Peds Exam 3

A nurse is teaching about neural tube defect to a group of females who are pregnant which of the following disease processes should the nurse include as an example of a neural tube defect? A) Cerebral palsy B) Hydrocephalus C) Muscular dystrophy D) Spina bifida

D) Spina bifida

A child is brought to the ED with what is presumed to be acute adrenocortical insufficiency. Which of the following should the nurse do first? 1. Insert an IV line to administer fluids and cortisol. 2. Prepare for admission to the intensive care unit. 3. Indicate the likelihood of a slow recovery. 4. Discuss the likelihood of the child's imminent death.

1. Insert an IV line to administer fluids and cortisol.

Which nursing actions apply to the care of a child who is having a seizure? Select all that apply. 1. Time the seizure. 2. Restrain the child. 3. Stay with the child. 4. Insert an oral airway. 5. Loosen clothing around the child's neck. 6. Place the child in a lateral side-lying position.

1. Time the seizure. 3. Stay with the child. 5. Loosen clothing around the child's neck. 6. Place the child in a lateral side-lying position.

The nurse is aware that cloudy cerebrospinal fluid most likely indicates? 1. Viral meningitis 2. Bacterial meningitis 3. No infections, as CSF is usually cloudy 4. Sepsis

2. The CSF in bacterial meningitis is usually cloudy

A teen comes into the clinic with complaints of having been under a lot of stress recently. The teen is being treated for Addison disease and is taking cortisol and aldosterone orally. Today, the teen shows symptoms of muscle weakness, fatigue, salt craving, and dehydration. What should the nurse discuss with the teen regarding the medications? 1. The dosages may need to be decreased in times of stress. 2. The dosages may need to be increased in times of stress. 3. The aldosterone should be stopped, and the cortisol should be increased. 4. The cortisol may need to be given IV to raise its level.

2. The dosages may need to be increased in times of stress. Because the adrenal glands are not producing enough glucocorticoids, the dosage of both the cortisol and aldosterone must be increased and sometimes tripled in times of stress.

An infant is born with a sac protruding through the spine, containing CSF, a portion of meninges and nerve roots. the condition is referred to as 1. meningocele 2. myelomeningocele 3. spina bifida occulta 4. anencephaly

2. myelomeningocele a myelomeningocele is a sac that contains a portion of the meninges, the CSF and the nerve roots

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual.

3, 5 1. The anterior fontanel is usually raised and bulging in infants with increased ICP. 2. The infant is not able to comprehend blurred vision or make any statements. 3. A high-pitched cry is often indicative of increased ICP in infants. 4. The infant with increased ICP usually has a poor appetite and does not feed well. 5. The infant may be sleeping more than usual because of increased ICP. TEST-TAKING HINT: The test taker needs to be familiar with hydrocephalus and how increased ICP is manifested in infants. Answer 2 can be eliminated because an infant cannot specifically verbalize.

The nurse knows that young infants are at risk for injury from shaken baby syndrome because: A. the anterior fontanel is open. B. they have insufficient musculoskeletal support and a disproportionate head-to-body ratio. C. they have an immature vascular system with veins and arteries that are more superficial. D. there is immature myelination of the nervous system in a young infant.

B. they have insufficient musculoskeletal support and a disproportionate head-to-body ratio.

A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first .1. Administration of IV antibiotics 2. Administration of maintenance fluids 3. Placement of a foley catheter 4. Send the spinal fluid and blood samples to the lab for cultures

4. Cultures of spinal fluid and blood should be obtained , followed by administration of IV abx

A child with VP shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do? Select the nurses best response. 1. "Give her some APAP, and see if the symptoms improve. If they do not improve bring her to the pediatricians office" 2. "It is common for girls to have these symptoms. especially prior to their menstrual period, give her a few days and see if she improves" 3. "You are probably worried that she is having a problem with her shunt. This is very unlikely as it has been working well for 9 years" 4. "You should immediately take her to the ER as these may be symptoms of a shunt malfunction."

4. These are symptoms that the shunt malfunctioned and should be evaluated immediately.

A nurse is caring for a child who is having a seizure. Which of the following actions should the nurse take? SATA A) Assess the client's airway patency B) Place a tongue depressor in the client's mouth C) Remove objects from the client's bed D) Place the client in a side-lying position E) Restrain the client

A) Assess the client's airway patency C) Remove objects from the client's bed D) Place the client in a side-lying position

A parent calls a clinic and reports to a nurse that his 2-month-old infant is hungry more than usual but is projectile vomiting immediately after eating. Which of the following responses should the nurse make? A. "Bring your baby in to the clinic today." B. "Burp your baby more frequently during feedings." C. "Give your infant an oral rehydration solution." D. "Try switching to a different formula."

A. "Bring your baby in to the clinic today." Projectile vomiting followed by hunger are characteristic of pyloric stenosis. The infant needs to be examined in the clinic by a provider as soon as possible.

A nurse is providing teaching to the parent of an infant who has gastroesophageal reflux. Which of the following statements by the parent indicates an understanding of the teaching? A. "I will keep my baby in an upright position after feedings." B. "My baby's formula can be thickened with oatmeal." C. "I will have to feed my baby formula rather than breast milk." D. "I should position my baby side-lying during sleep."

A. "I will keep my baby in an upright position after feedings." The infant should be maintained in an upright position for 1 hr after feedings.

A nurse is providing teaching to a parent of a child who has Hirschsprung disease and is scheduled for initial surgery. Which of the following statements by the parent indicates an understanding of the teaching? A. "I'm glad that my child's ostomy is only temporary." B. "I'm glad my child will have normal bowel movements now." C. "I want to learn how to use my child's feeding tube as soon as possible." D. "I want to learn how to empty my child's urinary catheter bag."

A. "I'm glad that my child's ostomy is only temporary." Hirschsprung disease is also known as aganglionic megacolon and is characterized by an area of the large intestine without nerve innervation. The child will probably require two surgeries over an 18- to 24-month period before normal bowel function is obtained. The initial surgery creates an ostomy, which relieves the obstructed area and allows the bowel distal to the ostomy to rest.

A nurse is caring for a 4-year-old child who has a new diagnosis of diabetes mellitus and is distressed after an insulin injection. Which of the following play activities should the nurse recognize is therapeutic in helping the child deal with the injection? A. A needleless syringe and a doll B. A video game C. A story book about a child who has diabetes D. A period of play in the playroom

A. A needleless syringe and a doll Playing with a needleless syringe and a doll is an appropriate therapeutic activity for the child, because they will allow the child to act out feelings of anger and helplessness.

A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the IV line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which would the nurse expect to do immediately? A. Administer a bolus of normal saline. B. Administer a bolus of D10W. C. Administer a bolus of normal saline with 5% dextrose added to the solution. D. Offer the child an oral rehydrating solution such as Pedialyte.

A. Administer a bolus of normal saline.

What problems commonly occur with shunt placement in children?

A. Displacement B. Blockage C. Infection

The nurse is caring for a 10-year-old child who has an acute head injury, has a pediatric Glasgow Coma Scale score of 9, and is unconscious. What intervention should the nurse include in the child's care plan? A. Elevate the head of the bed 15 to 30 degrees with the head maintained in midline. B. Maintain an active, stimulating environment. C. Perform chest percussion and suctioning every 1 to 2 hours. D. Perform active range of motion and nontherapeutic touch every 8 hours.

A. Elevate the head of the bed 15 to 30 degrees with the head maintained in midline. Nursing activities for children with head trauma and increased intracranial pressure (ICP) include elevating the head of the bed 15 to 30 degrees and maintaining the head in a midline position. The nurse should try to maintain a quiet, nonstimulating environment for a child with increased ICP. Chest percussion and suctioning should be performed judiciously because they can elevate ICP. Range of motion should be passive and nontherapeutic touch should be avoided because both of these activities can increase ICP.

A nurse is caring for a 2-month-old infant who is postoperative following surgical repair of a cleft lip. Which of the following actions should the nurse take? A. Encourage the parents to rock the infant. B. Offer the infant a pacifier .C. Administer ibuprofen as needed for pain. D. Position the infant on her abdomen.

A. Encourage the parents to rock the infant. A rocking motion will calm and soothe the infant. Additionally, involving the parents in the infant's care can reduce feelings of helplessness.

A nurse is caring for a 6 month old infant who has a prescription for clear liquids by mouth after a repair of an intussusception. Which fluid should a nurse select for the infant? A. Oral electrolyte solution B. Half-strength infant formula C. Half-strength orange juice D. Sterile water

A. Oral electrolyte solution

A nurse is caring for a child who is admitted with suspected acute appendicitis. Which of the following manifestations should indicate to the nurse that the child's appendix is perforated? A. Sudden decrease in abdominal pain B. Absent Rovsing's sign C. Flaccid abdomen D. Low-grade fever

A. Sudden decrease in abdominal pain A sudden decrease in abdominal pain should indicate to the nurse that the appendix might be ruptured. If the appendix ruptures, the pain can disappear for a short period and the client might feel suddenly better. However, once peritonitis sets in, the pain returns and can spread into the whole abdomen.

A nurse is assessing an 11 month old infant. which of the following manifestations is associated with a CNS infection? A. Oliguria B. Bulging fontanel C. Negative Brudzinski sign D. Jaundice

Bulging fontanel A CNS infection causes increased intracranial pressure. Therefore, a bulging fontanel is a manifestation of a CNS infection.

A nurse is caring for a child who has Addison's disease. Which of the following actions should the nurse take? A. Teach the parents about cortisol replacement therapy. B. Place the child on a low-sodium diet. C. Monitor the child for fluid volume excess. D. Discuss the manifestations of hypoglycemia with the parents.

A. Teach the parents about cortisol replacement therapy. The nurse should plan to teach the child's parents about cortisol replacement therapy. Administration of glucocorticoids and mineralocorticoids is necessary because inadequate supplies or a sudden cessation of the medications can cause acute adrenal crisis.

A nurse is providing teaching to the parent of an infant who has GERD. Which of the following indicates understanding of the teaching? A. " I will keep my baby in an upright position after feedings" b. "My baby formula can be thickened with oatmeal" c. "I will have to feed my baby formula rather than breast milk" D. I should position my baby side-lying during sleep"

A. baby should be upright for 1 hr after feeding

The nurse is preparing to admit a 6-month-old infant with increased intracranial pressure (ICP). What clinical manifestations should the nurse expect to observe in this infant? (Select all that apply.) a. High-pitched cry b. Poor feeding c. Setting-sun sign d. Sunken fontanel e. Distended scalp veins f. Decreased head circumference

ANS: A, B, C, E Clinical manifestations of increased ICP in an infant include a high-pitched cry, poor feeding, setting-sun sign, and distended scalp veins. The infant would have a tense, bulging fontanel and an increased head circumference.

The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death? a. Papilledema b. Delirium c. Doll's head maneuver d. Periodic and irregular breathing

ANS: D Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Papilledema is edema and inflammation of optic nerve. It is commonly a sign of increased intracranial pressure Delirium is a state of mental confusion and excitement marked by disorientation for time and place. The doll's head maneuver is a test for brainstem or oculomotor nerve dysfunction.

Nurse is admitting an INFANT with severe dehydration from acute gastroenteritis, which of the following finding should the nurse expect? A. bulging anterior fontanel B. bradypnea C. 3% weight loss D. cap refill 3 seconds

C. 3% weight loss

A nurse is admitting a 6-month-old infant who has dehydration. Which of the following amounts of urinary output should indicate to the nurse that the treatment has corrected the fluid imbalance? A. 0.5 mL/kg/hr B. 2 mL/kg/hr C. 7.5 mL/kg/hr D. 15 mL/kg/hr

B. 2 mL/kg/hr The expected urinary output for infants up to the age of 1 year is 2 mL/kg/hr. An infant who is not dehydrated should produce this amount of urine.

A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. This is most likely an: A. Myoclonic seizure B. Absence seizure C. Non-epileptic seizure D. Partial seizure

B. Absence seizure

A nurse is planning care for a 10-month-old infant who is 8 hr postoperative following cleft palate repair. Which of the following interventions should the nurse include in the infant's plan of care? A. Feed the infant with a spoon for 48 hr. B. Apply and release elbow restraints every hour. C. Keep the infant supine. D. Suction the mouth with an oral suction tube.

B. Apply and release elbow restraints every hour. It is essential to apply elbow restraints after surgery to keep the infant from placing her hands in and around her mouth. The nurse should remove them periodically to inspect the skin and allow the infant to exercise her arms.

A nurse is providing teaching to an adolescent who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? A. Administer glucagon for hyperglycemia. B. Obtain an influenza vaccine annually. C. Inject insulin into the deltoid muscle. D. Take glyburide with breakfast.

B. Obtain an influenza vaccine annually. The client should obtain an influenza vaccine annually.

A nurse is caring for a toddler who is 24 hour postoperative following a cleft palate repair. Which of the following actions should the nurse take? A. Offer fluids through a straw. B. Apply bilateral wrist restraints. C. Administer opioids for pain. D. Implement a soft diet.

C. Administer opioids for pain. Administering opioids for pain is an appropriate action by the nurse. Opioids control pain in the immediate postoperative period are followed by administration of acetaminophen PRN.

An infant with short-bowel syndrome will be discharged home on TPN and G-Tube feedings. Nursing care should include which of the following? A. Prepare family for impending death. B. Teach family how to calculate caloric needs. C. Ensure that family can identify signs of central venous catheter infections. D. Secure TPN and gastrostomy tubing under diaper to lessen risk of dislodgement.

C. Ensure that family can identify signs of central venous catheter infections. During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device such as infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis of SBS depends in part on the length of residual small intestine. It has improved with advances in TPN. Nutritional needs are very important to be taught, but this is the job of a nutritionist. Wong's Nursing Care of Infants and Children (2007), 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Hockenberry Wilson (8th ed.).

A nurse is caring for a 6-week-old infant who has a pyloric stenosis. Which of the following clinical manifestations should the nurse expect? A. Red currant jelly stools B. Distended neck veins C. Projectile vomiting D. Ridged abdomen

C. Projectile vomiting Pyloric stenosis is a narrowing of the pylorus, the outlet from the stomach to the small intestine. The narrowing does not allow for emptying of the stomach contents. Vomiting, which is usually mild at first, becomes more forceful and progresses to projectile vomiting.

A nurse is orienting a newly licensed nurse in the care of an infant who has myelomeningocele. Which of the following actions by the new nurse indicates the teaching has been effective? A. Perform ROM on the infant's hip B. Maintains a dry dressing over the sac C. Takes an axillary temperature D. Places the infection in a side-lying position

C. Takes an axillary temperature

A nurse is caring for a child who is post operative following ventriculoperitoneal (VP) shunt placement. In which of the following positions should the nurse place the client? A) Trendelenburg B) Semi Fowler's C) Prone D) On the unoperated side

D) On the unoperated side (The nurse should position the child flat on the on operated side to prevent a rapid reduction of intracranial fluid and to protect the child from injuring the operative site)

A nurse is assessing an adolescent who has an exacerbation of Graves' disease. Which of the following findings should the nurse expect? A. Weight gain B. Bradycardia C. Lethargy D. Heat intolerance

D. Heat intolerance An exacerbation of Graves' disease can cause heat intolerance due to an increased metabolic rate, which leads to warm flushed moist skin and extreme diaphoresis.

A nurse is planning care for a 5-month-old infant who is scheduled for a lumbar puncture to rule out meningitis. Which of the following actions should the nurse include in the plan of care? A. Keep the infant NPO for 6 hr prior the procedure. B. Apply a eutectic mixture of lidocaine and prilocaine cream topically 15 min prior to the procedure. C. Place the infant in an infant seat for 2 hr following the procedure. D. Hold the infant's chin to his chest and knees to his abdomen during the procedure.

D. Hold the infant's chin to his chest and knees to his abdomen during the procedure. Rationale: This position opens up the subarachnoid space.

A nurse is caring for a child who has acute gastroenteritis but is able to tolerate oral fluids. The nurse should anticipate providing which of the following types of fluid? A. Broth B. Water C. Diluted apple juice D. Oral rehydration solution

D. Oral rehydration solution Oral rehydration solution is the fluid of choice for infants and children who have dehydration due to diarrhea.

A nurse is caring for an infant who has inadequate motility of part of an intestine resulting in a mechanical obstruction. The nurse should identify this finding as a manisfestation of which of the following disorders?

Hirschsprung's Disease

A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be: 1. Educate the family on ways to prevent bacterial meningitis. 2. Initiate appropriate isolation precautions and begin intravenous antibiotics. 3. Assess the infant's fontanels. 4. Encourage the mother to hold the infant and feed her.

Initiate appropriate isolation precautions and begin intravenous antibiotics.

A nurse is caring for a male infant who has a palpable mass in the upper right quadrant and stools mixed and mucus. The nurse should recognize that which of the following diagnoses is associated with these findings?

Intussusception

aA home health nurse is developing a plan of care for a child who has hemiplegic cerebral palsy. Which of the following goals is the priority for the nurse to include in the plan of care? A) provide respite services for the parents B) improve the client's communication skills C) foster self-care activities D) modify the environment

Modify the environment

A nurse is providing teaching about self-administration of insulin to the parent of a school-age child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parents indicates a need for further teaching a. "I will be sure my child aspirates before injecting insulin" b. "the insulin can be injected anywhere where there is adipose tissue" c. "I will be sure by child rotates sites after 5 injections in one area" d. "the insulin should be injected at a 90 degree angle"

a. "I will be sure my child aspirates before injecting insulin"

A nurse is providing discharge teaching to the parents of a child who has a new diagnosis of diabetes. Which of the following statements by the parents indicates and understanding of the teaching? a. "the onset of low blood glucose usually occurs slowly" b. "my son may complain of feeling shaky when he has low blood glucose" c. "sweating can occur with hyperglycemia" d. "my son might have nausea and vomiting with hypoglycemia"

b. "my son may complain of feeling shaky when he has low blood glucose"

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? a. Therapy is most successful if it is started during adolescence. b. Replacement therapy requires daily subcutaneous injections. c. Hormonal supplementation will be required throughout child's lifetime. d. Treatment is considered successful if children attain full stature by adolescence.

b. Replacement therapy requires daily subcutaneous injections.

The nurse prepares to administer Baclofen into a child with CP who just had her hamstring surgically released the child's parents ask with the medication is for select the nurses best response a. It is a medication that will help decrease the pain from her surgery b. it is a medication that will prevent her from having seizures c. it is a medication that will help control her spasms d. it is a medication that will help with bladder control

c. it is a medication that will help control her spasms

A nurse is developing a health program for the parents of school-age boys. Which of the following information about pubescent changes should the nurse include in the program? a) Changes in the voice signal the beginning of puberty. b) Gynecomastia commonly occurs during late puberty. c) Puberty might be delayed if scrotal changes have not occurred by the age of 11 years. d) Growth spurts in height occur toward the end of midpuberty.

d) Growth spurts in height occur toward the end of midpuberty. (Enlargement of the testicles signals the beginning of puberty; Gynecomastia typically occurs during midpuberty; Puberty changes might be delayed if scrotal changes have not occurred by 13½ to 14 years of age)

A nurse is orienting a newly licensed nurse on the care of pediatric patients with myelomeningocele. They are assigned a 1-day old female who was prenatally diagnosed with myelomeningocele. The patient is currently NPO while awaiting surgery. The mother had complications during delivery and remains in the post-partum unit. Which of the following actions by the new nurse indicates that the training has been effective? a. Maintains a dry dressing over the sac. b. Performs range of motion on the infant's hips. c. Places the infant in a side-lying position. d. Takes an axillary temperature.

d. Takes an axillary temperature