Peds Test 6 Practice Questions

Grief: 2-5 years

-child may see death as reversible -aggressive behavior may occur -child has a sense of loss and is concerned about who will provide care

Greif: Birth to 1 year

-infant has no concept of death -infant reacts to the loss of mother or caregiver

What are the priorities for a client with a Wilms tumor?

-protect the child from injury to the encapsulated tumor -prepare family and child for surgery

Grief: 1-2 years

-toddler may see death as reversible -toddler may scream, withdraw, or become disinterested in the environment -grief response occurs only to the death of the significant person in the toddler's life

The nurse reviews the latest laboratory results for a child who received chemotherapy last week and identifies a reduced neutrophil count. Which nursing dx has the highest priority for this child?

Risk for infection

5. A dying child's family says, "We're going to go home and get some rest. He'll probably linger on for a while. That's what our grandmother did." The healthcare provider suggests the family may want to stay because he or she has assessed that the child has what imminent sign of dying? a. Cheyne-Stokes respirations b. The child is pain free c. Korotkoff sounds d. Uniformly ashen colored skin

a. Cheyne-Stokes respirations

7. Information regarding the signs of imminent death should be discussed with the family, both before and as they occur. a. True b. False

a. True

10. The priority of care during the dying process is to: a. assess and manage the patient's pain. b. maintain the patient's hydration. c. inquire if the patient is hungry. d. keep the patient sedated.

a. assess and manage the patient's pain.

372. The nurse is performing an assessment on a 10- year-old child suspected to have Hodgkin's disease. Which assessment findings are specifically characteristic of this disease? Select all that apply. 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful, enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area

1. Abdominal pain 5. Painless, firm, and movable adenopathy in the cervical area

364. The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension

1. Palpating the abdomen for a mass

367. The nurse ismonitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache

1. Vomiting

Nursing interventions and medical treatments for a child with leukemia are based on what three physiologic problems?

1. anemia (decreased erythrocytes) 2. infection (neutropenia) 3. bleeding thrombocytopenia (decreased platelets)

365. The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a *need* *for information*? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

2. "The child does not experience pain at the primary tumor site."

368. A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? 1. Lumbar puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 mm3 (350Â109/L) 4. White blood cell count 4500 mm3 (4.5Â109/L)

2. Bone marrow biopsy showing blast cells

362. The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse perform *immediately*? 1. Reinforce the dressing 2. Notify the HCP 3. Document the findings and continue to monitor 4. Circle the area of drainage and continue monitor

2. Notify the HCP

371. Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1. Maintain the child in a semiprivate room. 2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. 5. Apply firm pressure to a needle-stick area for at least 10 minutes.

2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask.

369. A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden, and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. "I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."

3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time."

The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing. 2. Make the decisions for the family. 3. Encourage expression of feelings, concerns, and fears. 4. Explain everything that is happening to all family members. 5. Touch and hold the client's or family member's hand if appropriate. 6. Be honest and let the client and family know they will not be abandoned by the nurse.

3. Encourage expression of feelings, concerns, and fears. 5. Touch and hold the client's or family member's hand if appropriate. 6. Be honest and let the client and family know they will not be abandoned by the nurse.

370. A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? 1. Elevated vanillylmandelic acid urinary levels 2. The presence of blast cells in the bone marrow 3. The presence of Epstein-Barr virus in the blood 4. The presence of Reed-Sternberg cells in the lymph nodes

4. The presence of Reed-Sternberg cells in the lymph nodes

8. A family member says, "My son is suddenly acting like he doesn't care if I'm with him. Is he mad at me?" The healthcare provider appropriately responds: a. "No, not at all. Often before death, patients become less communicative." b. "Did you say something to upset him?" c. "He's probably withdrawing from you in an attempt to lessen your pain." d. "He may be depressed since his mother isn't here yet."

a. "No, not at all. Often before death, patients become less communicative."

A nursing student asks a pediatric intensive care nurse why being bed-bound for several weeks would affect a young child's growth and development. Which response by the nurse is the most appropriate? a. "growth and development are highly connected to activity." b. "bedrest causes muscle weakness that limits activity." c. "a child on bedrest has depression, slowing development." d. "isolation from peers has a negative effect on growth."

a. "growth and development are highly connected to activity."

A nurse is working with a student in the pediatric intensive care unit. The student reports that a 3-year-old patients looks very anxious, and the parents report that this behavior is not normal for her and she seems disoriented. Which action suggested by the registered nurse is the most appropriate? a. assess the child for sensory overload. b. encourage the child to take a short nap. c. have the parents leave for a short break. d. plan age-appropriate diversionary activities.

a. assess the child for sensory overload.

4. Which of the following observations DOES NOT indicate a dying child is experiencing air hunger? The child: a. has decreased respirations. b. gasps for breaths. c. has a panicked look on his or her face. d. becomes extremely restless.

a. has decreased respirations.

6.Humans normally have 46 chromosomes arranged in 23 matched pairs. a.True b.False

a.True

9.Meg has a 4 year old brother who does not have cystic fibrosis. This healthcare provider knows he may be a carrier. a.True b.False

a.True

7.An 8 month old, Meg, is diagnosed with cystic fibrosis. Her mother states, "How did she get this? I don't have it, nor does my husband." The healthcare professional knows, since this is an autosomal recessive trait,: a.both parents are carriers for the genetic disease. b.someone in previous generations must have had cystic fibrosis. c.it was passed from the mother to her daughter. d.an abnormal gene from one parent caused the disease.

a.both parents are carriers for the genetic disease.

Family members are visiting a child who is mechanically ventilated and heavily sedated. The parents are visibly distressed. Which statement from the nurse is most appropriate? a. "her latest arterial blood gases show compensated acidosis." b. "I'm glad you are here; let me get you some chairs to sit in." c. "she is so heavily sedated that she will not know if you are here or not." d. "you can talk to and touch your child to let her know you are here."

b. "I'm glad you are here; let me get you some chairs to sit in." d. "you can talk to and touch your child to let her know you are here."

2. A leading cause of death in infancy and childhood includes all of the following EXCEPT: a. accidents. b. diabetes. c. prematurity. d. cancer.

b. diabetes.

9. Which of the following assessment findings most likely indicates death is imminent? The child: a. moans as he or she breathes. b. has cold feet and hands. c. is dehydrated. d. has generalized pallor.

b. has cold feet and hands.

A pediatric intensive care nurse wants to practice in a way that helps reduce parents' stress while their child is in the unit. Which action by the nurse would be most helpful? a. explain procedures to the parents first, then to the child. b. include the parents in all decisions and care activities. c. provide comprehensive discharge teaching in advance. d. round with physicians to ensure parents' understanding.

b. include the parents in all decisions and care activities

6. When caring for the dying child in the final hours of life, the healthcare provider should: a. keep the child warm by putting extra blankets on him or her. b. provide good mouth care, routinely. c. suction deep secretions if the child is making gurgling sounds. d. not administer pain medication to an unresponsive child.

b. provide good mouth care, routinely.

8.If Meg's parents become pregnant again, what is the probability of that child having cystic fibrosis? a.0% - since they have already had one affected child b.25% c.50% d.75%

b.25%

1.Genetic disorders are immediately apparent at birth. a.True b.False

b.False

5.A chromosome is: a.the same as a gene. b.a package of DNA. c.any normal body cell. d.unpaired until conception.

b.a package of DNA.

2.A pair of genes is said to be heterozygous when they code for: a.the same trait, such as eye color or height. b.two different characteristics of a trait, such as blonde versus brown hair. c.the same characteristics of a trait, such as two genes for blue eyes. d.different characteristics in different people, such as a tall person versus a short person.

b.two different characteristics of a trait, such as blonde versus brown hair.

4.Which of the following is an example of an autosomal dominant disease? a.Tay Sachs disease b.Down syndrome c.Huntington disease d.hemophilia

c.Huntington disease

10.Parents of a 4 year old boy, admitted with hemophilia, are expecting their second child. They ask,"What are the chances of this baby having hemophilia? We know we're having a girl." The healthcare professional knows: a.since the gene is passed to males from their carrier mother, there is a 0% chance. b.there's a 25% chance the new baby won't have hemophilia. c.there's a 50% chance that the new baby won't have hemophilia. d.all of these parents' children will have hemophilia.

c.there's a 50% chance that the new baby won't have hemophilia.

1. At what age do children first have an adult understanding of death? a. 1-3 years b. 3-6 years c. 6-9 years d. 9-12 years

d. 9-12 years

3. When caring for a dying 8 year old, her father asks, "What are my daughter's vital signs now? She looks worse." The healthcare provider responds, "I'm sorry, she is getting worse. Her: a. blood pressure is increasing." b. respirations are normalizing." c. body temperature is increasing." d. blood pressure is becoming more difficult to hear."

d. blood pressure is becoming more difficult to hear."

3.A dominant gene is one that: a.causes various genetic diseases. b.breaks off and attaches to another area of the chromosome. c.is unlikely to be passed on from parent to child. d.exhibits its characteristics regardless of other genes.

d.exhibits its characteristics regardless of other genes.

The parents of an adolescent male with Ewing sarcoma ask the nurse what is the most significant factor contributing to their son's prognosis. Which factor should the nurse include when answering the parents' concern?

degree of metastasis

Identify the five stages of death and dying

denial anger bargaining depression acceptance

The nurse is assessing the coping behaviors of the parents who child has been recently diagnosed with a chronic illness. What reaction by the parents is a positive step in the ability to cope with this new situation?

endowing the illness with meaning

Preop nursing care for a child with Wilms' tumor should include which intervention?

put a sign of the bed reading "DO NOT PALPATE ABDOMEN"

The nurse is developing the plan of care for a school-aged boy with a chronic disability. The child frequently cries about being different from his siblings and wants others to do things for him that he is capable of doing for himself. To assist the family in coping with the child's chronic illness, which intervention is most important for the nurse to implement?

recommend the use of consistent discipline and reward for acceptable behavior

Grief: preadolescent-adolescent

-adolescent may regress -adolescent sees death as permanent -adolescent experiences a strong emotional reaction

Grief: 5-9 years

-child has difficulty concentrating -child begins to see death as permanent -child may feel responsible for the occurrence

A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? 1. Encourage the child's parents to stay with the child. 2. Encourage play with other children of the same age. 3. Advise the family to visit only during the scheduled visiting hours. 4. Provide a private room, allowing the child to bring favorite toys from home.

1. Encourage the child's parents to stay with the child.

366. The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5Â109/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.

1. Initiate bleeding precautions.

363. A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock.Which is the most appropriate nursing action? 1. Place the child in a supine position. 2. Notify the health care provider (HCP). 3. Place the child in Trendelenburg position. 4. Increase the flow rate of the intravenous fluids.

2. Notify the health care provider (HCP).