Peds Exam

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? Forming superficial relationships Depression and sadness Inactivity Exhibit loud crying

Exhibit loud crying

A 12-year-old child is admitted for an emergency appendectomy and rushed into surgery. The parents tell the nurse that they also have a 4-year-old son at home and wonder if they should tell him about his older brother being in the hospital. The best response by the nurse to this query would be to? Have the parents go home and bring their 4-year-old back to the hospital so he can be present throughout this family stress experience. Have the parents bring their son in during visiting hours and arrange for a tour of the hospital unit. Tell the parents to refrain from telling the 4-year-old as he will not be able to understand the concepts of hospitalization and surgery. It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age.

It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age.

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? Hypoactivity of the autonomic nervous system Atrophic changes in the mucosal wall of the intestines Hyperactivity of the apocrine glands Mechanical obstruction caused by increased viscosity of exocrine gland secretions

Mechanical obstruction caused by increased viscosity of exocrine gland secretions

A nurse is preparing to administer a gavage feeding to an infant. Which type of restraining method would be indicated? Car seat restraint Mummy restraint Jacket restraint Arm restraints

Mummy restraint

What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? Thermal instability Wheezing Barrel chest Nasal flaring and retractions

Nasal flaring and retractions

The nurse needs to take the blood pressure of a preschooler for the first time. What action would be best for gaining the child's cooperation? Take the blood pressure when a parent is there to comfort the child. Tell the child that this procedure will help the child to get well faster. Permit the child to handle equipment and see the dial move before putting the cuff in place. Explain to the child how blood flows through the arm and why taking the blood pressure is important.

Permit the child to handle equipment and see the dial move before putting the cuff in place.

A child has a long standing history of abuse which has triggered many emotional problems. Which type of therapy would be indicated to possibly help the child explore these emotional problems? Creative expression Play therapy Therapeutic play Dramatic play

Play therapy

A child is standing playing with toys and suddenly collapses. Attempts to engage the child in conversation are met with no response. Skin color indicates cyanosis. A preliminary assessment of the environment presents no specific issues. Based on this information, you would suspect that the child is? Potential aspiration of foreign body Experiencing seizure activity Potential allergic reaction Traumatic injury

Potential aspiration of foreign body

The nurse is doing preoperative teaching with a child and the parents. The parents say the child "is dreading the shot for before surgery." On which of the following facts should the nurse's response be based? Preanesthetic medication should be "atraumatic," using oral, existing IV, or rectal routes. In children, the intramuscular (IM) route is safer than the intravenous (IV) route. The child will have no memory of the injection because of amnesia. Preanesthetic medication can only be given intramuscularly.

Preanesthetic medication should be "atraumatic," using oral, existing IV, or rectal routes.

A nurse has been assigned as the home health nurse for a technologically dependent child. The nurse recognizes that the background of this family differs widely from the nurse's own. The nurse views some of their lifestyle choices as less than ideal. What is the most appropriate nursing intervention? Respect the differences. Assign the nurse a different family to follow. Determine whether the family is dysfunctional. Assess why the family is different.

Respect the differences.

The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect? Child abuse Suffocation Infantile apnea Sudden infant death syndrome (SIDS)

Sudden infant death syndrome (SIDS)

In order to determine if a child's "toy" does not present a choking hazard while in the hospital, which type of process would the nurse utilize? Use a toilet paper roll to indicate whether the toy will pass the choke test. Drop the toy on the floor to see if any parts break off. Have the parents bring a "new" toy that is just bought from the store as that is the best indicator that there will be no loose parts. Have the child agree to not place the toy in his/her mouth while in the hospital.

Use a toilet paper roll to indicate whether the toy will pass the choke test.

A ventilator-dependent child is being discharged home from the hospital. Prior to discharge, the home health care nurse discusses the development of an emergency plan with the family. The most essential component of the plan is: notifying the power company that the child is on life support designation of an emergency shelter. acquisition of a backup generator. notifying emergency medical services that child is on life support.

acquisition of a backup generator.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent: nephrotic syndrome. acute rheumatic fever. diabetes insipidus. otitis media.

acute rheumatic fever.

A home health nurse is caring for a 2-week-old infant and notes on assessment that the infant has a string tied around the wrist. The nurse checks for adequate circulation. The most appropriate nursing intervention by the nurse is to: remove the string and inform the parents that the string is dangerous. report the parents to Social Services for child endangerment. ask the parents the meaning of the string and leave the string in place. ask the parents to remove the string.

ask the parents the meaning of the string and leave the string in place.

One of the goals for children with asthma is to prevent respiratory tract infection because infections: encourage exercise-induced asthma. lessen effectiveness of medications. can trigger an episode or aggravate asthmatic state. increase sensitivity to allergens.

can trigger an episode or aggravate asthmatic state.

A 4-year-old child is scheduled for cardiac surgery in a week. The child's parents call the hospital to ask how to prepare the child for the upcoming hospitalization and surgical procedure. The nurse's reply should be based on the knowledge that: children who are prepared experience less fear and stress during hospitalization. children who are prepared experience overwhelming fear by the time hospitalization occurs. preparation at this age will only increase the child's stress. preparation needs to be at least 2 to 3 weeks before hospitalization to be effective.

children who are prepared experience less fear and stress during hospitalization.

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress the: importance of relaxing discipline and limit-setting to prevent crying. importance of reducing caloric intake to decrease cardiac demands. desirability of promoting normalcy within the limits of the child's condition. need to be extremely concerned about cyanotic spells.

desirability of promoting normalcy within the limits of the child's condition.

A 10-year-old child requires daily medications for a chronic illness. The mother tells the nurse that she is always nagging the child to take the medicine before school. The most appropriate nursing intervention to promote the child's compliance is to: ask the child to bring her medicine containers to each appointment so that the pills can be counted. discuss with the child's mother the damaging effects of nagging. suggest time-outs when the child forgets her medicine. establish a contract with the child, including rewards.

establish a contract with the child, including rewards.

In helping a child to adapt to a hospitalization experience, the best approach would be to: let the parents bring in food from home that the child is used to eating for all meals. establish a daily routine and schedule with the child and parent to help maintain consistency. allow the child to select his room on the unit. allow the child to bring in all of his favorite toys to the hospital so as to represent a more familiar environment.

establish a daily routine and schedule with the child and parent to help maintain consistency.

The nurse working in an outpatient surgery center for children should understand that: families need to be prepared for what to expect after discharge. waiting is not stressful for parents in such a center. children's anxiety is minimal in such a center. accurate and complete discharge teaching is the responsibility of the surgeon.

families need to be prepared for what to expect after discharge.

Standard precautions for infection control include: needles are capped immediately after use and disposed of in a special container. gloves are worn anytime a patient is touched. gloves are worn to change diapers when there are loose or explosive stools. masks are needed only when caring for patients with airborne infections.

gloves are worn to change diapers when there are loose or explosive stools.

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to: have someone call for an ambulance and paramedic rescue squad or 9-1-1. move the child to the nurse's office or hallway. administer diphenhydramine (Benadryl) PO stat. determine what the child has eaten.

have someone call for an ambulance and paramedic rescue squad or 9-1-1.

The nurse observes erythema, pain, and edema at a child's intravenous (IV) infusion site with streaking along the vein. The nurse's priority action is to: check for a good blood return. immediately stop the infusion. ask another nurse to check the IV site. increase IV drip with normal saline for 1 minute and recheck.

immediately stop the infusion.

Several types of long-term central venous access devices are used in practice. The benefit of using a long-term central venous access device such as a Port-a-Cath is that implanted devices cannot dislodge, even if child "plays" with the port site. implanted devices do not require piercing the skin for access. implanted devices are easy to use for self-administered infusions. implanted devices do not require limiting regular physical activity, including swimming.

implanted devices do not require limiting regular physical activity, including swimming.

Several types of long-term central venous access devices are used in practice. The benefit of using a long-term central venous access device such as a Port-a-Cath is that: implanted devices cannot dislodge, even if child "plays" with the port site. implanted devices do not require piercing the skin for access. implanted devices are easy to use for self-administered infusions. implanted devices do not require limiting regular physical activity, including swimming.

implanted devices do not require limiting regular physical activity, including swimming.

A physiologic benefit of fever in a child is that it: increases interferon production. prevents spread of infection due to decrease in release of chemical mediators. indicative of the infectious process being viral in origin. correlates with overall prognosis of medical event.

increases interferon production.

The best explanation for using pulse oximetry on young children is that it: is noninvasive. is more accurate than arterial blood gas measurements.Pulse oximetry is a noninvasive method for determining oxygen saturation. Capnography measures carbon dioxide exhalation. It does not reflect oxygen perfusion. Pulse oximetry is less invasive and easier to test than arterial blood gases. Pulse oximetry provides continuous or intermittent measurements of oxygen saturation. is better than capnography.Pulse oximetry is a noninvasive method for determining oxygen saturation. Capnography measures carbon dioxide exhalation. It does not reflect oxygen perfusion. Pulse oximetry is less invasive and easier to test than arterial blood gases. Pulse oximetry provides continuous or intermittent measurements of oxygen saturation. INCORRECT provides intermittent measurements of oxygen.Pulse oximetry is a noninvasive method for determin

is noninvasive.

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after gastrostomy feedings, there is often a backup of feeding into the tube. The most appropriate intervention by the nurse is to: leave the gastrostomy tube open and suspended after feedings. position the child in a supine position after feedings. leave the gastrostomy tube clamped after feedings. position the child on the left side after feedings.

leave the gastrostomy tube open and suspended after feedings.

A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to: auscultate the child's lungs and make preparations for placement in a mist tent. examine the child's oropharynx and report the assessment to the health care provider. notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation. make the child lie down and rest quietly.

notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation.

The nurse is preparing a plan to teach a mother how to administer 1 and 1/2 teaspoons of medicine to her 6-month-old child. Based on the nurse's knowledge of administering pediatric medications, the nurse teaches the parent to use a: regular silverware teaspoon. household measuring spoon. paper cup measure in 5-ml increments. plastic syringe (without needle) calibrated in milliliters.

plastic syringe (without needle) calibrated in milliliters.

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of: pneumothorax. carbon dioxide retention. increased viscosity of sputum. bronchodilation.

pneumothorax.

An immediate intervention to teach parents for when an infant chokes on a piece of food would be to: have infant lie quietly while a call is placed for emergency help. administer mouth-to-mouth resuscitation. position infant in a head-down, face-down position and administer five quick back slaps. give some water by a cup to relieve the obstruction.

position infant in a head-down, face-down position and administer five quick back slaps.

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to: make isolation of the infant with RSV unnecessary. prevent secondary bacterial infection. decrease toxicity of antiviral agents. prevent respiratory syncytial virus (RSV) infection.

prevent respiratory syncytial virus (RSV) infection.

A 2 1/2-year-old ventilator-dependent child will be discharged home soon. The family expresses concern that their child might change the ventilator settings by exploring the control knobs and buttons. Based on the nurse's knowledge of child development, the most appropriate intervention by the nurse is to: INCORRECT explain that the child cannot be left alone because of the risk of the child changing the settings. reassure the family that developmentally the child is unable to change the ventilator settings. recommend ways to cover the controls to reduce the risk of the child changing the settings. teach the child not to touch controls.

recommend ways to cover the controls to reduce the risk of the child changing the settings

A child, age 7 years, is being treated at home and has a fever associated with a viral illness. The principal reason for treating the child's fever is: prevention of secondary bacterial infection. relief of discomfort. prevention of life-threatening complications. reassurance that illness is temporary.

relief of discomfort.

Treatment methods used for status asthmaticus focus on: supportive oxygen therapy to maintain saturation at 90%. resolving acid-base disturbances that have led to alkalosis. restoring hydration. decreasing airway compliance.

restoring hydration.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it: improves oxygenation. promotes ventilation. soothes inflamed mucous membrane. liquefies secretions.

soothes inflamed mucous membrane.

Prior to accepting an assignment as a home health nurse, the nurse must realize that: the family will adapt their lifestyle to the needs of the nurse. the family is in charge. all decisions are made by the health care provider. independent decisions regarding emergency care of the child are made by the nurse.

the family is in charge.

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37° C (98.6° F). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend: trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement. controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.

trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.

The most appropriate nursing intervention for a child following a tonsillectomy is to: encourage gargling to reduce discomfort. apply warm compresses to the throat. watch for continuous swallowing. position the child on the back for sleeping.

watch for continuous swallowing.

Which hospitalized children should have their intake and output (I&O) recorded as part of the plan of care? (Select all that apply.) 14-year-old postoperative for laparoscopic appendectomy with IV access but not receiving any fluids at this time 3-year-old receiving parenteral therapy along with antibiotics 8-year-old admitted with dehydration 14-year-old admitted for observation of concussion as a result of motor vehicle accident 16-year-old admitted for treatment of diabetes mellitus

14-year-old postoperative for laparoscopic appendectomy with IV access but not receiving any fluids at this time 3-year-old receiving parenteral therapy along with antibiotics 8-year-old admitted with dehydration 14-year-old admitted for observation of concussion as a result of motor vehicle accident 16-year-old admitted for treatment of diabetes mellitus

A 4-year-old boy needs to use a metered-dose inhaler (MDI) of an inhaled cortocosteroid to treat his asthma. What should the nurse anticipate as being required to correctly adminster this type of medication? An incentive spirometry A trial of chest physiotherapy A spacer A peak expiratory flow meter

A spacer

Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary? A, E, K A, D, E, K C, folic acid C, D

A, D, E, K

A toddler is hospitalized for an upcoming surgical procedure. Which method might provide the best way to inform the child about the surgery? Having the child sign his name with an "X" on an actual surgical consent form.The concept of dramatic play is used to provide information to children who are having complex health issues or who have to undergo surgical procedures or therapies. Taking the child to the operating theater to view a surgery. Allowing the child to dress up using surgical gown and mask. By using anatomical drawings as illustrations and allowing the child to color them with markers.

Allowing the child to dress up using surgical gown and mask.

A parent with a toddler who has a respiratory infection wants to use the traditional method of topical vapor rub. Which statement by the parent indicates that additional teaching is needed with regard to administration of this treatment? Application of the medication will be given orally to avoid potential sneezing. The parent will inform the pediatrician that the medication is being used. The parent states that he will wash his hands before applying the medication. The parent will read the product label before administering the medication.

Application of the medication will be given orally to avoid potential sneezing.

A child with a serious chronic illness will soon be discharged home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. Based on the principles of family-centered care, which statement addresses this principle? Inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily. Inappropriate because of legal issues when parents care for their children on hospital property. Appropriate because families are usually eager to get involved Appropriate because it can be beneficial to the transition from hospital to home.

Appropriate because it can be beneficial to the transition from hospital to home.

Working with parents in preparation for discharge of a hospitalized child who will need to have wet to dry dressing changes performed at home will require that the nurse include which element in the plan of care? Provide the parents with a detailed instruction sheet regarding the dressing change procedure as the method of instruction. Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding. Arrange for home health nurse to change dressings as the parents may not understand the complexity of the task. Arrange for follow up with the child's pediatrician prior to the next scheduled dressing change so that the parents can receive further instruction.

Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding.

A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)? Identifies the "triggers" of asthma Assesses the severity of asthma Confirms the diagnosis of asthma Determines the cause of asthma

Assesses the severity of asthma

Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include? Advice that the infant not be left with caretakers other than the parents Foreign airway obstruction removal using the Heimlich maneuver Cardiopulmonary resuscitation (CPR) Administration of intravenous (IV) fluids

Cardiopulmonary resuscitation (CPR)

With regard to separation anxiety displayed in a child who is hospitalized, which behavior would indicates the stage of despair? Child clings to parents for comfort. Child tells nurses and staff to "go away."Demonstrating regressive behavior is a characteristic of the stage of despair. Child is constantly crying and sobbing.Demonstrating regressive behavior is a characteristic of the stage of despair. Child no longer cries.

Child no longer cries.