones will often bend rather than break when an injury occurs.
When teaching a group of parents about the skeletal development in children, what information will the nurse provide?
