peds practice questions 2

Which statement best describes B-thalassemia major? A. Symptoms include pallor, failure to thrive and severe anemia (hub < 6) B. The condition is usually not discovered until early in adolescence C. Inadequate numbers of red blood cells are present D. All formed elements of the blood are depressed

A. Symptoms include pallor, failure to thrive and severe anemia (hub < 6)

A toddler is being evaluated for SIADH. The nurse should observe the child for which symptoms? SATA A. Fluid retention B. Hyponatremia C. Hypoglycemia D. Myxedema

A.Fluid Retention B.Hyponatremia

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years b. Boys, 12 years; girls, 10 years c. Boys, 9 years; girls, 8 years d. Boys, 10 years; girls, 9 1/2 years

A= Boys, 9 years, girls, 8years

A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? Select all that apply. A. Weight loss B. Fatigue C. Cold intolerance D. Dry, thick skin E. Diarrhea

ANSWER= B,C,D

Nursing interventions aimed at decreasing complications from immobility include: (SATA): A.Encourage active and or passive range of motion exercises B. encourage use of an incentive spirometer. C. Restrict number of visitors to decrease risk of infection. D. Encourage intake of clear liquids E. encourage a high-protein diet. F. encourage an intake of high fiber foods.

Answer= A,B,D,E,F

What is considered a cardinal sign of diabetes mellitus? A. Frequent urination B. Impaired vision C. Seizures D. Nausea

Answer= A. Frequent Urination

The impact of immobilization on the respiratory system includes all of the following (SATA): A. Venous stasis B. Diminished vasopressor mechanism. C. Decreased need for oxygen. D. Bacterial and viral pneumonia. E. Loss of respiratory muscle strength.

Answer= C,D,E

A possible cause of acquired aplastic anemia in children is: A. Injury B. Drugs C. Deficient Diet D. COngenital Defect

B. Drugs

The nurse is caring for a seven-year-old child who will be on bedrest with his left foot stabilized for at least 4 weeks. Which is an appropriate nursing intervention to prevent a urinary tract infection? A. discourage fluid intake, which can lead to incontinence. B. encourage fluid intake to prevent urinary stasis. C. keep the child in a prone position when voiding. D. Insert a Foley catheter to record strict I&O's.

B. Encourage fluid intake to prevent urinary stasis

What oral medication or treatment is used to reduce or prevent multiple complications of sickle cell anemia A. Bone marrow transplant B. Hydroxurea C. Crizanlizumab-Tmca D. Voxelotor

B. Hydroxurea

The nurse is recommending how to prevent iron deficiency anemia in a healthy term breast-fed infants what should he or she suggest? A. Iron fortified commercial formula can be used by ages 4 to 6 months B. Iron fortified infant cereal can be used at approximately six months of age C. Iron fortified infant cereal can be used by age 2 months D. Iron(ferrous sulfate) drops after age 1 month

B. Iron fortified infant cereal can be used at approximately six months of age

The most appropriate nursing diagnosis for a child with anemia is: A. Risk for injury related to dehydration and abnormal hemoglobin B. Decreased cardiac output related to abnormal hemoglobin C. Activity intolerance related to generalized weakness D. Risk for injury related to depressed sensorium

C. Activity intolerance related to generalized weakness

School-age child is admitted in vaso-occlusive sickle cell crisis. The childcare should include: A. Correction of acidosis B. Adequate oxygenation and replacement of factor VIII C. Adequate hydration and pain management D. Pain management and administration of heparin

C. Adequate hydration and pain management

Which is considered a physical effect of immobilization on the metabolic system? A. increased metabolic rate. B. Muscular atrophy. C. Decreased metabolic rate. D. Bone demineralization.

C. Decreased metabolic rate.

A toddler with hemophilia is at risk for: A. Infection related to decreased white blood cells B. Altered growth related to poor appetite C. Developmental delay related to activity restrictions D. All of the above

C. Developmental delay related to activity restrictions

What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease? A. Soft tissue swelling B. Soft to hard, non-tender mass in the pelvic area C. Enlarged, painless, firm cervical lymph nodes D. Protuberant, firm, abdomen

C. Enlarged, painless, firm cervical lymph nodes

A Hospital in Ice child with insulin-dependent diabetes mellitus suddenly becomes unresponsive and unconscious and suffers from seizures. Which medication should the nurse administer immediately? A. Glucocorticoids B. Steroids C. Glucagon D. Insulin

C. Glucagon

Hey school age child with leukemia experience severe nausea and vomiting when receiving chemotherapy for time. The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to: A. Administer an antiemetic as soon as the child has nausea B. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside C. Encourage drinking large amounts of favorite fluids D. Administer an antiemetic before chemotherapy begins

D. Administer an antiemetic before chemotherapy begins

Chelation therapy is begun on a child with B-thalassemia major the purpose of this therapy is to: A. Decrease the risk of hypoxia B. Manage nausea and vomiting C. Treat the disease D. Eliminate excess iron

D. Eliminate excess iron

Bone demineralization is a consequence of immobilization. This condition can lead to the following secondary affect.: A. decreased exercise tolerance. B. impaired healing. C. joint contractures. D. pathologic fracture's.

D. Pathologic fractures

The nurse is caring for a child with a suspected diabetes insipidus. Which clinical manifestation would he or she expect to observe? A. Nausea and Vomiting B. Glycosuria C. Oliguria D. Polyuria and Polydipsia

D. Polyuria and Polydipsia

Type one diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? A. Moist skin B. Weight Gain C. Fluid Overload D. Poor Wound healing

D. Poor wound healing

Manifestations of hypoglycemia include: A. Thirst B. Nausea and vomiting C. Lethargy D. Shaky feeling and dizziness

D. Shaky feeling and dizziness

The nurse is taking the blood pressure of a 3-year old child admitted to the hospital for mild dehydration from vomiting and diarrhea and obtains a reading of 90/50 mmHg. The nurse interprets this finding as: a. A normal finding for a 3 year old child b. An elevated finding for 3-year old child c. Significant, indicating possible fluid volume deficit d. A decreased finding based on the child's age

a. A normal finding for a 3 year old child The normal BP of a 3 year old ranges from 72-110 mmHg systolic and from 40-73 mmHg diastolic.

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

a. Asthma Atopy is correlated with asthma. So often children with asthma have atopic skin disorders such as eczema

A high-protein diet for the child with major burns is ordered to: a. Avoid protein breakdown. b. Promote growth. c. Improve appetite. d. Diminish risks of stress-induced hyperglycemia.

a. Avoid protein breakdown. The diet must provide sufficient calories to meet the increased metabolic needs and enough protein to avoid protein breakdown. Healing, not growth, is the primary consideration. Many children have poor appetites, and supplementation will be necessary. Hypoglycemia, not hyperglycemia, can occur from the stress of burn injury because the liver glycogen stores are rapidly depleted.

In addition to the application of a pediculicide, parents are instructed to: a. Comb the child's hair daily with a special comb to remove nits. b. Avoid sending the child to daycare of school until nits are no longer visible. c. Treat all family members with a pediculicide for 7 days. d. Cut the child's hair to a length of 1 inch.

a. Comb the child's hair daily with a special comb to remove nits. Nit removal is the key to prevent re-infestation of lice. Most pediculicides kill live lice, but not nits. Nits contain the lice eggs and when they hatch the child will develop a new lice infestations.

Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse's response should be based on knowing that: a. Scratching the lesions may cause them to become secondarily infected. b. Scratching the lesions will cause the poison ivy to spread. c. Scratching the lesions will not cause a problem. d. Poison ivy does not itch and needs further investigation.

a. Scratching the lesions may cause them to become secondarily infected. Poison ivy is a contact dermatitis that results from exposure to the oil urushiol in the plant. Every effort is made to prevent the child from scratching because the lesions can become secondarily infected. The poison ivy produces localized, streaked or spotty, oozing, and painful impetiginous lesions. Itching is a common response. The lesions do not spread by contact with the blister serum or by scratching.

Very soon after birth, the nurse notes a significant amount of secretions in the infant's mouth. During the first feeding, the infant begins choking and becomes cyanotic. An oral gastric tube is ordered, but the nurse is unable to pass the tube into the stomach. These are possible clinical manifestations of which condition? a. Tracheoesophageal fistula (TEF) b. Cleft palate c. Pyloric stenosis d. Hirschprung's disease

a. Tracheoesophageal fistula (TEF)

The FIRST action parents should be taught to initiate in an accidental poisoning is to: a. call the poison control center b. induce vomiting c. take the child to the family physician's office or emergency center d. follow the instructions on the label of the house hold product.

a. call the poison control center ALWAYS call the poison control center first. Some poisons do more harm coming back up (acids), so inducing vomiting is not always recommended.

The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis? a. "The baby is a very fussy eater and just does not want to eat." b. "The baby tends to have a very forceful vomiting episode about 30 minutes after most feedings." c. "The baby is happy in spite of getting really upset after spitting up." d. "The baby is always hungry after vomiting, so I feed her again."

b. "The baby tends to have a very forceful vomiting episode about 30 minutes after most feedings." -Infants with pyloric stenosis vomit immediately after a feeding, especially as the pylorus becomes more hypertrophied. -Infants with pyloric stenosis tend to be perpetually hungry because most of their feedings do not get absorbed. -Most infants with pyloric stenosis are irritable because they are hungry. Parents do not usually describe the vomiting episodes as "spitting up" because infants tend to have projectile vomiting.

The nurse is talking to a parent of a 2-year old child with severe atopic dermatitis. What should the nurse reinforce with the parent? Select all that apply. a. 'You can try a fragranced fabric softener in the laundry to avoid rough cloth.' b. 'You will need to keep your child's skin well hydrated by only using a mild soap in the bath.' c. 'You should bathe your child in a bubble bath at least twice a day.' d. 'You can help prevent your child from scratching the area by using a mild antihistamine.' e. 'You can use warm wet compresses to relieve discomfort.' f. 'You should apply an emollient to the skin immediately after a bath.'

b. 'You will need to keep your child's skin well hydrated by only using a mild soap in the bath.' d. 'You can help prevent your child from scratching the area by using a mild antihistamine.' f. 'You should apply an emollient to the skin immediately after a bath.' The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection; an antihistamine can be used. Keeping the skin hydrated is a goal of treating atopic dermatitis. Applying an emollient immediately after a bath helps to trap moisture and prevent moisture loss. Using warm compresses to relieve discomfort, bathing the baby in a bubble bath, and using fabric softener are not appropriate suggestions for this condition.

An effective strategy to reduce the stress of burn dressing procedures in a pre-school age child is to: a. Explain in detail with the dressing change procedure will entail. b. Give the child as many choices as possible during the procedure. c. Reassure the child that dressing changes are not painful. d. Explain to the child why analgesics cannot be used.

b. Give the child as many choices as possible during the procedure. Children who have an understanding of the procedure and some perceived control demonstrate less maladaptive behavior. They respond well to participating in decisions and should be given as many choices as possible. The dressing-change procedure is very painful and stressful. The child should not be misinformed. Analgesia and sedation can and should be used. Detailed explanations are not appropriate for a pre-school age child.

After the acute stage and during the healing process the primary complication from burn injury is: a. Renal shutdown. b. Infection. c. Shock. d. Asphyxia.

b. Infection. During the healing phase local infection and sepsis are the primary complications. Respiratory problems, primarily airway compromise, are the primary complications during the acute stage of burn injury.

A child with extensive burns requires debridement. The nurse should anticipate that a priority goal related to this procedure is to: a. Prevent bleeding. b. Reduce pain. c. Maintain airway. d. Restore fluid balance.

b. Reduce pain. Partial-thickness burns require debridement of devitalized tissue to promote healing. The procedure is very painful and requires analgesia and sedation before the procedure. Preventing bleeding, maintaining the airway, and restoring fluid balance are not goals of debridement.

Which of these is NOT an appropriate goal in the management of atopy? (select one) a. reduce inflammation b. avoid live virus vaccines c. skin hydration d. prevent secondary infections e. provide relief from pruritis

b. avoid live virus vaccines Live virus vaccines have nothing to do with atopic skin disease. With atopic conditions such as ezcema, it is important to: keep the skin hydrated, control itching through topical and oral medications, reduce inflammation with steroid creams and prevent secondary infections by keeping nails short and controlling for itching.

A common pediatric feature of inflammatory bowel disease is: a. obstruction b. slowed growth c. burning epigastric pain d. chronic constipation

b. slowed growth Inadequate nutrition d/t decreased appetite, diarrhea, abdominal pain all contribute to growth restriction.

The nurse is administering omeprazole (Prilosec) to a 3-month-old with GER. The child's parents ask the nurse how the medication works. Which is the nurse's best response? a. "Prilosec is a proton pump inhibitor that is commonly used for reflux in infants." b. "Prilosec helps food move through the stomach quicker, so there will be less chance for reflux." c. "Prilosec decreases stomach acid, so it will not be as irritating when your child spits up." d. "Prilosec relaxes the pressure of the lower esophageal sphincter."

c. "Prilosec decreases stomach acid, so it will not be as irritating when your child spits up." This accurate description gives the parents information that is clear and concise without using confusing medical terminology.

The nurse is providing instructions to the mother of an infant who had a cleft palate repair. Which is appropriate post operative instructions for the mother? a. "You need to use a plastic spoon to feed your child" b. "You must keep the infant's arm restraints on all day so she doesn't pull out the stiches" c. "You may resume breastfeeding in the postoperative period" d. "You need to monitor the temperature with an oral thermometer to identify signs of infection"

c. "You may resume breastfeeding in the postoperative period" The infant may resume oral feedings (at breast or by bottle) in the postoperative period. Straws, pacifiers, spoons should be kept from the infant for 7-10 days and all efforts should be made to keep the infant's fingers from the mouth. Arm restrains may be needed, but they must be removed regularly (at least every 2 hours). Avoid oral thermometer as this can disrupt the stitches (and would not be used in an infant)

Which clinical manifestation would most suggest acute appendicitis? a. Rebound tenderness b. Abdominal pain that is relieved by eating c. Abdominal pain that is most intense at McBurney point d. Bright red or dark red rectal bleeding

c. Abdominal pain that is most intense at McBurney point Pain is the cardinal feature. It is initially generalized and usually periumbilical. The pain localizes to the right lower quadrant at McBurney point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Abdominal pain that is relieved by eating and is most intense at McBurney point are not signs of acute appendicitis.

The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is restless with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115. The parents state that the child has not urinated in 12 hours. After establishing a saline lock, the nurse reviews the physician's orders. Which order should the nurse question? a. Administer a saline bolus of 10 mL/kg, which may be repeated if the child does not urinate. b. Recheck serum electrolytes in 12 hours. c. After the saline bolus, begin maintenance fluids of D5 ¼ NS with 10 mEq KCl/L. d. Give clear liquid diet as tolerated.

c. After the saline bolus, begin maintenance fluids of D5 ¼ NS with 10 mEq KCl/L. Potassium is contraindicated because the child has not yet urinated. Potassium is not added to the maintenance fluid until kidney function has been verified. Fluid boluses of normal saline are administered according to the child's body weight. It is not unusual to have to repeat the bolus multiple times in order to see an improvement in the child's condition. It is important to monitor serum electrolytes frequently in the dehydrated child. The child with dehydration secondary to vomiting and diarrhea is placed on a clear liquid diet until the vomiting subsides.

An important nursing consideration when caring for a child with impetigo contagiosa is to: a. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. b. Examine child under a Wood lamp for possible spread of lesions. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Apply topical corticosteroids to decrease inflammation.

c. Carefully wash hands and maintain cleanliness when caring for an infected child. A major nursing consideration related to bacterial skin infections such as impetigo contagiosa is to prevent the spread of the infection and complications. This is done by thorough handwashing before and after contact with the affected child. Corticosteroids are not indicated in bacterial infections. Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states such as tinea capitis.

One of the first signs of overwhelming sepsis in a child with burn injuries is: a. Seizures. b. Decreased blood pressure. c. Disorientation. d. Bradycardia.

c. Disorientation. Disorientation in the burn patient is one of the first signs of overwhelming sepsis and may indicate inadequate hydration. Seizures, bradycardia, and decreased blood pressure are not initial manifestations of overwhelming sepsis.

An invagination (telescoping) of one portion of the intestine into another is called: a. Tracheo-esophageal fistula b. Pyloric stenosis c. Intussusception d. Hirschprung disease

c. Intussusception

A common fungal infection of the skin in pediatrics is: a. scabies b. warts c. tinea corporis d. herpes simplex type 1

c. tinea corporis Tinea is the only fungal infection listed. Herpes is a virus, scabies is an infestation, warts are viral.

An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is: a. Aplastic anemia. b. Thalassemia major. c. Disseminated intravascular coagulation. d. Idiopathic thrombocytopenic purpura

d. Idiopathic thrombocytopenic purpura

The family of a 4-month-old infant will be vacationing at the beach. The best recommendation for preventing sunburn is to: a. Use sun block on the infant's nose and ear tips. b. Use a topical sunscreen product with a sun protective factor of 15. c. The infant can be exposed to the sun for 15-minute increments. d. Keep the infant in total shade at all times.

d. Keep the infant in total shade at all times. The infant should be kept out of the sun or physically shaded from it. Fabric with a tight weave such as cotton, offers good protection. Infants should be covered with clothing or kept in the shade to prevent sun damage to the delicate skin at all times. The blocker can protect the nose and ear tips, but none of the infant"s skin should be exposed. Sunscreens should not be used extensively on infants younger than 6 months.

Therapeutic management of the child with acute diarrhea and dehydration usually begins with: a. Antidiarrheal medications such as paregoric. b. Clear liquids. c. Adsorbents such as kaolin and pectin. d. Oral rehydration solution (ORS).

d. Oral rehydration solution (ORS). ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended and neither are antidiarrheals because they do not get rid of pathogens.

What fluid is the best choice when a child with mucositis asks for something to drink? a. Hot chocolate b. Orange juice c. Lemonade d. Popsicle

d. Popsicle No hot or citrus drinks that could be irritating

An infant is being evaluated in clinic for diaper dermatitis. The parent states they are changing the diaper frequently to keep the infant dry, but it does not seem to be helping. Which of the following interventions would be most appropriate to suggest to this parent? a. Be certain to cleanse the area thoroughly after each void or stool with commercial wipes. b. Apply talcum powder after applying the skin barrier cream. c. Use a hair dry on the "cool" setting to assist in drying the buttocks and then reapply the skin barrier cream. d. Remove the waste material from the infant's buttocks and reapply the skin barrier cream.

d. Remove the waste material from the infant's buttocks and reapply the skin barrier cream. -Remove the waste material and reapply the skin barrier cream- Keeping the stool enzymes off the skin and reapplying a barrier cream will enhance protection and healing. -Talc is never recommended - the child may inhale the powder -Commercial wipes may be caustic to the skin. Better to use a hypoallergenic soap and water. -Air drying is a safer method to keep the skin clean and dry. A parent may err and use the dryer on a higher setting which could burn the infant

Several complications can occur when a child receives a blood transfusion. Which is an immediate sign or symptom of an air embolus? a. Chills and shaking b. Nausea and vomiting c. Irregular heart rate d. Sudden difficulty in breathing

d. Sudden difficulty in breathing

An infant with moderate dehydration may demonstrate: a. tachycardia, bulging fontanel and decreased blood pressure b. decreased urine output, tachycardia and high fever c. mottled skin color and decreased pulse and respirations d. dry mucous membranes, slowed capillary refill (2-4 sec) and decreased tears

d. dry mucous membranes, slowed capillary refill (2-4 sec) and decreased tears As a child becomes dehydrated you will see dry mucous membranes, slower cap refill and decreased tearing. See page 1256 (table) in the textbook.

The most important therapeutic management for the child with celiac disease is: a. adding iron, folic acid and fat soluble vitamins to the diet. b. eliminating corn, rice and millet from the diet. c. educating the child's parents about the short term effects of the disease and the necessity of reading all food labels for content until the disease is in remission. d. eliminating wheat, rye, barley and oats from the diet.

d. eliminating wheat, rye, barley and oats from the diet. Celiac is a permanent condition of intestinal intolerance to dietary wheat gliadin and related proteins. There is no remission from this condition. (pg. 1300 in the text)