PEDS Test 2

The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching? A. Red blood cell counts should show increase with appropriate therapy B. Urine output will increase with therapy C. These injections are intended to thin the blood and increase blood flow to the kidney D. These injections will need to be given on a monthly basis

A. Red blood cell counts should show increase with appropriate therapy

A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply) A. Vomiting B. Jaundice C. Swelling of the face D. Persistent diaper rash E. Failure to gain weight

A, D, E

The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? (Select all that apply.) A. Do not reuse needles B. Inject insulin when it is cold C. Flex or tense the muscle during injection D. Remove all bubbles from the syringe prior to injection E. Do not move the direction of the needle-syringe during insertion or withdrawal

A, D, E

The nurse is caring for a child with a Wilms' tumor. What is the most important nursing intervention preoperatively? A. Avoid abdominal palpation. B. Closely monitor the arterial blood gases. C. Prepare the child and family for long-term dialysis. D. Prepare the child and family for renal transplantation.

A. Avoid abdominal palpation. Wilms' tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. A sign should be placed over the bed indicating that no abdominal palpation should be conducted. Monitoring of arterial blood gases is not indicated preoperatively for this abdominal surgery. Long-term dialysis is not indicated, unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative irradiation and/or chemotherapy is used to minimize the tumor size. Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.

Calcium carbonate is given with meals to a child with chronic renal disease. What is the purpose of administering calcium carbonate? A. Bind phosphorus B. Increase absorption of vitamin C C. Prevent stomach upset D. Stimulate bone growth

A. Bind phosphorus

What is the most important nursing consideration related to congenital hypothyroidism? A. Early identification of the disorder B. Facilitation of parent-infant attachment C. Initiation of referrals for mental retardation D. Help for parents in dealing with the child's future prospects

A. Early identification of the disorder Early diagnosis of congenital hypothyroidism is imperative. Because brain growth is complete by 2 to 3 years of age, the thyroid hormone deficiency must be detected and replacement therapy begun as soon as possible to prevent long-term or life-threatening complications. The promotion of parent-infant attachment is important with all infants. With appropriate intervention, the child may not have any developmental deficit. With appropriate intervention, the child may not have any developmental deficit.

The nurse is planning care for a child recently diagnosed with diabetes insipidus. Which nursing intervention should be planned? A. Encourage the child to wear medical identification. B. Discuss with the child and family ways to limit fluid intake. C. Teach the child and family how to do required urine testing. D. Reassure the child and family that diabetes insipidus is usually not a chronic or life-threatening illness.

A. Encourage the child to wear medical identification. Because of the unstable nature of the child's fluid and electrolyte balance, wearing a medical alert bracelet or carrying a medical identification card is an extremely important intervention. With diabetes insipidus, the child should have unrestricted access to fluids because the child will characteristically have polyuria due to a hyposecretion of antidiuretic hormone. No urine testing is required with diabetes insipidus. This disorder should not be confused with diabetes mellitus. Diabetes insipidus is both lifelong and life-threatening. Medication must be taken and the effects monitored closely.

An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What should the nurse's explanation include? A. Explain the disorder so that the parents can explain it to others. B. Help the parents understand that no one knows how this occurs. C. Suggest that the parents avoid family and friends until the gender is assigned. D. Encourage the parents not to worry while the tests are being done.

A. Explain the disorder so that the parents can explain it to others. Explaining the disorder to the parents so that they can explain it to others is the most therapeutic approach while the parents await the gender assignment of their child. Ambiguous genitalia are caused by decreased enzyme activity required for adrenocortical production of cortisol. Avoidance of family and friends is impractical and would isolate the family from their support system while awaiting test results. The parents will be concerned. Telling the parents not to worry without giving them specific alternative actions will not be effective.

A child with lymphoma is receiving extensive radiotherapy. What is the most common side effect of this treatment? A. Fatigue B. Seizures C. Neuropathy D. Lymphadenopathy

A. Fatigue Fatigue is the most common side effect of radiotherapy. For children, the fatigue may be distressing because they cannot keep up with their peers.

What is the most appropriate action to stop an occasional episode of epistaxis? A. Have the child sit up and lean forward. B. Apply ice under the nose and above the lip. C. Have the child lie down quietly with the feet elevated. D. Apply continuous pressure to the nose with the thumb and forefinger for at least 1 minute.

A. Have the child sit up and lean forward. Sitting up and leaning forward is the position used to prevent the child from aspirating blood. Pressure, not ice, is indicated for an occasional episode of epistaxis. Lying the child down with the feet elevated can potentially lead to aspiration. Continuous pressure for 10 minutes is recommended; 1 minute would not be long enough.

In addition to presenting symptoms, what laboratory finding indicates nephrosis? A. Hypoalbuminemia B. Low specific gravity C. Decreased hematocrit D. Decreased hemoglobin

A. Hypoalbuminemia Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into the urine in a child with nephrosis. The specific gravity is increased due to the large amount of protein in a child with nephrosis. The hematocrit would be elevated secondary to nephrosis. The hemoglobin would be elevated secondary to the hypovolemia in a child with nephrosis.

During the summer, many children are more physically active. What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise? A. Increased food intake B. Decreased food intake C. Increased risk of hyperglycemia D. Decreased risk of insulin shock

A. Increased food intake Food intake should be increased in the summer when the child is more active. During races and other competitions, more food may be required than at other practice times to maintain a balance between glucose and exogenously administered insulin. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid administering too much insulin during a time of reduced need.

Which statement best describes Cushing syndrome? A. It is caused by excessive production of cortisol. B. The major clinical features are exophthalmia and pigmentary changes. C. Treatment involves replacement of cortisol. D. Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

A. It is caused by excessive production of cortisol. Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. Exophthalmia and pigmentary changes are manifestations of hyperthyroidism, not Cushing syndrome. The treatment for Cushing syndrome involves the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Hypertension and hypokalemia—not hypotension, hyperkalemia, or polyuria—are expected findings with Cushing syndrome.

Nursing considerations related to the administration of chemotherapeutic drugs include? A. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates B. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary C. Infiltration will not occur, unless superficial veins are used for the intravenous infusion D. Anaphylaxis cannot occur, because the drugs are considered toxic to normal cells

A. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates

The clinical manifestations of nephrotic syndrome include which of the following? A. Massive proteinuria, hypoalbuminemia, edema B. Hypertension, weight loss, proteinuria C. Gross hematuria, albuminuria, fever D. Hematuria, bacteriuria, weight gain

A. Massive proteinuria, hypoalbuminemia, edema

What are the most common signs and symptoms of leukemia related to bone marrow involvement? A. Petechiae, infection, fatigue B. Headache, papilledema, irritability C. Muscle wasting, weight loss, fatigue D. Decreased intracranial pressure, psychosis, confusion

A. Petechiae, infection, fatigue Petechiae, infection, and fatigue are signs of infiltration of the bone marrow. Petechiae occur from a lowered platelet count, infection occurs from the depressed number of effective leukocytes, and fatigue occurs from the anemia. Headache, papilledema, and irritability are not signs of bone marrow involvement. Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. The acute phase seems to be over when ascending flaccid paralysis occurs. What is the most appropriate nursing action? A. Reassure the family that this condition is temporary. B. Reassure the family that flaccid paralysis is not problematic. C. Prepare the family for impending death. D. Prepare the family for the long-term consequences of paralysis.

A. Reassure the family that this condition is temporary. During the recovery phase, paralysis may develop. It is a temporary, quickly reversible clinical manifestation. Flaccid paralysis is problematic if not reversible. Flaccidity can indicate impending death in a child with neurologic deficits but is not associated with adrenocortical insufficiency. Ascending flaccid paralysis is a reversible condition when associated with adrenocortical insufficiency. Paralysis is a temporary, quickly reversible clinical manifestation.

What is the most important nursing consideration when caring for a child with sickle cell anemia? A. Teach the parents and child how to minimize crises. B. Refer the parents and child for genetic counseling. C. Help the child and family to adjust to a short-term disease. D. Observe for complications of multiple blood transfusions.

A. Teach the parents and child how to minimize crises. Children and their families need specific instructions on how to minimize crises, including preventing infections; maintaining adequate hydration; and addressing environmental concerns, such as avoidance of extreme cold. Genetic counseling is important, but teaching care for the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority is that the child and the parents are properly prepared to manage the chronic disease.

Marcus is a 9 year old with chronic renal failure. His family is trying to decide whether to choose peritoneal dialysis or hemodialysis for Marcus' chronic dialysis treatment. Which of the following is an advantage of peritoneal dialysis for the treatment of chronic renal failure in children? A. The child can attend school for five days a week. B. Treatments are donein clinics or hospitals. C. The risk of infection is extremely low. D. The skill can be taught in one to two hours.

A. The child can attend school for five days a week.

Which physiologic alteration is characterized by destruction of pancreatic beta cells that produce insulin? A. Type 1 diabetes B. Type 2 diabetes C. Impaired glucose tolerance D. Gestational diabetes

A. Type 1 diabetes Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta cells that produce insulin.

In a non-potty-trained child with nephrotic syndrome, what is the best way to detect fluid retention? A. Weigh the child daily. B. Test the urine for hematuria. C. Measure the abdominal girth weekly. D. Count the number of wet diapers.

A. Weigh the child daily. A daily weight taken at the same time every day, with the child wearing the same clothing, is the most accurate way to determine fluid gains and losses. The presence or absence of blood in the urine will not help with the determination of fluid retention. The abdominal girth will reflect edema, but weekly measurements are too infrequent. The number of wet diapers reflects how often the diapers have been changed. The diapers should be weighed to reflect the fluid balance.

Which urine test would be considered abnormal? A. pH: 4 B. Specific gravity: 1.020 C. Protein level: absent D. Glucose level: absent

A. pH: 4 The expected pH of urine is 4.8 to 7.8. A specific gravity of 1.020 is within the normal specific gravity range of 1.015 to 1.030. Protein should not be present in the urine. It would indicate an abnormality in glomerular filtration. Glucose should not be present in the urine. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

The father of an infant with hypospadias asks the nurse why the defect is repaired early in life. The best response is that the repair is done early in order to: A. promote development of normal body image and sexual function B. promote acceptance of hospitalization C. prevent complications from anesthesia D. prevent separation anxiety

A. promote development of normal body image and sexual function

The nurse is admitting a 12-year-old girl to the hospital prior to surgery. The physician has ordered a urinalysis. In order to obtain accurate urinalysis data, the nurse should: A. provide client/parent education for specimen collection before the specimen is obtained. B. allow the urine to cool to room temperature before taking it to the lab. C. cleanse the specimen container with povidone-iodine (Betadine) prior to collecting the specimen. D. encourage fluids to 1000 mL prior to specimen collection.

A. provide client/parent education for specimen collection before the specimen is obtained.

A young child is diagnosed with grade III vesicoureteral reflux. The nurse should know that this condition usually results in: A. recurrent urinary tract infections B. incontinence C. urinary obstruction D. infarction of renal vessels

A. recurrent urinary tract infections

A breastfed newborn has just been diagnosed with galactosemia. The therapeutic management for this newborn is to? A. stop breastfeeding. B. add amino acids to the breast milk. C. Substitue a lactose-containing formula for breast milk D. give the appropriate enzyme along with breast milk.

A. stop breastfeeding. All milk- and lactose-containing formulas, including breast milk, must be stopped during infancy. Soy protein is the formula of choice for newborns and infants with galactosemia. Breast milk should not be used in newborns and infants with galactosemia. The formula used for a newborn and infant with galactosemia cannot contain lactose. Breast milk should not be used in newborns and infants with galactosemia.

A child is status post hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (Select all that apply.) A. Preparing the child to return to school within six weeks B. Keeping the child on a high-calcium diet C. Avoiding live plants and fresh vegetables D. Avoiding influenza vaccinations E. Practicing good hygiene

B, C, E

The parents of a child hospitalized with acute glomerulonephritis ask the nurse why blood pressure readings are being taken so often. The nurse's reply should be based on the knowledge of which of the following? A. Blood pressure fluctuations are a sign that the condition will likely be fatal. B. Acute hypertension must be identified and treated. C. Blood pressure fluctuations are common side effects of antibiotic therapy. D. Hypotension leading to sudden shock can develop at any time.

B. Acute hypertension must be identified and treated.

What is the most common cause of secondary hyperparathyroidism? A. Diabetes mellitus B. Chronic renal disease C. Congenital heart disease D. Growth hormone deficiency

B. Chronic renal disease Chronic renal disease is the most common cause of secondary hyperparathyroidism. The parathyroid gland plays an integral role in the maintenance of calcium in the body, as do the kidneys. Diabetes mellitus does not contribute to secondary hypoparathyroidism. Congenital heart disease does not contribute to secondary hypoparathyroidism. Growth hormone deficiency does not contribute to secondary hypoparathyroidism.

The nurse should recognize that when a child develops diabetic ketoacidosis (DKA), treatment will be instituted as described in which of the following statements? A. No treatment is required, because DKA is an expected outcome of type 1 diabetes mellitus B. Immediate treatment is required because DKA is a life-threatening situation C. DKA is best treated at home D. DKA is best treated at a practitioner's office or clinic

B. Immediate treatment is required because DKA is a life-threatening situation DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an intensive care unit for assessment, intravenous insulin administration, and fluid and electrolyte replacement. DKA is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. It is not an expected outcome of type 1 diabetes mellitus. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit.

The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication? A. Hypertension B. Infection C. Edema D. Mental Status changes

B. Infection

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? A. Lemon glycerin swabs for cleansing B. Mouthwashes with normal saline C. Mouthwashes with hydrogen peroxide D. Local anesthetic such as viscous lidocaine before meals

B. Mouthwashes with normal saline

The school nurse is explaining to a child's kindergarten teacher that the child is allergic to peanuts. The nurse should include information that? A. the child will most likely outgrow the allergy soon. B. the child should have an injectable epinephrine cartridge available at all times. C. the child allergic to peanuts can usually have peanut butter, but not whole peanuts. D. the child usually only shows skin signs such as hives when allergic.

B. the child should have an injectable epinephrine cartridge available at all times.

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. Which response by the nurse is most accurate? A. "SCA is not inherited." B. "All siblings will have SCA." C. "There is a 25% chance of a sibling having SCA." D. "There is a 50% chance of a sibling having SCA."

C. "There is a 25% chance of a sibling having SCA." SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, there is a 25% chance that each subsequent child will have the disorder. SCA is an inherited hemoglobinopathy. In autosomal recessive disorders, there is a chance that 25% of the children will not have either SCA or sickle cell trait. There is a chance that 50% of the siblings will have sickle cell trait.

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. The most appropriate response by the nurse is? A. "The pills work with an adult pancreas only." B. "The drugs affect fat and protein metabolism, not sugar." C. "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." D. "Perhaps when your child is older, the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

C. "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." In type 1 diabetes, the beta cells have been destroyed. It is necessary to supply the insulin no longer produced by the beta cells. The oral medications have different modes of action that supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes and are primarily used in type 2 diabetes mellitus. Oral hypoglycemics can supplement insulin production by the pancreas, decrease insulin resistance, or affect the liver production of glucose. In type 1 diabetes, the beta cells have been destroyed. Without a pancreatic beta cell transplant, it is unlikely that insulin would be produced.

A 6-year-old child with acute renal failure (ARF) is being transferred out of the intensive care unit. Which children, considering their diagnoses, would be the most appropriate roommate for this child? A. 6-year-old child with pneumonia B. 4-year-old child with gastroenteritis C. 5-year-old child who has a fractured femur D. 7-year-old child who had surgery for a ruptured appendix

C. 5-year-old child who has a fractured femur The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin. A child with pneumonia has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF. A child with gastroenteritis has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF. A child who has had surgery for a ruptured appendix may have an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.

What is an advantage to teach to the family about continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents who require dialysis? A. Hospitalization is only required several nights per week. B. Dietary restrictions are no longer necessary. C. Adolescents can carry out procedures themselves. D. Insertion of a catheter does not require surgical placement.

C. Adolescents can carry out procedures themselves. This type of dialysis provides the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves, and the procedure is usually performed at night, enabling the adolescent to live life more normally during the day. CCPD and CAPD can be done at home. Dietary restrictions are still required but are less strict when an adolescent is on CCPD or CAPD. The catheter is surgically implanted in the abdominal cavity for both CCPD and CAPD.

What statement should the nurse include when discussing a child's precocious puberty with the parents? A. The child is not yet fertile. B. Sexual interest is usually advanced. C. Dress and activities should be appropriate to the chronologic age. D. The appearance of secondary sex characteristics does not proceed in the usual order.

C. Dress and activities should be appropriate to the chronologic age. Development of the secondary sex characteristics proceeds in the usual order. Functioning sperm or ova may be produced, making the child fertile. Heterosexual interest is usually appropriate to the chronologic age. Because of the child's early sexual maturation, both the family and child require extensive teaching. Included in this teaching is the information that the child should be engaged in activities according to his or her chronologic age.

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted? A. Apply warm, moist compresses. B. Apply pressure for at least 1 minute. C. Elevate the area above the level of the heart. D. Begin passive range-of-motion unless the pain is severe.

C. Elevate the area above the level of the heart. The initial response should include elevation of the arm to minimize bleeding. Cold should be applied to the arm. This will aid in vasoconstriction, minimizing blood loss. Pressure is effective in small areas but would not be as effective for an extremity. Passive range-of-motion is not recommended. The child can perform active range-of-motion after the bleeding episode has resolved.

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if playing soccer, playing baseball, and swimming are still possible. The nurse's response should be based on knowledge that? A. Exercise is contraindicated in the type 1 diabetic child B. Soccer and baseball are too strenuous, but swimming is acceptable C. Exercise is not restricted unless indicated by other health conditions D. The level of activity depends on the type of insulin required

C. Exercise is not restricted unless indicated by other health conditions Exercise is encouraged for children with type 1 diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged, with insulin and food adjusted for the exercise. The child needs to be cautioned to monitor responses to the exercise. The level of activity does not depend on the type of insulin used. Long-acting and short-acting insulin may both be used to provide coverage for the training and sporting events.

What is the most common cause of acute renal failure in children? A. Urinary tract infection B. Diabetes mellitus C. Hypovolemia and decreased perfusion D. Pyelonephritis

C. Hypovolemia and decreased perfusion

The school nurse is discussing prevention of acquired immunodeficiency syndrome (AIDS) with some adolescents. Which statement is appropriate to include? A. the virus is easily transmitted. B. The virus is transmitted only through blood. C. Intravenous drug users should not share needles. D. Condoms should be used if a person is sexually active and homosexual.

C. Intravenous drug users should not share needles.

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this is usually associated with? A. incontinence B. Urinary obstruction C. Recurrent kidney infections D. infarction of renal vessels

C. Recurrent kidney infection Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to kidney infections. Incontinence may be associated with urinary tract infections but not directly with vesicoureteral reflux. Vesicoureteral reflux can cause renal scarring but not obstruction. Infarction of the renal vessels does not occur with vesicoureteral reflux.

A child is receiving cyclosporine following a kidney transplant. The child's parents ask the nurse the reason for the cyclosporine. The nurse's response is based on the knowledge that the medication's purpose is to? A. Decrease pain B. Boost immunity C. Suppress rejection D. Improve circulation to the kidney

C. Suppress rejection Cyclosporine is given to suppress rejection. Cyclosporine does not decrease pain, boost immunity, or improve circulation.

The parent of a child hospitalized with acute glomerulonephritis (AGN) asks the nurse why blood pressure readings are being taken so often. Based on the nurse's knowledge of AGN, the most appropriate response by the nurse is? A. blood pressure fluctuations are a common side effect of antibiotic therapy. B. blood pressure fluctuations are a sign that the condition has become chronic. C. acute hypertension must be anticipated and identified. D. hypotension leading to sudden shock can develop at any time.

C. acute hypertension must be anticipated and identified. Vital signs, in particular the blood pressure, provide information about the severity of AGN and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations are not indicative of chronic disease. Most children with AGN fully recover. Hypertension, not hypotension, is more likely with AGN.

A 3-year-old child is scheduled for surgery to remove a Wilms' tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation should be based on knowledge that? A. no additional treatments are usually necessary. B. chemotherapy is usually not necessary. C. chemotherapy with or without radiotherapy is indicated. D. kidney transplant will be indicated within the year.

C. chemotherapy with or without radiotherapy is indicated. The determination of chemotherapy and/or radiotherapy as treatment modalities will be made 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 transplants.

A neonate with a goiter has just been admitted to the newborn nursery. A priority nursing intervention is to? A. position the neonate on the left side. B. explain to the parents how to place the dressing on the goiter. C. have a tracheostomy set at bedside. D. suction at least every 5 to 10 minutes.

C. have a tracheostomy set at bedside. The goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including having a tracheostomy set at the bedside. Placing the neonate in a side-lying position is not indicated. Hyperextension of the child's neck may facilitate breathing. No dressing is indicated in a neonate who has a goiter. There is no indication for suctioning in a neonate with goiter.

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to? A. administer 100% oxygen to relieve hypoxia. B. administer pain medication to relieve symptoms. C. notify practitioner because chest syndrome is suspected. D. notify practitioner because child may be having a stroke.

C. notify practitioner because chest syndrome is suspected. Severe chest pain, fever, a cough, and dyspnea are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. Breathing 100% oxygen to relieve hypoxia may be ordered by the practitioner, but the first action is notification because these symptoms indicate a medical emergency. Pain medications may be indicated, but evaluation is necessary first. Severe chest pain, fever, cough, and dyspnea are not signs of a stroke.

A 5-year-old child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to the child's parent that the first action is to have the child evaluated for? A. school phobia. B. emotional causes. C. possible urinary tract infection. D. possible structural defects of urinary tract.

C. possible urinary tract infection. Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection. A physical cause of the problem needs to be eliminated before a psychological cause is considered. Emotional causes should be investigated only once a physical cause has been ruled out. Possible structural defects would be explored as a cause after a urinary tract infection is confirmed.

A 17-year-old with type 1 diabetes mellitus tells the school nurse about recently starting to drink alcohol with friends on weekends. The most appropriate intervention by the nurse is to? A. tell the adolescent not to drink alcohol. B. ask the adolescent about the reasons for drinking alcohol. C. teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake. D. recommend counseling so that the adolescent understands the serious consequences of alcohol consumption.

C. teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake. The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the management of the illness. Telling someone not to drink will not help should the person choose to continue drinking. Asking the adolescent why the drinking is occurring will provide information to the nurse but will not address the information that the adolescent needs to have about managing the disease. Counseling can be included in the teaching plan.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include to? A. restrict oral fluids. B. institute strict isolation. C. use good hand-washing technique. D. give immunizations appropriate for age.

C. use good hand-washing technique.

A child with β-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine (Desferal) therapy. The child's parents ask the nurse what deferoxamine does. The most appropriate response by the nurse is? A. "The medication helps to prevent blood transfusion reactions." B. "The medication stimulates red blood cell production." C. "The medication provides vitamin supplementation." D. "The medication helps to prevent iron overload."

D. "The medication helps to prevent iron overload." A side effect of hypertransfusion therapy is often iron overload. Deferoxamine is an iron-chelating drug that binds excess iron; therefore, it can be excreted by the kidneys. Deferoxamine does not prevent blood transfusions. Deferoxamine does not stimulate red cell production. Deferoxamine is not a vitamin supplement.

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed? A. Restrain the child as necessary. B. Discourage the parents from holding the child. C. Do passive range-of-motion exercises once a day. D. Adjust activities to the child's tolerance level.

D. Adjust activities to the child's tolerance level. The child will have a variable level of tolerance for activity. The activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child that are age appropriate. Restraints should not be used to confine children to bed, unless they are a potential threat to themselves or others. Parents should be encouraged to hold the child. The child should be encouraged to move all extremities while in bed to prevent the potential complications of immobility.

A 10-year-old child with renal failure requires erythropoietin injections to treat anemia. Which of the following contribute to the anemia associated with chronic renal failure? A. Decreased iron stores B. Decreased erythropoietin secretion by the kidney C. Decreased life span of red blood cells due to uremia D. All of the above

D. All of the above

A child in renal failure has hyperkalemia. Which foods should be avoided? A. Cold cuts, chips, and canned foods B. Hamburger on a bun and lime Jell-O C. Spaghetti with meat sauce and breadsticks D. Bananas, carrots, and green leafy vegetables

D. Bananas, carrots, and green leafy vegetables Bananas, carrots, and green leafy vegetables are high in potassium. Cold cuts, chips, and canned foods are high in sodium but not necessarily in potassium. A hamburger on a bun and lime Jell-O is an acceptable choice for a low-potassium diet. Spaghetti with meat sauce and breadsticks is an acceptable choice for a low-potassium diet.

Which best describes acute glomerulonephritis? A. It requires a low protein diet as part of the treatment regimen B. It occurs after a lower urinary tract infection C. It is associated with anomalies of the GU tract D. It occurs after a streptococcal infection

D. It occurs after a streptococcal infection

What is an important nursing consideration when caring for a child with end-stage renal disease (ESRD)? A. Children with ESRD usually adapt well to the minor inconveniences of treatment. B. Children with ESRD require extensive support until they outgrow the condition. C. Multiple stresses are placed on children with ESRD and their families until the illness is cured. D. Multiple stresses are placed on children with ESRD and their families because their lives are maintained by drugs and artificial means.

D. Multiple stresses are placed on children with ESRD and their families because their lives are maintained by drugs and artificial means. ESRD is a chronic, progressive illness with dependence on technology. Families need to arrange for continuing examinations and procedures that are often painful and may require hospitalization. ESRD is a complex disease process that requires substantial medical intervention and is not minor in its treatment modalities. ESRD cannot be outgrown. Dialysis is necessary until renal transplantation is performed. ESRD cannot be cured. Dialysis is necessary until renal transplantation is performed.

The nurse suspects a child is having an adverse reaction to a blood transfusion. What should the nurse's first action be? A. Notify the physician. B. Take vital signs and blood pressure and compare them with baseline values. C. Dilute infusing blood with equal amounts of normal saline. D. Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

D. Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

A toddler is hospitalized with acute renal failure (ARF) secondary to severe dehydration. The nurse should assess the child for what possible complications? A. Hypotension B. Hypokalemia C. Hypernatremia D. Water intoxication

D. Water intoxication The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes. The child needs to be monitored for hypertension, not hypotension, when hospitalized with acute renal failure. Hyperkalemia, not hypokalemia, is a concern in acute renal failure. Hyponatremia, not hypernatremia, may develop in acute renal failure as the sodium is diluted in large amounts of water.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. The nurse should explain that this is? A. a symptom of iron deficiency anemia. B. an adverse effect of the iron preparation. C. an indicator of an iron preparation overdose. D. a normally expected change due to the iron preparation.

D. a normally expected change due to the iron preparation. An adequate dosage of iron turns the stools a tarry black color. Tarry black stools are not a sign of iron deficiency anemia. Tarry black stools are not an adverse effect of the iron preparation but an expected effect. Tarry black stools are not an indicator of iron preparation overdose.

Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes? A. application of cold salts to suppress the inflammatory process. B. a high-protein, low-salt diet. C. a rigorous exercise regimen to build up muscle strength and endurance. D. administration of corticosteroids to control inflammation.

D. administration of corticosteroids to control inflammation.

You are analyzing the lab results for a child admitted to the emergency room. The following results are noted: Blood Urea Nitrogen: 74 Creatinine: 0.8 Sodium: 141 Potassium: 3.9 Based on the laboratory findings, you will further assess the child for: A. hypokalemia B. hyponatremia C. acute renal failure D. dehydration

D. dehydration

External defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to ensure? A. prevention of urinary tract complications. B. prevention of separation anxiety. C. acceptance of hospitalization. D. development of normal body image.

D. development of normal body image. Promotion of a normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Surgical intervention for external defects of the genitourinary system should be done as soon as possible. Prevention of urinary tract complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible. Proper preprocedure preparation can help prevent or at least reduce separation anxiety. Acceptance of hospitalization is important but not the reason for early surgical intervention of external defects of the genitourinary system.

Dialysis or transplantation becomes necessary for chronic renal failure when: A. anemia develops B. growth declines to less than the 5th percentile C. acidosis develops D. glomerular filtration rate decreases below 10 to 15% of normal

D. glomerular filtration rate decreases below 10 to 15% of normal

The nurse is explaining blood components to an 8-year-old child. Based on the nurse's knowledge of child development, the most appropriate description of platelets is that they? A. help keep germs from causing infection. B. make up the liquid portion of blood. C. carry the oxygen you breathe from your lungs to all parts of your body. D. help your body stop bleeding by forming a clot (scab) over the hurt area.

D. help your body stop bleeding by forming a clot (scab) over the hurt area.

Which of the following lab abnormalities is not usually associated with acute renal failure? A. Increased BUN B. metabolic acidosis C. increased creatinine D. hypokalemia

D. hypokalemia

The newborn diagnosed with phenylketonuria (PKU) will require long-term follow-up to assess for the development of? A. obesity B. diabetes insipidus. C. respiratory distress. D. mental retardation.

D. mental retardation. PKU, an inborn error of metabolism, may lead to mental retardation if early intervention is not performed. Obesity is not associated with PKU. Diabetes insipidus is not associated with PKU. Respiratory distress is not associated with PKU.

Under normal conditions, which of the following substances is not filtered by the glomerulus of the kidney? A. water B. urea C. electrolytes D. protein

D. protein

You are the pediatric nurse on call for a pediatric clinic. At 1:00 am, you receive a telephone call from the mother of Ben. Ben is a 13-year-old boy, who is complaining of sudden onset of groin and testicular pain that began 2 hours ago. He also complains of nausea. The nurse recognizes these complaints as signs and symptoms of testicular torsion, and recommends: A. limitation of sports activities until pain subsides. B. follow up in clinic at 9:00 am the next morning. C. application of ice packs every 2 hours until pain subsides. D. referral to the emergency department immediately for surgical evaluation.

D. referral to the emergency department immediately for surgical evaluation.