peds final exam

A 3-year-old child is scheduled for surgery to remove a Wilms tumor from one kidney. The parents ask the nurse what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation is based on which knowledge?1Chemotherapy is usually not necessary.2No additional treatments are usually necessary.3Kidney transplant will be indicated within the year.4Chemotherapy with or without radiotherapy is indicated.

4The choice of chemotherapy, radiotherapy, or both as treatment modalities will be based on the histologic pattern of the tumor. Chemotherapy with or without radiotherapy is usually indicated. Additional therapy of some type is indicated after the tumor is removed. Chemotherapy or radiotherapy, or both, may be indicated as a postsurgical intervention. Most children with Wilms tumor do not require renal transplant.

Neurofibromatosis

-genetic -disorder that affects the development and growth of neural cells -neurofibromatosis 1 (von Recklinghausen) -causes tumors to grow on nerves -produces skin changes and bone deformities - can be inherited but half are from genetic mutation -inheritance pattern is autosomal dominant (affected individuals have a 50% chance of passing to offspring and presenting with symptoms) -complications: --headaches; hydrochephalus; scoliosis; cardiac defects; hypertension; seizures; vision and hearing loss; autism spectrum disorder; behaviorial and psychosocial issues; abnormalities of speech; higher risk for neoplasms -no cure -treatment - control symptoms, manage complications -surgical interventions

Which are the clinical manifestations of Wilms tumor? Select all that apply. 1 Fever 2 Fatigue 3 Hematuria 4 Weight gain 5 Abdominal swelling or mass

1,2,3,5Clinical manifestations of Wilms tumor include abdominal swelling or a mass, hematuria, fatigue, and fever. Weight loss, rather than weight gain, is a clinical manifestation of Wilms tumor.

How is Ewing sarcoma different from osteosarcoma?1Psychological trauma is less in Ewing sarcoma.2Ewing sarcoma involves the metaphyseal region of bones.3A "sunburst" appearance is seen on x-ray images of Ewing sarcoma.4Surgery and chemotherapy are the treatment of choice for Ewing sarcoma.

1Psychological trauma is less in Ewing sarcoma than osteosarcoma. Many families accept the diagnosis with a sense of relief, because it does not necessitate amputation. Ewing sarcoma mostly involves the diaphysis of bones whereas osteosarcoma involves the metaphyseal region. A "sunburst" appearance is a characteristic feature of osteosarcoma and is not seen in Ewing sarcoma. Optimum treatment of osteosarcoma includes surgery and chemotherapy whereas most cases of Ewing sarcoma require involved field radiotherapy and chemotherapy.

Which is the main difference between neuroblastoma and Wilms tumor?1Wilms tumor is confined to one side of the abdomen.2Neuroblastoma is devoid of any kind of urinary symptoms.3Neuroblastoma causes a painless swelling in the abdomen.4Wilms tumor is often diagnosed in children less than 5 years of age.

1Wilms tumor is usually confined to one side of the abdomen whereas neuroblastoma crosses the midline of the abdomen. Urinary symptoms are seen in both types of tumors. The swelling or abdominal mass is painless in both neuroblastoma and Wilms tumor. Both conditions are often diagnosed in children less than 5 years of age. Neuroblastoma is a more common malignancy in the first year of life whereas Wilms tumor is more common between 2 and 3 years of age.

Fever, low blood counts, lymph node enlargement, and enlarged liver and spleen are diagnostic criteria for what illness?1Hepatitis2Leukemia3Wilms tumor4Cystic fibrosis

2Fever, low blood counts, lymph node enlargement, and enlarged liver and spleen are diagnostic criteria for leukemia, not hepatitis, Wilms tumor, or cystic fibrosis.

Which is the most common soft-tissue sarcoma in children? 1 Osteosarcoma 2 Ewing sarcoma 3 Rhabdomyosarcoma 4 Skeletal tuberculosis

3Rhabdomyosarcoma is the most common soft-tissue sarcoma in children. Osteosarcoma is the most common bone cancer in children. Ewing sarcoma is the second most common malignant bone tumor. Skeletal tuberculosis is an infection of the bones and joints

Which factor determines the initial treatment of a neuroblastoma?1Child's mental health2Presence of an infection3Accurate clinical staging4Type of health insurance

3The initial treatment of a neuroblastoma is determined with accurate clinical staging. Surgery is used both to remove as much of the tumor as possible and to obtain biopsies. Treatment will depend on the clinical stage of the cancer. The child's mental health, presence of an infection, or type of health insurance is not associated with the treatment of a neuroblastoma.

Which is the most common congenital malignant intraocular tumor of childhood? 1 Leukokoria 2 Glioblastoma 3 Retinoblastoma 4 Nephroblastoma

3The most common congenital malignant intraocular tumor of childhood is a retinoblastoma. Glioblastoma is a type of brain cancer; nephroblastoma is a type of cancer that occurs in the kidneys. Leukokoria is a white reflex that suggests retinoblastoma.

What is the similarity between acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML)?1High number of leukocyte cells2Incidence more frequent in boys than in girls3Formation of tumor in the blood-forming tissues4Unrestricted proliferation of immature white blood cells

4Acute leukemia is an unrestricted proliferation of immature white blood cells in the blood-forming tissues in the body. This is the cause of both acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML). In leukemia, there is an overproduction of white blood cells, but most often the leukocyte count is low. ALL is more common in boys than in girls. However, the incidence of AML is similar for both boys and girls. The leukemic cells of both AML and ALL do not form a tumor as such, but they have neoplastic properties of solid cancers.

How is childhood non-Hodgkin lymphoma (NHL) different from Hodgkin lymphoma?1In NHL, there is a presence of Reed-Sternberg cells.2In NHL, the B-cells are more abundant than T-cells.3NHL is usually a nodular rather than diffuse lymphoma.4NHL disseminates earlier, more often, and more rapidly.

4In NHL, the dissemination occurs more often and more rapidly than with Hodgkin disease. The presence of Reed-Sternberg cells is the characteristic feature of Hodgkin lymphoma, not NHL. Both B- and T-cells are evenly present in NHL. NHL is usually diffuse while Hodgkin lymphoma is mostly nodular, with painless enlargement of lymph nodes.

How is the clinical manifestation of infratentorial brain tumors different from that of supratentorial brain tumors?1Visual disturbances2Emesis after feeding3Development of diabetes insipidus4Headache, especially on awakening

4In cases of infratentorial tumors, it is common to have headaches, especially on awakening. Supratentorial tumors most commonly involve visual disturbances. In infratentorial tumors, there are occurrences of vomiting, but it is not related to feeding. Supratentorial tumors involve structures of the midbrain, such as the hypothalamus and pituitary gland tumors, and may cause endocrinopathies such as diabetes insipidus. Diabetes insipidus is not a common manifestation in infratentorial tumors.

The postoperative care of a preschool child who has had a brain tumor removed should include which action?1No administration of analgesics2Recording of colorless drainage as normal on the nurses' notes3Placement of the child on the right side in the Trendelenburg position4Close supervision of the child while the child is regaining consciousness

4The child must be observed closely, with careful and frequent assessment of the vital signs and monitoring for signs of increasing intracranial pressure. Any changes should be reported immediately to the practitioner. Colorless drainage may represent cerebrospinal fluid leaking from the incision site. This needs to be reported to the practitioner immediately. The child should not be positioned in the Trendelenburg position after surgery. Analgesics may be used for postoperative pain as needed.

A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). What nursing consideration should be included? a. Monitor heart rate. b. Administer NSAIDs between meals. c. Check for abdominal pain and bloody stools. d. Expect inflammation to be gone in 3 or 4 days.

ANS: C NSAIDs are the first-line drugs used in JIA. Potential side effects include gastrointestinal (GI), renal, and hepatic side effects. The child is at risk for GI bleeding and elevated blood pressure. The heart rate is not affected by this drug class. NSAIDs should be given with meals to minimize gastrointestinal problems. The antiinflammatory response usually takes 3 weeks before effectiveness can be evaluated.

A nurse is teaching the parents of an infant with congenital adrenal hyperplasia about the signs and symptoms of adrenal crisis. The nurse determines that the teaching was successful when the parents identify which of the following? Select one: A. Persistent vomiting B. Fluid overload C. Constipation D. Bradycardia

A. Persistent vomiting Rationale: Signs and symptoms of acute adrenal crisis include persistent vomiting, dehydration, hyponatremia, hyperkalemia, hypotension, tachycardia, and shock.

A nurse is providing an in-service program on child abuse for a group of newly hired nurses. When evaluating the effectiveness of the teaching, the nurse determines a need for additional review when the group identifies which of the following as an indicator of possible child abuse?Select one:A. Sexual behavior that correlates with the child's developmental ageB. Frequent changes in history information with visitsC. Injuries that are inconsistent with the reported traumatic eventD. Consistent delays in seeking treatment for the child's injuries

A. Sexual behavior that correlates with the child's developmental age Rationale: Sexual behavior that correlates with the child's developmental age would be appropriate and not an indicator of child abuse. A delay in seeking medical treatment, a history that changes over time, or a history of trauma that is inconsistent with the observed injury all suggest child abuse.

A patient is diagnosed with Sickle cell anemia the nurse reconizes that the best way to avoid a crisis is to educate the parents on prevention .What would the nurse include in her teaching? Select all that apply A. Stay hydrated B. Increase oxygen demand with exercise C. Encourage immunizations D. Hypothermia

A. Stay hydrated C. Encourage immunizations

A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which of the following? Select one: A. Syndrome of inappropriate antidiuretic hormone (SIADH) B. Cushing syndrome C. Thyroid storm D. Vitamin D toxicity

A. Syndrome of inappropriate antidiuretic hormone (SIADH) Rationale: SIADH, although rare in children, is a potential complication of excessive administration of vasopressin. Thyroid storm may result from overadministration of levothyroxine (thyroid hormone replacement). Cushing syndrome is associated with corticosteroid use. Vitamin D toxicity may result from the use of vitamin D as treatment of hypoparathyroidism.

17. As related to inherited disorders, which statement is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

ANS: C The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency (hemophilia A or classic hemophilia), and factor IX deficiency (hemophilia B or Christmas disease). The disorder involves coagulation factors, not platelets. The disorder does not involve red cells or the Y chromosome.

. The parents of a child with spastic cerebral palsy (CP) state that their child seems to have significant pain. In addition to systemic pharmacologic management, the nurse includes which teaching? a. Patterning b. Positions to reduce spasticity c. Stretching exercises after meals d. Topical analgesics for muscle spasms

ANS: B Parents and children are taught positions to assume while sitting and recumbent that reduce spasticity. The American Academy of Pediatrics has stated that patterning should not be used for neurologically disabled children. Patterning attempts to alter abnormal tone and posture and elicit desired movements through positional manipulation or other means of modifying or augmenting sensory output. Stretching should be done after appropriate analgesic medication has been given and is effective. Topical analgesia is not effective for the muscle spasms of spastic CP.

What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)? a. Apply ice packs to relieve acute swelling and pain. b. Administer acetaminophen to reduce inflammation. c. Teach the child and family correct administration of medications. d. Encourage range of motion exercises during periods of inflammation.

ANS: C The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.

1. What findings should the nurse expect to observe in a 7-month-old infant with Werdnig-Hoffman disease? (Select all that apply.) a. Noticeable scoliosis b. Absent deep tendon reflexes c. Abnormal tongue movements d. Failure to thrive e. Prominent pectus excavatum f. Significant leg involvement

ANS: B, C, D Clinical manifestations of Werdnig-Hoffman disease in an infant include absent deep tendon reflexes, abnormal tongue movements, and failure to thrive. Scoliosis, prominent pectus excavatum, and significant leg involvement are findings observed in a child with intermediate spinal muscular atrophy.

A 24-hour urine collection for vanillylmandelic acid (VMA) has been ordered on a child suspected of having neuroblastoma. When is the most appropriate time for the nurse to begin the collection?1. At 07002. After the next time the child voids3. At bedtime4. When the order is noted

Answer: 2Explanation: 1. A 24-hour urine collection is started after the child voids. That specimen is not saved, but all subsequent specimens in that 24-hour period should be collected. It would not be an accurate collection of 24 hours of urine if the collection began at 0700, bedtime, or when the order is noted.

. The nurse is caring for a 14-month-old boy with rickets who was recently adopted from overseas. His condition was likely a result of a diet very low in milk products. The nurse is providing teaching regarding treatment. Which response by the parents indicates a need for further teaching? A. "We must give him calcium and phosphorus with food every morning." B. "He must take vitamin D as prescribed and spend some time in the sunlight." C. "He must take calcium at breakfast and phosphorus at bedtime." D. "We should encourage him to have fish, dairy, and liver if he will eat it."

Answer: A Rationale: The nurse should emphasize that the calcium and phosphorus supplements should be administered at alternate times to promote proper absorption of both of these supplements. Taking vitamin D, spending time in the sun, and encouraging intake of fish, dairy, and liver are appropriate responses

A nurse is assessing a 6 month old infant at a well-child visit. Which of the following findings should the nurse expect? A. Uses thumb and index fingers in a pincer grasp B. Closed posterior fontanel C. Lateral incisors D. sitting steadily without support

B. Closed posterior fontanel

A nurse is providing teaching to a school age child who has a new diagnosis of type 1 diabetes mellitus. Which of the following statments by the child indicates an understanding of the teaching? A. "My morning blood glucose should be between 90 and 130." B. "I should not take my regular insulin when I am sick" C. "I should eat a snack half an hour before playing soccer." D. "I can store unopened bottles of insulin in the freezer."

C. "I should eat a snack half an hour before playing soccer."

A nurse is planning care for a 6 year old child who has bacterial meningitis. Which of the following nursing interventions is unnecessary in the client's plan of care? A. implement seizure precautions B. admit client to a private room C. Measure head circumference every shift D. Place the client in a semi-fowlers position

C. Measure head circumference every shift

A nurse creates a care plan for a client who has a traumatic head injury to determine motor function response. Which of the following client responses to painful stimulus is within normal limits? A. shows no reactions to the painful stimuli B. Extends the body part toward the stimuli C. Pushes the painful stimulus away D. flexes the upper and extends the lower extremities

C. Pushes the painful stimulus away

The nurse has completed parent education related to treatment for a child with congenital clubfoot. The nurse knows that parents need further teaching when they state:Select one:a. "We'll watch for any swelling of the feet while the casts are on."b. "We're happy this is the only cast our baby will need."c. "We'll keep the casts dry."d. "We're getting a special car seat to accommodate the casts."

b. "We're happy this is the only cast our baby will need."

A nurse is caring for a hospitalized 3 month old infant admitted following a motor vehicle accident. The child is being monitored for increased intracranial pressure. The nurse notes that the anterior fontanel bulges when the infant cries. Based on this assessment finding, which action would the nurse take?Select one:a. Lower the head of the bedb. Have the mother provide comfort measures and reassess.c. Place the infant on NPO statusd. Notify the physician immediately

b. Have the mother provide comfort measures and reassess.Rationale: When an infant cries intercranial pressure increases causing the fontanel to bulge. Since crying can occur because of hunger, thirst, pain, the nurse should attempt to decrease the crying by assessing the cause. Notifying the MD first would result in the MD asking the question, "What have you done to decrease the cause of the cry which is increasing the icp?

A child has just returned from spinal fusion surgery. The nurse should check for signs of:Select one:a. Seizure activity.b. Impaired pupillary response during neurological checks.c. Impaired color, sensitivity, and movement to lower extremities.d. Increased intracranial pressure.

c. Impaired color, sensitivity, and movement to lower extremities. Rationale:When the spinal column is manipulated, there is a risk for impaired color and circulation, sensitivity, and movement to lower extremities.

A nurse is assessing an adolescent admitted for a severe ventriculoperitoneal shunt infection. Which of the following assessment findings would the nurse expect to see?Select one or more:a. Bulging fontanel b. Positive Babinski sign c. Vomiting d. Loss of coordination or balance e. Redness along the shunt tract

c. Vomiting Vomiting is a sign of increased intracranial pressure, which is often present with a shunt infection. WBCs collect in the CSF, and clog the shunt, resulting in shunt malfunction as well as infection.d. Loss of coordination or balance Loss of coordination or balance is a sign of increased intracranial pressure, which may be present with a shunt infection. WBCs collect in the CSF, and clog the shunt, resulting in shunt malfunction as well as infection.e. Redness along the shunt tract Redness along the shunt tract is often present with a shunt infection as a result of the body's response to the infectious agent.

the nurse is assessing a 2-day-old newborn and suspects Down syndrome based on which of the following? Select all answers that apply.Select one or more:A. Rigid jointsB. Flat facial profileC. Simian creaseD. Large tongue compared to mouthE. Epicanthal foldsF. Downward slant to the eyes

The correct answer is: Flat facial profile, Large tongue compared to mouth, Simian crease, Epicanthal foldsRationale: Common clinical manifestations of Down syndrome include flat facial profile, upward slant to the eyes (oblique palpebral fissures), tongue that is large in comparison to the mouth size, simian, crease, epicanthal folds, and loose joints.

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. Which of the following would the nurse expect the physician to prescribe? Select all answers that apply.Select one or more:A. IbuprofenB. AcetaminophenC. Intravenous immunoglobulinD. AspirinE. Alprostadil

The correct answer is: Intravenous immunoglobulin, Acetaminophen, Aspirin Rationale: In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever. Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent in infants with ductal-dependent congenital heart defects.

Which of the following are appropriate interventions in the management of severe brain injury?Select one or more:a. Mannitol administrationb. Seizure prevention/treatmentc. Decreasing environmental stimulationd. Invasive ICP monitoringe. Assisting with electromyography

The correct answer is: Mannitol administration, Invasive ICP monitoring, Seizure prevention/treatment, Decreasing environmental stimulation

A nurse is caring for a child who is postoperative following a ventriculoperitoneal (VP) shunt placement. In which of the following positions should the nurse place the client? A. Prone B. semi-fowlers C. on the non operative side D. trendelenburg

C. on the non operative side

a nurse is caring for a client who has a prescription for balanced skeletal traction with a Thomas splint of the treatment of a fractured femur. Which of the following interventions should the nurse implement to prevent pressure points from developing around the edges of the splint? A. Remove the weights for a few minutes each hour B. apply lotion to the skin under the edges of the splint C. reposition the client to keep him from staying in the same position in bed D. apply a foot plate to the bed

C. reposition the client to keep him from staying in the same position in bed

A child is diagnosed with atopic dermatitis. Which laboratory test would the nurse expect the child to undergo to provide additional evidence for this condition?Select one:A. Potassium hydroxide prepB. Erythrocyte sedimentation rateC. Wound cultureD. Serum immunoglobulin E (IgE) level

D. Serum immunoglobulin E (IgE) levelRationale: IgE levels are often used to evaluate for atopic dermatitis. IgE levels are elevated in this condition. Erythrocyte sedimentation rate may be used but this test is nonspecific and only indicates infection or inflammation. Potassium hydroxide prep is used to identify fungal infections. Wound culture would be done to identify a specific organism if an infection occurs with atopic dermatitis.

A nurse is teaching a school age child who has type 1 diabetes mellitus and his parents about illness management. Which of the following actions should the nurse include? A. "Limit fluid intake during meal time" B. Withhold insulin dose if feeling nauseous C. Notify the provider if blood glucose levels are over 350 mg/dL D. Test the urine for ketones.

D. Test the urine for ketones.

A child is diagnosed with failure to thrive. The nurse understands that the criteria for this includes?A. Weight below 35th percentile for height and ageB. Weight below 25th percentile for height and ageC. Weight below the 15th percentile for height and ageD. Weight below 5th percentile for height and age

D. Weight below 5th percentile for height and age

A nurse is assessing a preschooler for a routine wellness checkup. Which of the following should indicate a need for further evaluation? A. The child is crying and states, "I do not want a shot." B. Respiratory rate of 25/min C. The child is sitting on the exam table pretending to be in a boat surrounded by sharks D. blood pressure 122/80 mm Hg

D. blood pressure 122/80 mm Hg

A nurse is caring for an infant who has a congenital heart defect. Which of the following defects is associated with increased pulmonary flow? A. Tetralogy of fallot B. coarctation of the aorta C. tricuspid atresia D. patent ductus arteriosus

D. patent ductus arteriosus

developmental tasks of the preschooler

-participates in imaginary play -

A nurse is caring for a school age child who sustained a closed head injury. Which of the following findings is an early indicator of increased intracranial pressure? A. Irritability B. bradycardia and hypertension C. glasgow coma scale of 14 D. pupils 4 mm and reactive

A. Irritability

A nurse is assessing the psychosocial development of a toddler. The nurse should recognize that this stage is characterized by which of the following? A. Negative behaviors characterized by the need for autonomy B. Demonstrations of sexual activity C. Imaginary playmates D. Erikson's stage of initiative vs guilt

A. Negative behaviors characterized by the need for autonomy

A nurse is caring for a client who has a new short leg cast on his lower leg to treat an ankle fracture. Which of the following findings require immediate notification of the provider? A. Inability to flex the toes of the casted foot B. Dependent edema distal to the cast C. Ecchymosis of the distal foot D. moderate level of pain

B. Dependent edema distal to the cast

A nurse is caring for a 10 month old infant who is in a cast for developmental dysplasia of the hip (DDH) Which of the following stratgies should the nurse implement to promote the infant's growth and development A. change the infant's diaper as soon as soiling occurs B. tie colorful latex balloons to the side of the crib C. provide a small electronic toy D. allow the infant to stand in the crib

D. allow the infant to stand in the crib

Which type of JIA has the best prognosis?

Oligoarticular (pauciarticular) JIA

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? a. "limit the amount of t.v. he watches" b. "watch for changes in his behavior or eating patterns" c. "call the doctor if he gets a headache." d. "always keep his head raised 30 degrees"

b. "watch for changes in his behavior or eating patterns" rationale: Changes in behavior or in eating patterns can suggest a problem with his shunt, such as infection or blockage. Irritability, lack of appetite, increased crying, or inability to settle down may indicate increased intracranial pressure. Any headache needs to be monitored, but if it goes away quickly, such as after eating, it probably isn't a problem. It is not necessary to keep the child's head raised 30 degrees. The child's shunt will not be affected by the amount of television viewed.

The nurse caring for a hospitalized child with failure to thrive (FTT) will focus first on: a. forming a positive relationship with the child b. assisting the child to attain adequate nutrition to demonstrate weight gain c. providing appropriate developmental stimulation d. determining the quality of the parent-child relationship

b. assisting the child to attain adequate nutrition to demonstrate weight gain. Attaining nutrition to promote weight gain is the primary focus. Special feeding situations and methods may be needed such as desensitizing the child to certain food textures or beginning enteral feedings. All the other options are important in helping the child with FTT but are not the initial focus.

The nurse assesses a child and finds that the child's pupils are pinpoint. The nurse interprets this finding as indicating which of the following? a. intracranial mass b. brain stem dysfunction c. seizure activity d. brain stem herniation

b. brain stem dysfunction Rationale: Pinpoint pupils are commonly observed in poisonings, brain stem dysfunction, and opiate use. Dilated but reactive pupils are seen after seizures. Fixed and dilated pupils are associated with brain stem herniation. A single dilated but reactive pupil is associated with an intracranial mass.

10. Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet, painful joints

d. Painful swelling of hands and feet, painful joints ANS: D A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises.

A nurse is obtaining a health history from a child who is suspected acute rheumatic fever. Which of the following questions should the nurse ask? A. "Have you given your child aspirin in the past two weeks?" B. "Has your child had any injuries recently?" C. "Has your son had a sore throat recently?" D. "Was your son born with this cardiac defect?"

C. "Has your son had a sore throat recently?"

A nurse receives a call from a parent of a child who has von Willebrand disease and has a nosebleed. Which of the following instructions should the nurse give to the parent? A. "have your child sit with her head tilted forward and hold pressure on her nose for 10 minutes.." B. "Place your child in a supine position with a pillow under her back" C. "apply ice at the base of the nose for 5 minutes and then check for bleeding " D,. "place your child in a sitting position with her head tilted back"

A. "have your child sit with her head tilted forward and hold pressure on her nose for 10 minutes..

The nurse is doing a routine assessment on a 14 month old infant and notes that the anterior fontanel is closed. This should be interpreted as: A. A normal finding B. An abnormal finding- indicates need for developmental assessment C. A questionable finding- infant should be rechecked in 1 month D. An abnormal finding- indicates need for immediate referral to practitioner

A. A normal finding

A nurse is providing anticipatory guidances about child development to the parents of a preschooler. Which of the following developmental tasks should the nurse include as expected of a preschooler? A. participates in imaginary play B. Builds a collection of cards C. Controls impulsive feelings D. Expresses need for privacy

A. participates in imaginary play

The nurse is caring for a 6 month old with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? Select all that apply A. photophobia B. fever C. edema D. irritability E. bulging anterior fontanel

A. photophobia B. fever D. irritability E. bulging anterior fontanel

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

A. place the client in a side lying position B. Assess the client's airway patency E. Remove objects from the client's bed

A nurse has accepted a position on a pediatric unit and is learning more about psychosicial development. Place eriskon's stages of psychosocial development in order from birth through age 18 years. A. Trust Vs Mistrust B. Autonomy vs shame and doubt C. Initiative vs guilt D. industry vs inferiority E. Identity vs role confusion

ABCDE

A nurse is caring for a 7 year old who has an upper respirtoary infection and type 1 diabetes mellitus. Which of the following statments made by the mother indicates a need for further instruction? A. "I will encourage her to drink half a cup of water or sugar free fluids every 30 minutes." B. "I will continue to check her blood sugar two times every day." C. "I will notify the doctor if her temperature is not controlled with acetaminophen." D. "I will report a change in her breathing or any sign of confusion"

B. "I will continue to check her blood sugar two times every day."

A nurse is caring for a child that is experiencing a seizure. Which of the following would be most appropriate action for the nurse to do? A. Restrain the child's arms B. Position the child laterally C. Use a padded tongue blade D. attempt to stop the seizure

B. Position the child laterally

A nurse is assessing an infant who has possible cerebral palsy. Which of the following manifestations of cerebral palsy should the nurse expect to find? A. Smiles when mother appears at 3 months B. Sits with pillow props at 8 months C. Tracks an object in surroundings with eyes D. Uses pincer grasp to pick up a toy

B. Sits with pillow props at 8 months

A nurse is assessing an 11 month old infant. Which of the following manifestations is associated with a CNS infection? A. jaundice B. bulging fontanel C. negative Brudzinski sign D. oliguria

B. bulging fontanel

A nurse is preparing to adminster oral medication to a 3 month old infant. Which of the following actions should the nurse take to ensure successful adminstration? A. place infant supine in crib B. position syringe to the side of the tongue C. measure elixir using a medicine cup D. mix medication with formula

B. position syringe to the side of the tongue

A nurse is assessing an infant following a motor vehicle crash. Which of the following findings should the nurse monitor to identify increased intracranial pressure? A. Depressed fontanels B. Brisk pupillary reaction to light C. Tachycardia D. Increased sleeping

D. Increased sleeping

A nurse is caring for a child who has juvenile rheumatoid arthritis. Which of the following actions should the nurse take? A. Administer opioids on a schedule B. Encourage the child to take daytime naps C. Apply cool compresses for 20 mins every hour D. Maintain night splints to the affected joint

D. Maintain night splints to the affected joint

pauciarticular JIA

Which type of JIA has the highest risk for uveitis?

A child's medical record contains the diagnosis failure to thrive (FTT). The nurse realizes: Select all that apply. a. the cause may be organic or inorganic b. it may have developmental delay as a contributing factor c. it could be related to poverty d. the growth chart shows an extended period of poor weight gain. e. that special needs children often carry this diagnosis

a, b, c, d and e rationale: All are true of failure to thrive. Physical or physiologic problems cause organic failure to thrive. Inorganic failure to thrive derives from psychosocial sources. The line between the two may not always be clear, however, since causes of the problem can be mixed.

A 3-month-old boy was diagnosed with failure to thrive. What action will be most helpful in assisting the nurse to determine if there is an inorganic cause? a. reviewing the medical records for a history of prematurity or a congenital anomaly b. assessing for adequate calorie intake through recording ounces of formula consumed c. observing the mother-child interaction during feeding and hygiene activities d. observing the child's interest in and ability to feed

c. observing the mother-child interaction during feeding and hygiene activitiesRationale: Observing the mother:child interaction during feeding and hygiene activities would disclose lack of knowledge of child care, poor feeding techniques, or inappropriate maternal bonding and interaction as inorganic causes or failure to thrive. The child's lack of interest in or inability to feed would indicate organic causes, as would determining that the child consumed adequate calories for age and finding a history of prematurity or congenital anomaly.

osteogenesis imperfecta

inherited disorder characterized by connective tissue and bone defects leading to bones that are fractured by the slightest trauma characterized by occurence of pathologic fractures resulting from connective tissue and bone defects -bones are so fragile that fractures result from trauma, but also from simple walking or pressure of birth - a client with this diagnosis should not be confused with client with fractures because of abuse -assessment: major clinical manifestations include multiple and frequent fractures, some of which may be present at birth. -other clinical manifestations: blue sclera; thin, soft skin with easy bruising; increased joint flexibility; weak muscles; short stature; conductive hearing loss often by adolescence or young adulthood. -may have dentinogenesis imperfecta: hypoplastic teeth with opalescent blue or brown discoloration -planning and implementation: - keep floors dry; remove objects that could cause falls - handle pt gently: avoid lifting by a single arm or leg; use a blanket for extra support when lifting and moving -never hold by ankles when being diapered, but lift gently by slipping a hand under the buttocks

Which are clinical manifestations of increased intracranial pressure (ICP) in infants? Select all that apply Irritability Low-pitched cry Sunken fontanel bulging fontanelle

Irritability bulging fontanelle

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. What should the nurse suspect? Shaken-baby syndrome Unintentional injury Congenital neurologic problem Sudden infant death syndrome (SIDS)

Shaken-baby syndrome

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. What is the most appropriate nursing action? A. Discuss with practitioner what analgesia can be safely administered B. Discuss with parents the child's previous experiences with pain C. Explain that analgesia is contraindicated with a head injury D. Explain that analgesia is unnecessary when child is not fully awake and alert

A. Discuss with practitioner what analgesia can be safely administered

Which is an important consideration when the nurse is discussing enuresis with the parents of a young child? Select all that apply A. Organic causes that may be related to enuresis should be considered first B. Enuresis is more common in boys than in girls C. Enuresis is neither inherited nor has a familial tendency. D. Psychogenic factors that cause enuresis persist into adulthood

A. Organic causes that may be related to enuresis should be considered first B. Enuresis is more common in boys than in girls

Which is true concerning hepatitis B? Select all that apply A.Hepatitis B can be prevented by HBV vaccine B. Hepatitis B can be transferred to an infant from holding the child. C. Principal mode of transmission for hepatitis B is fecal-oral route D. Principal mode of transmission for hepatitis B is infected body fluids

A. Hepatitis B can be prevented by HBV vaccine D. Principal mode of transmission for hepatitis B is infected body fluids

The nurse is providing information on how to prevent burns in young children she will include? Select all that apply A. keep covers on outlets B. keep pot handles pointed back of stove when cooking C. Set water heaters at 160 degrees F D. use sunscreen on toddlers

A. keep covers on outlets B. keep pot handles pointed back of stove when cooking D. use sunscreen on toddlers

58. The nurse is planning care for a 16-year-old, who has juvenile rheumatoid arthritis (JRA). The nurse includes activities to strengthen and mobilize the joints and surrounding muscle. Which physical therapy regimen should the nurse encourage the adolescent to implement? a. Exercise in a swimming pool. b. Splint affected joints during activity. c. Perform passive range of motion exercises twice daily. d. Begin a training program lifting weights and running.

ANS: A Exercising in a swimming pool (A) allows freedom of movement with minimum gravitational pull and thereby less discomfort. Physical therapy for clients with JRA is directed toward specific joints and focuses on strengthening muscles, mobilizing restricted joints, and preventing or correcting deformities. Splinting and positioning of joints helps to minimize pain, prevents or reduces flexion deformities, and is recommended during periods of rest (B). To strengthen and mobilize towards maximizing independence, the adolescent should engage in active (not passive) range of motion exercises (C). (D) may be a more painful weight-bearing activity and the adolescent's previous level of activities should be considered.

When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of which of the following? a. Asthma b. Nephrosis c. Lower respiratory tract infections d. Neurotoxicity

ANS: A Most children with atopic dermatitis have a family history of asthma, hay fever, or atopic dermatitis, and up to 80% of children with atopic dermatitis have asthma or allergic rhinitis. Complications of atopic dermatitis relate to the skin. The renal system is not affected by atopic dermatitis. There is no link between lower respiratory tract infections and atopic dermatitis. Atopic dermatitis does not have a relationship to neurotoxicity.

When changing an infant's diaper, the nurse notices small bright red papules with satellite lesions on the perineum, anterior thigh, and lower abdomen. This rash is characteristic of a. candidiasis. b. irritant contact dermatitis. c. intertrigo. d. seborrheic dermatitis.

ANS: A Small red papules with peripheral scaling in a sharply demarcated area involving the anterior thighs, lower abdomen, and perineum are characteristic of candidiasis. A shiny, parchment- like erythematous rash on the buttocks, medial thighs, mons pubis, and scrotum, but not in the folds, is suggestive of irritant contact dermatitis. Intertrigo is identified by a red macerated area of sharp demarcation in the groin folds. It can also develop in the gluteal and neck folds. Seborrheic dermatitis is recognized by salmon- colored, greasy lesions with a yellowish scale found primarily in skinfold areas or on the scalp.

What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)? a. Control pain and preserve joint function .b. Minimize use of joint and achieve cure .c. Prevent skin breakdown and relieve symptoms. d. Reduce joint discomfort and regain proper alignment.

ANS: A The goals of therapy are to control pain, preserve joint range of motion and function, minimize the effects of inflammation, and promote normal growth and development. There is no cure for JIA at this time. Skin breakdown is not an issue for most children with JIA. Symptom relief and reduction in discomfort are important. When the joints are damaged, it is often irreversible.

1. A child has small red macules and vesicles that become pustules around the child's mouth and cheek. Older lesions are crusted and honey-colored. What should the nurse teach the parents about this condition? a. Keep the child home from school for 24 hours after starting antibiotics. b. Clean the rash vigorously with Betadine three times a day. c. Notify the physician for any itching. d. Keep the child home from school until the lesions are healed.

ANS: A This child has impetigo. To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours after treatment is initiated. Good handwashing is imperative in preventing the spread of impetigo. The lesions should be washed gently with a warm soapy washcloth. Itching is common and does not necessitate medical treatment. Rather, parents should be taught to clip the child's nails to prevent maceration of the lesions. The washcloth should not be shared with other members of the family. The child may return to school 24 hours after initiation of antibiotic treatment.

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching? a. "I should gently massage the skin under the straps once a day to stimulate circulation." b. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." c. "I should remove the harness several times a day to prevent contractures." d. "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."

ANS: A To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder because this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.

What measure is important in managing hypercalcemia in a child who is immobilized? a. Provide adequate hydration .b. Change position frequently. c. Encourage a diet high in calcium. d. Provide a diet high in calories for healing

ANS: A Vigorous hydration is indicated to prevent problems with hypercalcemia. Suggested intake for an adolescent is 3000 to 4000 ml/day of fluids. Diuretics are used to promote the removal of calcium. Changing position is important for skin and respiratory concerns. Calcium in the diet is restricted when possible. A high-protein diet served as frequent snacks with favored foods is recommended. A high-calorie diet without adequate protein will not promote healing.

10. A 4-month-old with significant head lag meets the criteria for floppy infant syndrome. A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made. What should be included in the nursing care for this child? a. Infant stimulation program b. Stretching exercises to decrease contractures c. Limited physical contact to minimize seizures d. Encouraging parents to have additional children

ANS: A Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). An infant stimulation program is essential. Frequent position changes, including changes in environment, provide the child with more physical contacts. Verbal, tactile, and auditory stimulation are also included. Contractures do not occur because of muscular atrophy. Sensation is normal in children with this disorder. Frequent touch is necessary as part of the stimulation. Werdnig-Hoffmann disease is inherited as an autosomal recessive trait. Parents should be referred for genetic counseling

What finding is characteristic of fractures in children? a. Fractures rarely occur at the growth plate site because it absorbs shock well. b. Rapidity of healing is inversely related to the child's age .c. Pliable bones of growing children are less porous than those of adults .d. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.

ANS: B Healing is more rapid in children. The younger the child, the more rapid the healing process. Nonunion of bone fragments is uncommon except in severe injuries. The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma. Children's bones are more pliable and porous than those of adults. This allows them to bend, buckle, and break. The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact. The adult periosteum is thinner, is weaker, and has less osteogenic potential than that of a child.

What statement is true concerning osteogenesis imperfecta (OI)? a. It is easily treated .b. It is an inherited disorder .c. Braces and exercises are of no therapeutic value. d. Later onset disease usually runs a more difficult course.

ANS: B OI is a heterogeneous, autosomal dominant disorder characterized by fractures and bone deformity. Treatment is primarily supportive. Several investigational therapies are being evaluated. The primary goal of therapy is rehabilitation. Lightweight braces and splints help support limbs, prevent fractures, and aid in ambulation. The disease is present at birth. Prognosis is affected by the type of OI.

11. A school-age child is admitted in vaso-occlusive sickle cell crisis. The childs care should include: a. Correction of acidosis. b. Adequate hydration and pain management. c. Pain management and administration of heparin. d. Adequate oxygenation and replacement of factor VIII.

ANS: B The management of crises includes adequate hydration, minimizing energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII are not indicated in the treatment of vaso-occlusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.

12. The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics: a. Are often ordered but not usually needed. b. Rarely cause addiction because they are medically indicated. c. Are given as a last resort because of the threat of addiction. d. Are used only if other measures such as ice packs are ineffective.

ANS: B The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild-to-moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and given around the clock. Patient-controlled analgesia reinforces the patients role and responsibility in managing the pain and provides flexibility in dealing with pain. Few if any patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vaso-occlusive crisis. Ice is contraindicated because of its vasoconstrictive effects.

9. What should the nurse teach an adolescent who is taking tretinoin (Retin-A) to treat acne? a. The medication should be taken with meals. b. Apply sunscreen before going outdoors. c. Wash with benzoyl peroxide before application. d. The effect of the medication should be evident within 1 week.

ANS: B Tretinoin causes photosensitivity, and sunscreen should be applied before sun exposure. Tretinoin is a topical medication. Application is not affected by meals. If applied together, benzoyl peroxide and tretinoin have reduced effectiveness and a potentially irritant effect. Optimal results from tretinoin are not achieved for 3 to 5 months.

5. Gingivitis is a common problem in children with cerebral palsy (CP). What preventive measure should be included in the plan of care? a. High-carbohydrate diet b. Meticulous dental hygiene c. Minimum use of fluoride d. Avoidance of medications that contribute to gingivitis

ANS: B Meticulous oral hygiene is essential. Many children with CP have congenital enamel defects, high- carbohydrate diets, poor nutritional intake, and difficulty closing their mouths. These, coupled with the childs spasticity or clonic movements, make oral hygiene difficult. Children with CP have high carbohydrate intake and retention, which contribute to dental caries. Use of fluoride should be encouraged through fluoridated water or supplements and toothpaste. Certain medications such as phenytoin do contribute to gingival hyperplasia. If that is the drug of choice, then meticulous oral hygiene must be used.

What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration? a. Give nystatin suspension with a syringe without a needle. b. Apply nystatin cream to the affected area twice a day. c. Give nystatin before the infant is fed. d. Swab nystatin suspension onto the oral mucous membranes after feedings.

ANS: D It is important to apply the nystatin suspension to the affected areas, which is best accomplished by rubbing it onto the gums and tongue, after feedings, until 3 to 4 days after symptoms have disappeared. Medication may not reach the affected areas when it is squirted into the infant's mouth. Rubbing the suspension onto the gum ensures contact with the affected areas. Nystatin cream is used for diaper rash caused by Candida. To prolong contact with the affected areas, the medication should be administered after a feeding.

A child has undergone surgery using steel bar placement to correct pectus excavatum. Which of the following would the nurse instruct the parents to avoid?Select one:A. High FowlerB. Side-lyingC. Semi-FowlerD. Supine

B. Side-lying Rationale: After surgery to correct pectus excavatum, the nurse would instruct the parents to avoid positioning the child on either side because this could disrupt the bar's position. Semi- or high Fowler's position and the supine position would be appropriate.

A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route?Select one:A. Subcutaneous injectionB. Intramuscular injectionC. OralD. Intravenous infusion

B. Intramuscular injectionRationale: Botulin toxin is administered by injection into the muscle. It may cause dry mouth. It is not administered orally, by subcutaneous injection, or by intravenous infusion.

A nurse is completing discharge teaching to a parent of a child with a new diagnosis of diabetes mellitus. Which of the following staments by the parents require clarification of the teaching? A. "the onset of low blood glucose usually occurs rapidly." B. "sweating can occur with hypoglycemia" C. "my son may be very thirsty or have fruity breath when hypoglycemia." D. "my son may complain of feeling shaky when he has a low blood glucose level"

C. "my son may be very thirsty or have fruity breath when hypoglycemia."

A nurse is reviewing data for four children. Which of the following children should the nurse asses first? A. A 4 year old child who has asthma and a PCO2 of 37 mm Hg B. A 7 year old child who has diabetes insipidus and a urine specific gravity of 1.000 C. A 10 year old who has sickle cell anemia who reports severe chest pain D. A 1 year old toddler who has roseola and temperature of 38 degrees Celsius

C. A 10 year old who has sickle cell anemia who reports severe chest pain

The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the physician to order?Select one:A. RetinoidsB. CorticosteroidsC. AntifungalsD. Antibiotics

C. AntifungalsRationale: Candidal diaper rash would require a fungicide. The nurse would expect to administer topical antifungals as ordered. Corticosteroids are not typically recommended for young infants and are used for atopic dermatitis and certain types of contact dermatitis. Antibiotics would be ineffective against fungal infections. Retinoids are indicated for moderate to severe acne.

A nurse is completing a history and physical on a 3 year old child who is admitted for a surgical repair of Tetrology of Fallot (TOF). Which of the following manifestations of the condition should the nurse expect? (Select all that apply) A. Decreased PO B. Obesity C. Cyanosis D systolic murmur E. Energetic

C. Cyanosis D systolic murmur

A nurse is developing a plan of care for an infant with nonorganic failure to thrive. What is the most important aspect of care to be incorporated into the plan? A. Periodically changing the seating arrangement during meals B. Force the child to eat everything on there plate C. Following a structured routine throughout the day D. Maintaining silence while feeding the infant

C. Following a structured routine throughout the day

Todd is a 3-year-old child who has acute lymphoblastic leukemia. He is being seen in the oncology clinic for chemotherapy.Todd's mother asks the nurse, "What is wrong with my child's blood?" Based on the nurse's knowledge of leukemia and developmental stages, the most appropriate response is to tell the mother that Todd's blood has more:A. platelets.B. red blood cells.C. older-mature white blood cells.D. young-immature white blood cells.

D. young-immature white blood cells. Rationale: A. Bone-marrow dysfunction causes a proliferation of immature cells, which depress bone marrow production of the formed elements of the blood by competing for and depriving the normal cells of the essential nutrients for metabolism; thus, platelet production is decreased. B. Bone-marrow dysfunction causes a proliferation of immature cells, which depress bone marrow production of the formed elements of the blood by competing for and depriving the normal cells of the essential nutrients for metabolism; thus, red blood cell production is decreased. C. Bone-marrow dysfunction causes a proliferation of immature cells, which depress bone marrow production of the formed elements of the blood by competing for and depriving the normal cells of the essential nutrients for metabolism; thus, mature white blood cells production is decreased. D. Bone-marrow dysfunction causes a proliferation of immature cells; thus young-immature white blood cell production is increased.

A 24 hour urine collection is ordered for a patient. How should this be done? If the collection gets contaminated or forgotten to be placed in the container, how should the nurse proceed?

The appropriate steps for a 24 hour urine collection include: -obtaining a specimen container from the lab (which may or may not have a preservative in it) -ensure specimen container is properly labeled with patient identifier, the test being performed, start time, and end time -place a clean hat, urinal, or other collection device in the patient's room or bathroom -post notices on the chart and in the patient's room indicating that a 24 hour urine collection is in process, in order to prevent a urine occurrence from being dumped in the toilet instead of in the 24 hour urine collection container (Once the urine collection time has begun, any missed collections indicate restarting the 24 hour urine collection. Discard previous specimen container and obtain a new one from the lab. Replace collection container with a clean one from the supply room.) -at the start of collection have the patient empty their bladder, discard this occurrence -each time the patient voids over the next 24 hours the entire collection should be poured into the specimen container -the specimen container should be kept refrigerated or on ice -at the end of the 24 hour time frame, have the patient empty their bladder again, adding the collection to the specimen container, and thereby ending the 24 hour urine collection -Specimen, with requisition, should be delivered to the lab During the collection period instruct the patient try to urinate (and collect the occurrence) before moving bowels (this is to try and prevent any contamination of urine with feces). Also, teach the patient not to place toilet paper in the collection container. If contamination occurs the 24 collection period would need to begin again. Discard previous specimen and collection container. Obtain a clean collection container from supply room and a new specimen container from the lab.

brain and spinal cord development

The brain and spinal cord make up the central nervous system. Development of these structures occurs in the first 3-4 weeks of gestation from the neural tube. Infection, trauma, teratogens (any environmental substance that can cause physical defects in the developing embryo and fetus), and malnutrition during this period can result in malformations in brain and spinal cord development and may affect normal CNS development.

A 2-month-old infant is admitted with suspected Spinal Muscular Atrophy. Which of the following findings is the nurse likely to assess?Select one or more: a. Generalized weakness b. Scoliosis c. Weak cry d. Low weight-to-length ratio

The correct answer is: C. Weak cry, A. Generalized weakness, D. Low weight-to-length ratio

An infant with Tetralogy of Fallot is having a hypercyanotic episode. Which of the following nursing interventions should the nurse implement? Select all that apply.Select one or more:a. Administer oxygen.b. Administer demerol as ordered PRN.c. Administer diphenhydramamine (Benadryl) as ordered PRN.d. Place the child in knee-chest position.e. Draw blood for a serum hemoglobin.

The correct answer is: Administer oxygen., Place the child in knee-chest position.

A nurse is preparing a class for parents of infants about managing diaper dermatitis. Which of the following would the nurse include in the presentation? Select all answers that apply.Select one or more:A. Using scented diaper wipes to clean the areaB. Refraining from using rubber pants over diapersC. Applying topical nystatin to the diaper areaD. Washing the diaper area with an antibacterial soapE. Using a blow dryer on warm to dry the diaper area

The correct answer is: Using a blow dryer on warm to dry the diaper area, Refraining from using rubber pants over diapers Rationale: For diaper dermatitis, topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum help to provide a barrier. Nystatin is an antifungal agent used for diaper candidiasis. Using a blow dryer on warm to dry the area, avoiding the use of rubber pants, and using unscented diaper wipes or ones free of preservatives are appropriate. The area should be washed with a soft cloth, without harsh soaps.

A child with a myelomeningocele corrected at birth is now 5 years old. What is a priority nursing diagnosis for a child with corrected spina bifida at this age? Select one: a. Risk for altered urinary elimination b. Risk for altered comfort c. Risk for infection d. Risk for impaired tissue perfusion-cranial

a. Risk for altered urinary elimination Children with spina bifida are prone to neurogenic bladder. The bladder may not empty completely with voiding, resulting in urinary retention.

pauciarticular JIA (oligoarticular)

most common type of JIA

Which of the following are important nursing interventions when caring for an infant with a myelomeningocele in the preop stage? 1. Place infant prone with knees slightly flexed 2 . Apply a heat lamp to facilitate drying and toughening of the sac 3. Cover the sac with a sterile dressing, using betadine to prevent infection 4. Measure head circumference daily Select one: a. 1 and 3 only b. 1 and 4 only c. 1, 3, and 4 only d. 2, 3, and 4 only e. 2 and 3 only

b. 1 and 4 only Correct Early in the preop phase (>10 hours before surgery) the child could be fed with head turned to one side.

Which of the following activities are appropriate for an 8-year-old child with mild Cerebral Palsy? Select one or more: a. Participating in solitary or parallel play b. Attending school c. Participating in social groups such as Girl Scouts/Boy Scouts. d. Participating in physical therapy to promote gross motor skills

b. Attending school Children with Cerebral Palsy can and should attend school. If modifications for learning are needed, the child should have an Individualized Education Plan. c. Participating in social groups such as Girl Scouts/Boy Scouts. Correct Developing social skills is a primary developmental task for a school age child. Providing opportunities to interact with same age peers is important in promoting normal growth & development for the child with CP. d. Participating in physical therapy to promote gross motor skills Gross and fine motor skills generally continue to mature in healthy children of school age. Motor skill delays are common in children with cerebral palsy so PT to promote normal development would be appropriate.

An infant has been diagnosed with Osteogenesis Imperfecta. (OI). The nurse is teaching the parents about how to care for their infant. What information is most important for the nurse to include in the instructions to the parents? Select one: a. Notify the health-care provider if your infant does not respond to sound because the infant's central nervous system fails to develop completely. b. If you note signs of infection bring your infant to the clinic because the infant has a significant immune dysfunction. c. Protect your infant from injury and handle your baby carefully because your infant's bones can break very easily d. Check the color of your infant's nail beds and mucous membranes for the signs of circulatory impairment

c. Protect your infant from injury and handle your baby carefully because your infant's bones can break very easily Rationale: OI is also known as brittle bone disease and the infant should be handled carefully and protected from injury.

A child has sustained a basilar skull fracture. For which complication should the nurse assess?Select one:a. Transient confusionb. Periorbital ecchymosisc. Headached. Cerebral spinal fluid leakage from the nose or ears

d. Cerebral spinal fluid leakage from the nose or ears. CSF leakage indicates a tear in the dural membrane, resulting in a direct opening from the environment into the brain. This can place the child at higher risk for infection. Surgical repair is performed if it persists after 7 - 10 days.Rationale: A fracture of the bones that form the base (floor) of the skull and results from severe blunt head trauma of significant force. A basilar skull fracture commonly connects to the sinus cavities. This connection may allow fluid or air entry into the inside of the skull and may cause infection. The key word is complication. While periorbital ecchymosis and CSF are both signs of a basilar skull fracture only the CSF leak is a complication because it involves an opening from the brain to the outside which provides a route for serious infection, primarily meningitis. A fracture of the bones that form the base (floor) of the skull and results from severe blunt head trauma of significant force. A basilar skull fracture commonly connects to the sinus cavities. This connection may allow fluid or air entry into the inside of the skull and may cause infection

A 28-day-old infant with a fever is admitted to rule out sepsis. Blood, urine, and CSF cultures are drawn and the child is placed on IV antibiotics. The following day the urine culture comes back positive. The nurse knows that a common cause of UTI in a child this age is:Select one:a. Nephrotic syndromeb. Ureteral pelvic junction obstructionc. Vesicoureteral refluxd. Hypospadias

d. Hypospadias Rationale: Hypospadias is a condition in which the urethral opening is on the ventral surface of the penis.70% of young children diagnosed with UTI have vesicoureteral reflux, a condition in which urine from the bladder flows back up the ureters. This reflux of urine occurs during bladder contraction with voiding.