Peds Final Exam

A graduate nurse tells the RN preceptor. "I need to insert a NG tube in a pediatric client, and though I was checked off on this procedure in my nursing school's simulation lab, I have never inserted one on a real person. "What is most appropriate response from the preceptor?

*Let us review the procedure, then I will supervise you while you perform the procedure

The nurse is planning care for a school-age child with bacterial meningitis. Which of the following should be included?

*Measure head circumference to assess developing complications *Keep environmental stimuli at a minimum Avoid giving pain medications that could dull sensorium Have child move head side to side at least every two hours

40) A nurse in a pediatric clinic is reviewing the history of a 12-year-old client. The nurse should prepare to administer which of the following immunizations if she confirms with the parent that the child has not yet received it?

*Meningococcal conjugate

A nurse is assessing a child after an open reduction of a fractured femur. Signs that compartment syndrome could be occurring would be (Select all that apply) THINK 6 P's

*Prolonged capillary-refill time with paresthesia *Pain not relieved by pain medication

A 2-month-old infant is admitted to the pediatric unit presents with projectile vomiting, non-bilious vomitus, appears hungry especially after emesis, is irritable, fails to gain weight, and has fever and smaller stools. The nurse recognizes these signs and symptoms are common in children with:

*Pyloric Stenosis

A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering ?

*Recognizing that the family is the constant in a child's life

A nurse is caring for a child in a hip spica cast that is in Buck extension traction. Which of the following is an appropriate action for the nurse to take?

*Reposition the child every 2 hr.

The nurse works in an oncology clinic. A preschool-age child is being seen in the clinic and the nurse anticipates a diagnosis of cancer. The nurse prepares for which of the common reactions preschool-age children have following illnesses and hospitalizations?

*Thoughts that they caused their illness, and are being punished

The nurse is administering packed red blood cells to a child with sickle cell disease. The nurse knows that a transfusion reaction will most likely occur:

*Within the first 20 minutes of administration of the transfusion

The nurse is caring for a 6-year-old child with acute lymphoblastic leukemia (ALL). The parent states, "My child has a low platelet count and we are being discharged this afternoon. What do I need to do at home?" Which of the following statements would be most appropriate for the nurse to make?

*Your child should avoid contact sports or activities that could cause bleeding.

A mother states that she brought her child to the clinic because the 3-year-old girl was not keeping up with her siblings. During physical assessment, the nurse notes that the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the practitioner of the results, the nurse's priority intervention is to:

*c. minimize energy expenditure to decrease cardiac workload..

A nurse has collected 160 mL of urine output from a 3-year-old client during 8 hr. The client weights 33 lb. What is the next nursing action?

*continue to monitor the client

A nurse has just administered a dose of diazepam (Valium) to a adolescent client. Which of the following actions should the nurse take before she leaves the client's room?

*put up the side rails on the client's bed

Which of the following should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations?

*this medicine will turn the stool a tarry green color.

The care provider is recommending pressure-equalizing tubes insertion for a child with persistent otitis media with effusion. The nurse is aware that these tubes (Select all that apply)

*will allow fluid to drain from the middle ear *will prevent future bouts of otitis media *will require a typanostomy for placement may become dislodged.

A parent asks the nurse why limiting the amount of time the child feeds is important in the care of the child with congestive heart failure. Which response by the nurse is the most appropriate?

Resting is essential in the care of the newborn with CHF

The nurse is caring for a 9-month-old who just returned from the PACU after a shunt placement for hydrocephalus. Which of the following physician's orders would the nurse question?

*Elevate head of bed

When caring for a child who is receiving both Digoxin and Furosemide (Lasix), the nurse should be particularly alert to signs and symptoms of:

*Hypokalemia

A child has third-degree burns of the hands, face, and chest. Which nursing diagnosis takes priority?

*Ineffective airway clearance related to edema

A nurse is monitoring a patient for side effects associated with opioid analgesics. Which side effects should the nurse expect to monitor for? ( Select all that apply)

Respiratory depression Sweating Pruritus

A female teen volunteer is assigned to the pediatric unit for the day and reports to the charge nurse for an assignment. Which one of the following assignments is unsafe for the volunteer ?

Reading a book to a 4 year old client who has aids.

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because:

Regression is seen during hospitalization.

The nurse is teaching an adolescent girl with scoliosis about a Milwaukee brace which her healthcare provider had prescribed. Which instruction is accurate?

Remove the brace one hour each day for bathing only.

The nurse is instructing parents of a 4 year-old with atopic dermatitis on ways of promoting skin hydration. Which of the following would be included in their instructions? Select all that apply

*Add oatmeal to the bath water *Dry skin thoroughly before applying creams or lotions Clean only dirty areas of the body Apply moisturizer only at bath time and bed time Apply crisco all over the body

The nurse has taught dietary restrictions to the 7-year-old child with celiac disease. After teaching, the child is allowed to choose a correct menu. The nurse would know that teaching was effective when the child chooses:

*Beef and barley soup, rice cakes, and celery. Ham & cheese sandwich w/ lettuce & tomato Beef patty on bun w/ fries *backed chicken green beans and cornbread

A nurse is obtaining vital signs from 2-months-old infant. The infant's heart rate is 190/min and his temp is 40 degrees Celsius (104 F). The father asks the nurse why the infants heart beating so fast. Which of the following responses by the nurse is appropriate?

"The fever is causing an increase in your baby's heart rate."

50) The nurse is caring for a 12-year-old child who is on fall precautions secondary to seizures. Which of the following interventions should be included in the child's care plan? Select all that apply.

**Place call light and desired items within reach. Turn off lights and television at night **Have child wear appropriate size gown and nonskid footwear.

A 7-year-old with a head injury is hospitalized after losing consciousness when he was hit in the head with a bat at baseball practice. The child was not wearing a helmet. The last set of vital signs showed heart rate 48, BP 148/74, respiratory rate 28 and irregular. What does the nurse suspect these findings indicate?

*A sign of increased intracranial pressure

A child with CHF is placed on a maintenance dosage of Digoxin (LANOXIN) . The dosage is 0.07 / Milligrams mg/kg/day, and the Childs weight is 7.2 Kg. The physician subscribes DIGOXIN to be given once a day by mouth. Each does will be __ milligrams. "Enter numerical value only, final answer round to the nearest tenths place".

0.5

When teaching a class on burn prevention to a group of parents, the parents should be instructed to keep hot water heater temperature below:

110 degrees F

A nurse is preparing to administer cefixime (Suprax) 8 mg/kg/day PO divided in equal doses every 12 hrs. to a toddler who weights 22 lbs. The amount available is cefixime suspension 100mg/5mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number.)

2

A child has a nasogastric (NG) tube to continuous low intermittent suction. The physician's prescription is to replace the previous 4-hour NG output with a normal saline piggyback over a 2-hour period. The NG output for the previous 4 hours totaled 50 mL. What milliliter/hour rate should the nurse administer to replace with a normal saline piggyback? ___ Record your answer as a whole number.

25

A nurse is doing developmental assessments on several children in the day-care setting. Which child indicates a delay in meeting developmental milestones?

A 6-year-old who is unable to sit still for a short story

The nurse is completing the intake and output record for a child admitted for fluid volume deficit. The child has had the following intake and output during the shift: 4 oz of Pedialye 1/2 of an 8-oz cup of clear orange jell-O 2 graham crackers 200 cc of D5 1/2 sodium chloride IV 345 cc of urine 50 cc of loose stool The nurse documents the clients intake as ___milliliters

440

A nurse is caring for a client who has a major burn and is experiencing severe pain. Which of the following is an appropriate nursing intervention to manage this client's pain?

Administer morphine sulfate IV via continuous infusion

A school nurse identifies that a child has pediculosis capitis and educates the child's parents about the condition. Which of the following statements by the parents indicates an understanding of the teaching?

All recently used clothing, bedding, and towels must be washed in hot water

10.) The child who had a tonsillectomy earlier today is now awake and tolerating fluids the child asks for something to eat. The most appropriate choice would be ?

Applesauce

The nurse observes a nursing student using lemon glycerin swabs for cleansing mucosal ulcers in a child receiving chemotherapy. The nurse should ?

Ask the student to step out of the room to discuss this.

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. Which of the following statement by the parent would indicate a correct understanding of the teaching?

I should gently massage the skin under the straps once a day to stimulate circulation

A child with bacterial conjunctivitis receives a prescription for erythromycin eye drops. Which information is most important for the nurse to include in the teaching plan?

Avoid sharing towels and washcloths with siblings.

The opthalmologist is considering using atropine eye drops for a child with amblyopia. The nurse is aware that this medication will work by:

Blurring the vision in the good eye

A grandparents of a 3 mo. old infant asks the nurse what kind of toys they should purchase to have in their home when the infant grandchild comes to visit. which should the nurse not recommend for purchase at this time?

Brightly colored blocks

70) An important nursing consideration when caring for a child with impetigo contagiosa is to:

Carefully wash hands and maintain cleanliness when caring for an infected child

Which task should the nurse have the AP perform first?

Collect a stool sample for ova parasites from a 2-year-old child

After years of treatment with chemotherapy and radiation, a child with a brain tumor is shown to be refractory to treatment, and a DNR has been obtained. The mother has reached the child. How would the multidisciplinary team best.

Continue to include the family in planning care, and assure them that the child will be kept comfortable in the days to come

The nurse instructs parents on Prevention of Dehydration in Children. The nurse instructs the parents to seek medical care when: (Select all that apply)

Diarrhea worsens child's mental alertness vomiting persists

A six year old has had a virial infection for the past 5 days and is now having severe vomiting, confusion, irritability although he is now afebrile. During the assessment the nurse should ask the parents which of the following questions ?

Do you use any medications like aspirin for the fever?

The nurse is preparing to assess the internal ear structures of a 3-year-old. The child is resistant to the otoscope. How should the nurse respond?

Lets see if I can find some puppies or kittens May I please look inside your ears? Come sit on this pretty, little red chair. **Please sit still so I can see inside your ears.

Parents of a child who will begin enteral feedings ask the nurse what advantage this type of feeding has over other methods. The nurse bases the response on what facts about enteral feedings? Select all that apply,

Enteral feeding will provide adequate nutrition. Enteral feeding has a high success rate.

The nurse observes excessive salivation and drooling accompanied by cyanosis, choking, coughing in a neonate. The nurse recognizes that this is a medical emergency in infants with:

Esophageal atresia

20) A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma?

Femur

When taking an initial health history from an adolescent suspected of having scoliosis, the nurse would expect the adolescent to state that:

I always have a backache.

A mother arrive to the clinic with her 6-month old child while the nurse is assessing the child the mother points to the umbilicus and says "what am I going to do about this when he cries it looks like its going to burst"

I know it looks scary but it wont burst

30) A nurse is caring for a client who has a moderate burn. Which of the following is an appropriate action for the nurse to take?

Initiate a high-protein, high-calorie diet and adequate hydration

The parents of infant with developmental dysplasia of the hip tell the nurse. "I know that the Pavlik harness is unbearable for our baby". The nurse should reply:

It must be upsetting to you but babies adjust readily to the harness.

Which item should the nurse remove from the bedside table of a 4-year old who has just been placed in bilateral long leg casts?

Legos

Which of the follwing immunizations should not be given to a child receiving chemotherapy for cancer?

Measles, mumps, rubella (MMR)

A child with nephrotic syndrome has been placed on prednisone for several weeks. An important point of teaching with the parents should include:

Never stop the medication suddenly.

The nurse is teaching the family of a child, age 8 years, with moderate hemophilia, the nurse indicates to them that the initial therapy for a joint injury in this child would be:

Nonsteroidal anti-inflammation drugs (NSAIDS) ***Intravenous (IV) infusion of factor VIII concentrates *Elevation and application of ice to involved joint DDAVP (synthetic vasopressin)

A nurse is applying a 5 percent permethrin lotion to a toddler with scabies. The nurse applies the lotion

Over the entire body from the chin down, as well as on the scalp and forehead

Two 4-year-olds are playing in the waiting room in a clinical. One child cuts out colored paper while the other glues it on a paper in a design. This type of play is termed:

Parallel play

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt. Which of the following issues should be addressed?

Shunt malfunction or infection requires immediate treatment

60) A 2-year-old starts to have a tonic-clonic seizure while in a crib in the hospital. The child's jaws are clamped. The most important nursing action at this time is to

Stay with the child and observe the respiratory status

A 2 year old is admitted with periorbital cellulitis. The nurse is aware that this is most often caused by

Strep or staph organisms

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness?

Substitute simple carbs or calorie-containing liquids for solid foods.

The emergency department nurse is cleaning mulitple facial abrasions on 9-year-old Mike. His mother is present. He is crying and screaming loudly. The nurse should:

Suggest that he talk to his mother instead of crying

A parent who's 2 school age children has asthma ask the nurse in what sport, if any they can participate. The nurse should recommend ?

Swimming

Which of the following nursing interventions would be appropriate for a child with muscular dystrophy? (Select all that apply)

Teach the family techniques to minimize contractures Teach the family proper body mechanics.

A 10-year-old has been receiving morphine every two hours for post-operative pain as ordered. The medication relives the pain for approximately 90 mins. and then the pain returns. The nurse should

Tell the child that pain medication cannot be administered more frequently than every two hours *Reposition the child and quietly leave the room Inform the parents that the child is dependent on the medication Call the physician to see if the child's order for pain medication can be changed

Nursing care of the child with Kawasaki disease is challenging because of:

The child's irritability.

The 9-year-old is hospitalized for neutropenia and is placed in reverse isolation. The child asks the nurse, "Why do you have to wear a gown and mask when you are in my room?" How should the nurse respond?

To protect you because you can get an infection very easily.

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What should the nurse suggest to remove this material?

a. Soak in a bathtub

Decreasing the demands on the heart is a priority in care for the infant with congestive heart failure (CHF). In evaluating the infant's status, which of the following is indicative of achieving this goal?

d. Positioned in high Fowler position to maintain oxygen saturation at 90%

Which of these questions is most important for a nurse to ask an adolescent whose weight is at the 95th percentile?

do you have any concerns about your weight?*

A nurse is conducting parenting classes for parents of children ranging in ages 2 to 7 years. The parents understand the term egocentrism when they indicate it means:

self-centeredness