PRACTICE QUESTIONS FOR EXAM 2 PEDS
TRUE OR FALSENewborn infants are unable to excrete a water load at rates similar to those of older persons.
TRUE
TRUE OR FALSEThe loop of Henle, the site of the urine-concentrating mechanism, is short in the newborn, thus reducing the ability to reabsorb sodium and water and to produce concentrated urine.
TRUE
TRUE OR FALSEThe newborn is unable to dispose of excess water and solute rapidly or efficiently because glomerular filtration and absorption do not reach adult values until the child is between 1 and 2 years of age.
TRUE
The nurse is caring for a child over the age of 2 years old, which of the following are concerning symptoms of a UTI? Select all that apply. a)Incontinence in a child previously toilet trained b)Abdominal pain c)Strong or foul order in urine d)Frequency of urination e)Diarrhea
a, b, c, d
Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include? a. Cardiopulmonary resuscitation (CPR) b. Administration of intravenous (IV) fluids c. Foreign airway obstruction removal using the Heimlich maneuver d. Advice that the infant not be left with caretakers other than the parents
a. Cardiopulmonary resuscitation (CPR)CPR is essential for all parents and caregivers to know, especially when an infant has a history of apnea of infancy that is being monitored at home. Most likely, the child will not be receiving home IV therapy as part of the discharge care. The Heimlich maneuver is used to intervene when a child or an adult is experiencing a choking episode. It would not be necessary for the parents to learn the maneuver at this time. (Back slaps and chest thrusts are used on the responsive infant for choking.) The parents should arrange for other caregivers to help when possible. There is no reason that the infant cannot be left with capable and trained individuals. Anyone caring for the infant will need to be taught to use equipment and how to perform CPR.
a nurse is assessing an infant who has coarctation of the aorta. Which of the following ndings should the nurse expect? (select all that apply.)
a. Weak femoral pulses B. Cool skin of lower extremities E. Heart failure
Five-year-old Ivy is brought to the clinic because of a suspected urinary tract infection. Which of the following is the correct method for collecting the specimen? a. Encourage large amounts of water because Ivy is unable to void at this time. b. Set Ivy on the toilet facing the tank to decrease likelihood of contamination. c. Wait until the first-morning voided specimen to be collected. d. Bag Ivy with the bag covering the entire perineal area.
b
A 12 year old child is in the urgent care clinic with a complaint of fever, headache, and sore throat. A diagnosis of group A beta-hemolytic streptococcus *GABHS pharyngitis is established with a rapid strep test, and oral penicillin is prescribed. The nurse knows which of the following statements about GABHS is correct? a. children with a GABHS infection are less likely to contract the illness again after the antibiotic regimen is completed b. a follow up throat culture is recommended following the completion of antibiotic therapy c. Children with a GABHS infection are at increased risk for the deelopment of rheumatic fever and glomerulonephritis d. Children with a GABHS infection are at increased risk for the development of rheumatoid arthritis in adulthood.
c. Children with a GABHS infection are at increased risk for the deelopment of rheumatic fever and glomerulonephritis
What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? a. Barrel chest b. Wheezing c. Thermal instability d. Nasal flaring and retractions
d. Nasal flaring and retractionsNasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not with acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability.
The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect? a. Suffocation b. Child abuse c. Infantile apnea d. Sudden infant death syndrome (SIDS)
d. Sudden infant death syndrome (SIDS)Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death. Although the child was found under the blanket, the other findings are consistent with SIDS. The findings as reported are consistent with SIDS, not child abuse. The history and physical findings are consistent with SIDS, not infantile apnea.
With fetal circulation, Some blood will follow the same path as a normal heart goes but is stopped by the ___________1________ and goes to the brain; There is still blood flow that goes to _________2_______ and lungs in order for that body part to develop
1. Ductus arteriosus2. R. ventricle
With Tetralogy of Fallot, Pulmonary artery is so skinny because of lack of _____1_____during growth; RV hypertrophy- occurs because it is working ____2____ and because of VSD
1. blood flow2. harder
The cardiovascular system is the ___1____ system in the embryo to begin functioning; Develops primarily between the _____2_____ week of gestation; Heart has four chambers by ___3____ weeks; Heart begins to contract days ___4_____; Blood can be seen circulating through the "body" as early as the ___5____ week.
1. first2. 4th and 7th3. 84. 21-225. 3rd
What is the 24-hour fluid requirement of a child weighing 32kg?
1740 ml/day
The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instruction? 1. "A balance of rest and exercise is important." 2. "I can apply lotion or powder to the incision if it is itchy." 3. "Activities in which my child could fall need to be avoided for 2 to 4 weeks." 4. "Large crowds of people need to be avoided for at least 2 weeks after surgery."
2
On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1. Cracked lips 2. Normal appearance 3. Conjunctival hyperemia 4. Desquamation of the skin
3
The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? 1. Pallor 2. Hyperactivity 3. Exercise intolerance 4. Gastrointestinal disturbances
3
The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF? 1. Pallor 2. Cough 3. Tachycardia 4. Slow and shallow breathing
3
A child with rheumatic fever will be arriving to the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? 1. "Has the child complained of back pain?" 2. "Has the child complained of headaches?" 3. "Has the child had any nausea or vomiting?" 4. "Did the child have a sore throat or fever within the last 2 months?"
4
A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen to the infant? 1. During sleep 2. When changing the infant's diapers 3. When the mother is holding the infant 4. When drawing blood for electrolyte level testing
4
The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? 1. "I will not mix the medication with food." 2. "I will take my child's pulse before administering the medication." 3. "If more than 1 dose is missed, I will call the health care provider." 4. "If my child vomits after medication administration, I will repeat the dose."
4
The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? 1. Immunoglobulin 2. Red blood cell count 3. White blood cell count 4. Anti-streptolysin O titer
4
. You are working with a family with a child who has a congenital heart defect. Future surgery is planned, and you are teaching the parent how to reduce cardiac demands. The parent needs more teaching when she says which of the following? A. "I will wake my child for feeding every 2 hours so he can get enough calories to gain weight." B. "When I give the digoxin, I will listen to the pulse for 1 full minute." C. "I should protect my child from people who have respiratory infections." D. "I will count the number of wet diapers to be sure my child is not getting too much or too little fluid."
A
A 3-month-old infant is seen in the clinic with the following symptoms: irritability, crying, refusal to nurse for more than 2 to 3 minutes, rhinitis, and a rectal temperature of 101.8°F (38.8°C). The labor, delivery, and postpartum history for this term infant is unremarkable. The nurse anticipates a diagnosis of: A. Acute otitis media (AOM) B. Otitis media with effusion (OME) C. Otitis externa D. Respiratory syncitial virus (RSV)
A
A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a a. spacer. b. nebulizer. c. peak expiratory flow meter. d. trial of chest physiotherapy.
A
A neonate's failure to pass meconium within the first 24 hours after birth may indicate which of the following? a) Hirschsprung's disease b) Celiac disease c) Intussusception d) Abdominal wall defect
A
An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to a. prevent respiratory syncytial virus (RSV) infection. b. make isolation of the infant with RSV unnecessary. c. prevent secondary bacterial infection. d. decrease toxicity of antiviral agents.
A
Clinical manifestations of nephrotic syndrome include: a. weight gain, pallor, edema, and decreased urinary output. b. weight loss, pallor, periorbital edema, flank pain. c. oliguria, decreased urinary output, and weight loss. d. weight gain, generalized edema, increased urinary output, and generalized erythema.
A
Common antiinfective agents used for urinary tract infections in children include all of the following except: a. quinolones. b. penicillins. c. sulfonamides. d. cephalosporins.
A
Diagnostic evaluation results for hemolytic uremic syndrome include which of the following? a. Anemia, thrombocytopenia, and renal failure b. High potassium, low sodium, high hemoglobin and hematocrit, and proteinuria c. High number of urinary casts, low serum BUN and creatinine, and decreased sedimentary rates d. Urine negative for protein but positive for red blood cells, normal hemoglobin and hematocrit, and elevated serum BUN and creatinine levels
A
In evaluation of the child with possible renal trauma, which of the following is usually indicative of kidney damage? a. Flank pain and hematuria b. Dysuria, proteinuria, and nausea c. Abdominal ascites, nausea, and hematuria d. Proteinuria and bladder spasms
A
Johnny, age 12, had a renal transplant 5 months ago. He now comes to the hospital outpatient clinic with fever, tenderness over the graft area, decreased urinary output, and slightly elevated blood pressure. The nurse's priority at this time is: a. to recognize that Johnny is probably undergoing acute rejection and to notify the physician immediately. b. to recognize that this is an episode of increased inflammation within the donor kidney because Johnny has probably been noncompliant with his immunosuppressant drugs. The nurse should educate Johnny regarding drug compliance and notify Johnny's physician when he makes rounds. c. to obtain a urine specimen for culture and sensitivity and a blood count to quickly identify Johnny's infection before alerting the physician. d. to recognize that Johnny is in chronic rejection and that no present therapy can halt the progressive process.
A
Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? a. Previous streptococcal throat infection. b. History of open heart surgery at 5 years of age. c. Playing too much soccer and not getting enough rest. d. Exposure to a sibling with pneumonia.
A
The most appropriate nursing intervention for a child following a tonsillectomy is to a. watch for continuous swallowing. b. encourage gargling to reduce discomfort. c. position the child on the back for sleeping. d. apply warm compresses to the throat.
A
The most immediate threat to the life of the child with acute kidney injury is: a. hyperkalemia. b. anemia. c. hypertension crisis. d. cardiac failure from hypovolemia.
A
The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess? a. Obesity from overeating. b. Clubbing of the nail beds. c. Squatting during play activities. d. Exercise intolerance.
A
The nurse, in preparing the child for a diagnostic test, explains that which of the following tests provides direct visualization of the bladder through a small scope? a. Cystoscopy b. Voiding cystourethrogram c. Intravenous pyelogram d. Renal biopsy
A
The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of a. pneumothorax. b. bronchodilation. c. carbon dioxide retention. d. increased viscosity of sputum.
A
What should the nurse do first after noting that a child with Hirschsprung's disease has a fever and water explosive diarrhea? a) Notify the healthcare provider immediately b) Administer an antidiarrheal c) Monitor the child every 30 minutes d) Nothing
A
When caring for a child with acute renal failure, which nursing measure requires immediate attention? A. Serum potassium concentrations in excess of 7 mEq/L B. Sodium level of 135 C. Transfusion for hemoglobin of 8 D. Mannitol and furosemide for a urine output of 2 ml/kg/hr
A
Which best describes a defect that results from residual peritoneal fluid trapped within the lower segment of the processus vaginalis? a) Noncommunicating hydrocele b) Communicating hydrocele c) Inguinal hernia d) Incarcerated hernia
A
Which child is most at risk for minimal-change nephrotic syndrome? a. A 4-year-old recovering from viral upper respiratory tract infection b. A 7-year-old after a group A β -hemolytic streptococcus throat infection c. A 6-year-old with acquired immunodeficiency syndrome (AIDS) d. A 2-year-old who recently received several bee stings
A
Which heart defect and hemodynamic change pairing is correct? A. Aortic stenosis and obstruction to blood flow out of the heart B. Ventricular septal defect and decreased pulmonary blood flow C. Tricuspid atresia and increased pulmonary blood flow D. Atrioventricular canal and mixed blood flow, in which saturated and desaturated blood mix within the heart or great arteries
A
Which laboratory values are most likely in a 3yr whose parents report, "Their face has swelling and puffy eyes in the morning, then it sort of travels down to her tummy and ankles by the afternoon. They are also very tired and don't want to eat." A.High Proteinuria, hypoalbuminemia, and high specific gravity B.High serum sodium and calcium with abnormally high RBC count C.Hypercholesterolemia, hyperalbuminuria, and low specific gravity D.Low Proteinuria, hypoalbuminemia, low total serum protein.
A
Which of the following is the most important nursing intervention to prevent urinary tract infections in pediatric patients? a. Teach parents of pediatric patients ways to practice good perineal hygiene b. Teach parents of pediatric patients the importance of administering prescribed medications for infection including dosage and scheduling c. Teach parents of pediatric patients the signs and symptoms of urinary tract infections d. Teach parents the proper collection techniques for urine samples
A
Which symptom suggests pyelonephritis in a 3-year-old child? a. Flank pain and tenderness b. Foul-smelling urine c. Dysuria or urgency d. Enuresis or daytime incontinence
A
Because children with celiac disease must limit their intake of products containing gluten in wheat, rye, oats, and barley, they are at risk for which of the following nutritional deficiencies? Select all that apply. A. Iron deficiency anemia B. Folic acid deficiency C. Zinc deficiency D. Vitamin A, D, E, and K deficiency E. Vitamin B12 deficiency
A B D
A 5-year-old is recovering from a tonsillectomy and adenoidectomy and is being discharged home with his mother. Home care instructions should include which of the following? Select all that apply. A. Observe the child for continuous swallowing. B. Encourage the child to take sips of cool, clear liquids. C. Administer codeine elixir as necessary for throat pain. D. Observe the child for restlessness or difficulty breathing. E. Encourage the child to cough every 4 to 5 hours to prevent pneumonia. F. Administer an analgesic such as acetaminophen for pain
A B D F
Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include (Select all that apply.) a. lung function. b. associated allergies. c. frequency of symptoms. d. frequency and severity of exacerbations.
A C D
A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) a. Vital signs b. Throat culture c. Medical history d. Assessment of breath sounds e. Emergency airway equipment readily available
A C D E
A 2-month-old formerly healthy infant born at term is seen in the urgent care clinic with intercostal retractions, respiratory rate of 62, heart rate of 128, refusal to breastfeed, abundant nasal secretions, and a pulse oximeter reading of 88% in room air. The diagnosis of respiratory syncytial virus is made. The infant's oxygen saturation remains 95% in room air, and the respiratory rate is 54, with intercostal retractions; heart rate is 120 beats per minute. After 2 hours of observation and an intravenous bolus of fluids, the infant is being discharged home. The nurse provides which of the following home care instructions for this infant? Select all that apply. A. Continue breastfeeding infant. B. Discontinue breastfeeding and administer Pedialyte for 24 hours. C. Observe infant for labored breathing or apnea (cessation of breathing). D. Instill normal saline drops in both nares and suction thoroughly before feeding and before placing to sleep. E. Place infant to sleep on his side with the head of bed slightly elevated to facilitate breathing. F. Keep the infant out of day care or nursery.
A C D F
You are discharging a 5-week-old infant with a congenital heart defect who will be going home on digoxin. Which of the following answers by the father indicate the need for more teaching? Select all that apply. A. "I know I give the drug carefully by slowly directing it to the side and back of the mouth." B. "I give the medication every 12 hours, and I can place it in a bit of formula so I know the baby will take it." C. "If I miss a dose, I don't give an extra dose, but I give the next dose as ordered." D. "If the baby vomits, I should give a second dose." E. "If more
A C E
You are working with a new graduate on the pediatric unit and your patient is returning from the cardiac catheterization laboratory. You feel the graduate understands the important nursing interventions when she says which of the following? Select all that apply. A. "Check pulses, especially below the catheterization site, for equality and symmetry." B. "Check vital signs, which may be taken as frequently as every 30 to 45 minutes, with special emphasis on the heart rate, which is counted for 1 full minute for evidence of dysrhythmias or bradycardia." C. "Special attention needs to be given to the BP, especially for hypertension, which may indicate hemorrhage or bleeding from the catheterization site." D. "Check the dressing for evidence of bleeding or hematoma formation in the femoral or antecubital area." E. "Allow the child to ambulate because this will prevent skin breakdown from lying so long in one place."
A D
A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following findings should the nurse expect? (Select all that apply.) A. Erythema marginatum (rash) B. Continuous joint pain of the digits C. Tender, subcutaneous nodules D. Decreased erythrocyte sedimentation rate E. Elevated C-reactive protein
A E
A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerulonephritis. Which of the following nursing measures should be considered? Select all that apply. A. On examination there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. B. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. C. The primary objective is to reduce the excretion of urinary protein and maintain protein-free urine. D. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable. E. Because these children are particularly vulnerable to upper respiratory tract infection, protect them from contact with infected roommates, family, or visitors.
A, B, D
The nurse is caring for a 4-year-old girl with a history of frequent urinary tract infections. What should the nurse be aware of before obtaining a urine sample? Select all that apply. A. To obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank. B. Because children who have a UTI will have painful urination, have the child drink a large amount of fluid before obtaining the sample. C. The specimen must be fresh—less than 1 hour after voiding with storage at room temperature or less than 4 hours after voiding with refrigeration. D. If a urinalysis obtained by a bag specimen is negative, a specimen still needs to be obtained by catheterization or suprapubic aspiration. E. The key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria. F. Because the child is febrile, the nurse should immediately start an antimicrobial and then obtain a urine culture.
A, C, E
When giving discharge instructions to a parent post hypospadias repair, the nurse recognizes a need for more teaching when the mother says which of the following? Select all that apply. A. "I know I should never clamp off the catheter." B. "My child can take a tub bath when we arrive home because it will soothe the area." C. "An antibacterial ointment may be applied to the penis daily for infection control." D. "Fluids should be monitored and rationed to prevent fluid overload." E. "My child should avoid straddle toys, sandboxes, swimming, and rough activities until allowed by the surgeon."
A, C,E
A 5-month-old infant is seen in the well-child clinic for a complaint of vomiting and failure to grow. His birth weight was 7 lb, and he now weighs 8 lb, 10 oz. The infant's mother reports that he is taking 4 to 7 oz of formula every 4 to 5 hours, but he "spits up a lot after eating and then is hungry again." The child is noted to be alert but appears malnourished. The mother reports that his stools are brown in color, and he has 1 to 2 bowel movements every day. Based on these findings, the nurse anticipates the infant has: A. Meckel diverticulum B. Hypertrophic pyloric stenosis C. Intussusception D. Hirschprung disease
B
A burn injury involving the epidermis and varying degrees of the dermal layer that is painful, moist, red, and blistered describes which of the following? A. Superficial or first-degree burn B. Partial-thickness or second-degree burn C. Full-thickness or third-degree burn D. Fourth-degree burn
B
A child is standing playing with toys and suddenly collapses. Attempts to engage the child in conversation are met with no response. Skin color indicates cyanosis. A preliminary assessment of the environment presents no specific issues. Based on this information, you would suspect that the child is? a. Experiencing seizure activity b. Potential aspiration of foreign body c. Potential allergic reaction d. Traumatic injury
B
A nurse is caring for a 2-year-old child who has a heart defect and is scheduled for cardiac catheterization. Which of the following actions should the nurse take? A. Place on NPO status for 12 hr prior to the procedure. B. Check for iodine or shellfish allergies prior to the procedure. C. Elevate the affected extremity following the procedure. D. Limit fluid intake following the procedure
B
An immediate intervention to teach parents for when an infant chokes on a piece of food would be to a. have infant lie quietly while a call is placed for emergency help. b. position infant in a head-down, face-down position and administer five quick back slaps. c. administer mouth-to-mouth resuscitation. d. give some water by a cup to relieve the obstruction.
B
Chronic glomerulonephritis (CGN) describes a variety of different disease processes that may be distinguished from one another by: a. renal biopsy. b. cystoscopy. c. blood cultures. d. serologic tests, including ASO titers.
B
Dietary regulation in the child with chronic renal failure includes: a. increasing dietary phosphorus. b. providing protein of high biologic value in the diet. c. continuous restricting of potassium. d. adding vitamin A, E, and K supplements.
B
Nursing interventions in caring for the child with acute glomerulonephritis include: a. enforced bed rest. b. daily weights. c. keeping the child NPO. d. a high-sodium diet.
B
The greatest threat to life as a result of dehydration in children is: A. Oliguria B. Shock C. Arrhythmia D. Hypotension
B
The most appropriate time to perform bronchial postural drainage is a. immediately before all aerosol therapy. b. before meals and at bedtime. c. immediately on arising and at bedtime. d. 30 minutes after meals and at bedtime.
B
The nurse caring for a 4-month-old infant with biliary atresia and significant urticaria can anticipate administering: A. Diphenhydramine B. Ursodiol (ursodeoxycholic acid) C. Loratidine D. Zantac
B
The nurse is developing a preventive teaching plan for Tracy, a sexually active 16-year-old who has been diagnosed with a urinary tract infection. Which of the following should be included in the plan? a. Promote perineal hygiene by wiping back to front b. Urinate as soon as possible after intercourse c. Douche as soon as possible after intercourse to flush out bacteria d. Eliminate all carbonated and caffeinated beverages because they irritate the bladder
B
When the nurse is caring for a child with hemolytic-uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention? a. Test urine for specific gravity. b. Weigh child daily. c. Weigh the wet diapers. d. Measure abdominal girth daily.
B
Which of the following clinical manifestations are associated with acute glomerulonephritis? a. Normal blood pressure, generalized edema, oliguria b. Periorbital edema, hypertension, dark-colored urine c. Fatigue, elevated serum lipid levels, elevated serum protein levels d. Temperature elevation, circulatory congestion, normal BUN and creatinine serum levels
B
Which of the following diagnostic findings would suggest decreased renal function? a. Decreased creatinine and elevated BUN b. Elevated BUN, creatinine, and uric acid levels c. Elevated potassium, phosphorus, and calcium d. Proteinuria and decreased creatinine and BUN
B
Which of the following manifestations of chronic kidney disease can have the most social consequences for the developing child? a. Anemia b. Growth delay c. Bone demineralization d. Septicemia.
B
The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37º C (98.6º F). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend a. controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. b. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. c. trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement. d. bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.
B Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will assist in opening up the child's airways. The child does not have a temperature and, therefore, does not need management with acetaminophen.
A school-age child has undergone a tonsillectomy and is being cared for postoperatively in the hospital setting. The nurse assigned to the patient is developing a plan of care with regard to nutrition and hydration. What factors should be included in the postoperative plan of care for this patient? (Select all that apply.) a. Medicate for pain around the clock to ensure that the patient will be able to eat and maintain hydration. b. Restrict food and oral fluids initially making sure that the patient is fully alert and there is no evidence of bleeding. c. Avoid giving fluids that are color tinged red or brown. d. Provide milk to help maintain nutritional balance.e. Provide pudding to facilitate swallowing.
B C
Hepatitis A virus is transmitted by which of the following? Select all that apply. A. Breast milk from mother with HAV B. Ingestion of contaminated food C. Fecal-oral route D. Casual contact with infected person E. Blood transfusion
B C
You are working in the pediatric clinic, and a child presents with symptoms that are suspicious of the acute phase of Kawasaki disease. Which of the following symptoms are included? Select all that apply. A. Periungual desquamation (peeling that begins under the fingertips and toes) of the hands and feet is present. B. The bulbar conjunctivae of the eyes become reddened, with clearing around the iris. C. A temporary arthritis is evident, which may affect the larger weight-bearing joints. D. Inflammation of the pharynx and the oral mucosa develops, with red, cracked lips and the characteristic "strawberry tongue." E. Loud pansystolic murmur along with ECG changes are present.
B D
a nurse is assessing an infant who has heart failure. Which of the following findings should the nurse expect? (select all that apply.)
B. . Cool extremities C. Peripheral edema E. Nasal flaring
Which of the following discharge instructions should NOT be included for the child who is post-hypospadias repair and still have a catheter or stent? A.Position the urine bag below the bladder B.The child is allowed to take a tub bath daily. C.Preventative bladder spasm medication is important D.Continue pain medication to control discomfort.
B. The child is allowed to take a tub bath daily. infection
A 10-year-old child suffered extensive second- and third-degree burns in an apartment fire. His weight is 75 lb (34 kg). Fluid replacement therapy will optimally: A. Result in an hourly urine output of 1 ml/kg B. Result in an hourly urine output of 20 ml/kg C. Result in an hourly urine output of 30 ml/kg D. Maintain a systolic blood pressure in the 95th percentile for the child's weight
C
A 12-year-old child is in the urgent care clinic with a complaint of fever, headache, and sore throat. A diagnosis of group A β-hemolytic streptococcus (GABHS) pharyngitis is established with a rapid-strep test, and oral penicillin is prescribed. The nurse knows that which of the following statements about GABHS is correct? A. Children with a GABHS infection are less likely to contract the illness again after the antibiotic regimen is completed. B. A follow-up throat culture is recommended after the completion of antibiotic therapy. C. Children with a GABHS infection are at increased risk for the development of rheumatic fever and glomerulonephritis. D. Children with a GABHS infection are at increased risk for the development of rheumatoid arthritis in adulthood.
C
A 16-month-old has a history of diarrhea for 3 days with poor oral intake. He received intravenous fluids, has tolerated some oral fluids in the emergency department, and is being discharged home. Instructions for diet for this child should include: A. BRAT diet (bananas, rice, applesauce, and toast) for 24 hours, then a soft diet as tolerated B. Chicken or beef broth for 24 hours, then resume a soft diet C. Offer a regular diet as child's appetite warrants D. Keep on clear liquids and toast for 24 hours
C
A 3-year-old boy is seen in the clinic at 8:30 pm with a history of vomiting for 2 days and poor oral intake; he has voided once since the previous day. Examination reveals a lethargic child sitting on the mother's lap. He has a capillary refill of 4 seconds, apical heart rate of 128, respiratory rate of 32, and poor skin turgor. Stated body weight is 25 kg. Based on this information, the nurse anticipates performing which of the following? A. Demonstrating to the mother how to give 5 to 10 ml of Pedialyte by mouth every 5 to 10 minutes B. Administering an intravenous fluid bolus of 450 ml of 5% dextrose in water over 60 minutes C. Administering an intravenous fluid bolus of 500 ml of 0.9% normal saline over 20 minutes D. Administering an intravenous fluid bolus of 1000 ml of 5% dextrose and 0.45% normal saline over 30 minutes
C
A 4-day-old infant is seen in the emergency department for a possible seizure earlier in the day. The infant was being breastfed but without much success, so an aunt gave him a bottle of water. The infant continued to cry, and the mother was too exhausted to breastfeed, so another bottle of water was given while someone went to the store to purchase infant formula. The pregnancy, delivery, and postpartum history reveal no particular problems for this term infant that might contribute to seizures. The physical examination is unremarkable, with the exception of hypertonic reflexes. The infant is awake, alert, and sucking on his fists. Diagnostic studies are obtained, including an electrocardiogram. The nurse anticipates which of the following as the possible explanation for the infant's condition? A. Serum potassium of 3.9 mEq B. Serum glucose of 69 mg C. Serum sodium of 118 mEq D. Arterial pH of 7.34
C
A 5-year-old is seen in the urgent care clinic with the following history and symptoms: sudden onset of severe sore throat after going to bed, drooling and difficulty swallowing, axillary temperature of 102.2°F (39.0°C), clear breath sounds, and absence of cough. The child appears anxious and is flushed. Based on these symptoms and history, the nurse anticipates a diagnosis of: A. Group A β-hemolytic streptococcus (GABHS) pharyngitis B. Acute tracheitis C. Acute epiglottitis D. Acute laryngotracheobronchitis
C
A formerly preterm infant who had surgery for necrotizing enterocolitis is now 6 months old and has short-bowel syndrome. He is unable to absorb most nutrients taken by mouth and is totally dependent on parenteral nutrition, which he receives via a central venous catheter. The clinic nurse following this infant is aware that this infant should be closely observed for the development of: A. Gastroesophageal reflux B. Chronic diarrhea C. Cholestasis D. Failure to thrive
C
A nurse is providing teaching to the mother of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include? A. "Do not offer your baby fluids after giving the medication." B. "Digoxin increases your baby's heart rate." C."Give the correct dose of medication at regularly scheduled times." D."If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount."
C
Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary? a. C, D b. A, E, K c. A, D, E, K d. C, folic acid
C
Bobby, age 12 years, has been diagnosed with chronic kidney disease since the age of 6 years. He has reached end-stage renal disease and will need to begin dialysis. Which of the following nursing care management interventions should not be included in Bobby's care plan? a. Assist Bobby in adjusting to the fact that he will always be different from his peers. He will be shorter, more tired at times, and unable to participate in all activities b. Anticipate possible disharmony and denial from Bobby and his family c. Explain to Bobby that he will no longer be able to go to school d. Assist the parents in exploring the financial drain the disease will have on the family resources and provide information on assistance that is available
C
In caring for the infant with exstrophy, which of the following is incorrect? a. Staged repair is started during the neonatal period, preferably within the first 1 to 2 days of life. b. Until closure is performed, the bladder is covered with clear plastic wrap or a thin film dressing. c. Petroleum jelly is used to keep the area moist and prevent breakdown. d. After closure, the infant is monitored for urinary output and signs of urinary tract infection.
C
In reviewing potential susceptibility to respiratory infections for children, which statement is based on supportive physiological evidence? a. Newborns are more likely to develop respiratory infections in the neonatal period due to changes from intrauterine to external environment. b. With advancing age, immunity decreases leading to greater chances of developing respiratory infections. c. There is an increase in infection rate between 3 to 6 months due to loss of protective effects of maternal antibodies. d. Viral respiratory infections increase dramatically by 5 years of age.
C
Multiple cases of hemolytic uremic syndrome caused by enteric infection of the E. coli O157:H7 serotype have been traced to:i. undercooked meat, especially ground beef.ii. unpasteurized apple juice.iii. alfalfa sprouts.iv. public pools.v. unwashed grapes. a. i, iv, and v b. i and ii c. i, ii, iii, and iv d. ii, iii, and v
C
The child with obstruction of the renal pelvis or ureter is most likely to present with which of the following clinical manifestations? a. Poor force of urinary stream or intermittency of voided stream b. Nocturia, urgency to urinate, and pain in the lower abdomen c. Pain in the flank and lower back or abdomen that is not relieved by changes in position d. Fever, chills, vomiting, and proteinuria
C
The diet requirement for minimal-change nephrotic syndrome includes: a. water restriction. b. low-protein diet in both acute and remission stages. c. salt restriction during periods of edema and while on corticosteroid therapy. d. high-protein diet during both acute and remission stages.
C
The most common type of dehydration in children occurs when electrolyte and water deficits are present in approximately balanced proportions. This is called ________________ dehydration. A. Hypotonic B. Hypertonic C. Isotonic D. Hyponatremic
C
Therapeutic management in nephrotic syndrome includes the administration of prednisone. The nurse teaches which of the following as correct administration guidelines? a. Corticosteroid therapy is begun after BUN and serum creatinine elevation. b. Prednisone is administered orally once daily for 3 weeks. c. The drug is given daily for 4 to 6 weeks, then decreased in dosage and given on alternate days for 2 to 5 months with taper. d. The drug is discontinued as soon as the urine is free from protein.
C
Treatment methods used for status asthmaticus focus on a. supportive oxygen therapy to maintain saturation at 90%. b. resolving acid-base disturbances that have led to alkalosis. c. restoring hydration. d. decreasing airway compliance.
C
Vesicoureteral reflux (VUR) is closely associated with which of the following? a. Acute glomerulonephritis b. Nephrotic syndrome c. Renal scarring and kidney damage d. High alkaline content in the urine
C
What is the most frequent cause of prerenal failure in infants and children? a. Nephrotoxic agents b. Obstructive uropathy c. Dehydration related to diarrhea and vomiting d. Burn shock
C
When assessing a child for possible intussusception, which of the following would be least likely to provide valuable information? a) Stool inspection b) Pain pattern c) Family history d) Abdominal palpation
C
Which of the following urine tests is conducted daily while the child is receiving medicine for nephrotic syndrome? a. Glucose b. Specific gravity c. Albumin d. pH
C
Which of the following would the nurse expect to assess in a child with celiac disease having a celiac crisis secondary to an upper respiratory tract infection? a) Respiratory distress b) Lethargy c) Watery diarrhea d) Weight gain
C
While assessing a child with pyloric stenosis, the nurse is likely to note which of the following? a) Regurgitation b) Steatorrhea c) Projectile vomiting d) "Currant jelly" stools
C
A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? a. Gallop and rales. b. Blood pressure discrepancies in the extremities. c. Right ventricular hypertrophy on ECG. d. Heart murmur.
D
A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)? a. Confirms the diagnosis of asthma b. Determines the cause of asthma c. Identifies the "triggers" of asthma d. Assesses the severity of asthma
D
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it a. liquefies secretions. b. improves oxygenation. c. promotes ventilation. d. soothes inflamed mucous membrane.
D
A nurse is evaluating a parent's understanding of their child's peritoneal dialysis. Which information in the parent's response indicates an understanding of the purpose of the dialysis? A."It reestablishes the kidney function." B."It cleans the peritoneal membrane." C."It provides fluid for intracellular spaces." D."It removes toxins in addition to other metabolic wastes."
D
A parent with a toddler who has a respiratory infection wants to use the traditional method of topical vapor rub. Which statement by the parent indicates that additional teaching is needed with regard to administration of this treatment? a. The parent states that he will wash his hands before applying the medication. b. The parent will read the product label before administering the medication. c. The parent will inform the pediatrician that the medication is being used. d. Application of the medication will be given orally to avoid potential sneezing.
D
After the child returns from cardiac catheterization, the nurse monitors the child's vital signs. For how many seconds should the heart rate be counted? A. 10 seconds B. 15 seconds C. 30 seconds D. 60 seconds
D
Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? a. Atrophic changes in the mucosal wall of the intestines b. Hypoactivity of the autonomic nervous system c. Hyperactivity of the apocrine glands d. Mechanical obstruction caused by increased viscosity of exocrine gland secretions
D
It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent a. otitis media. b. diabetes insipidus. c. nephrotic syndrome. d. acute rheumatic fever.
D
Justin, age 8 years, has been diagnosed with pyelonephritis. The nurse would expect medical management to include all of the following except: a. admission to the hospital with intravenous antibiotics administered for the first 48 hours. b. blood and urine cultures obtained on admission. c. urine cultures repeated after therapy. d. administration of nitrofurantoin.
D
One of the goals for children with asthma is to prevent respiratory tract infection because infections a. lessen effectiveness of medications. b. encourage exercise-induced asthma. c. increase sensitivity to allergens. d. can trigger an episode or aggravate asthmatic state.
D
Preprocedural preparation of the child who is scheduled to have a cystourethrography includes: a. keeping the child NPO (nothing by mouth) for 8 hours before the test. b. assessing for an allergy to iodine. c. administering a Fleet enema before the examination. d. preparing the child for catheterization.
D
The nurse is performing education for the parents of an infant with bladder exstrophy. Which statement by the parents would indicate an understanding of the child's future care? a. "Care will be no different than that of any other infant." b. "My infant will only need this one surgery." c. "My child will wear diapers all his life." d. "We will need to care for the urinary diversion."
D
The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to a. determine what the child has eaten. b. administer diphenhydramine (Benadryl) PO stat. c. move the child to the nurse's office or hallway. d. have someone call for an ambulance and paramedic rescue squad or 9-1-1.
D
When assessing a child with encopresis, the interview is most likely to reveal a history of: a) Psychological disorder b) Sexual abuse c) Recurrent diarrhea d) Painful bowel movements
D
Which of the following nursing diagnoses would be inappropriate for the infant with GER? a) Deficient fluid volume b) Risk for aspiration c) Imbalanced nutrition: less than body requirements d) Impaired oral mucous membrane
D
While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? a. Provide supplemental oxygen by face mask. b. Administer a dose of IV morphine sulfate. c. Begin cardiopulmonary resuscitation. d. Place the infant in a knee-to-chest position.
D
A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to a. examine the child's oropharynx and report the assessment to the health care provider. b. make the child lie down and rest quietly. c. auscultate the child's lungs and make preparations for placement in a mist tent. d. notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation.
D Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.
TRUE OR FALSE The primary responsibility of the kidney is to maintain the composition and volume of body fluids in excess of body needs.
FALSE- The kidneys primary responsibility is to maintain the composition and volume of the body fluids in EQUILIBRIUM
