Exam 3 Peds PrepU

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever?

Children who have this diagnosis may have had strep throat

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?

Factor VIII

The nurse is caring for a 2-year-old girl with spina bifida. The mother confides that she is depressed and feels that she has somehow contributed to her daughter's condition. Her guilt is compounded by her mother-in-law's accusations that the mother's poor nutrition during pregnancy caused the spina bifida. What should the nurse tell the mother?

Your feelings are normal and it is important to talk about this

The nurse cares for a child with for aplastic anemia with the note above. Based on the findings noted, what should the nurse include in the teaching? Select all that apply.

"A referral to an endocrinologist may be needed." "Facial hair may begin to appear in the coming days." "Using safety razors may be necessary for the hair that develops with puberty." "Voice deepening is an expected change."

The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?

He likes to stop and squat wherever he walks

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition?

degeneration of muscle fibers

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another?

"Keep in mind that the signs of leukemia are often subtle and difficult to recognize."

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?

"She has been down, but playing in soccer camp will cheer her up."

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:

"These make a smooth edge on the cast so the skin is better protected."

The nurse is teaching the parents of a 7-year-old child with sickle cell disease and enuresis. What statement(s) will the nurse include in the teaching? Select all that apply.

"To prevent bedwetting, have your child get up and go to the bathroom periodically at night." "Adequate hydration is essential to maintain blood flow." "Because of your child's condition, the urine output is greater than the capacity of the bladder." "Your child's kidneys are unable to concentrate urine."

The nurse is speaking to the mother of a dying child about the best ways to manage pain and discomfort. Which is the best response by the nurse?

"We will provide pain medication around the clock to help prevent recurrence or escalation of pain."

A 7-year-old child diagnosed with Duchenne muscular dystrophy (DMD) uses a wheelchair for mobility. The child's parent tells the nurse "I want my child to participate in activities with peers but I am so concerned about my child's health." Which comment(s) is appropriate for the nurse to make? Select all that apply

"Wheelchair team sports might be something your child would enjoy." "Encourage your child to remain active but to also take time to rest."

The nurse is caring for a 9-year-old client with sickle cell disease experiencing a vaso-occlusive crisis affecting the right shoulder and elbow. What should the nurse do to provide pain control for the client? Select all that apply.

Apply warm compresses. Transfuse blood products as prescribed. Teach the client and parents biofeedback techniques.

A hospitalized child is postoperative from having a brain tumor resected. Which assessment(s) will the nurse perform to detect if increased intracranial pressure (ICP) is occurring? Select all that apply.

Assess eyes for pupil size and reactivity. Note increased irritability. Observe for sunsetting eyes.

A child with a congenital heart defect comes to the clinic with flu-like symptoms, parental report of not eating, and weight loss. What assessment(s) should the nurse complete for this child? Select all that apply.

Assess temperature. Inspect the color of the conjunctiva. Assess the abdomen. Auscultate heart sounds.

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client?

Bracing

The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse?

Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs.

A nurse is administering a blood transfusion to a child. About 35 minutes after beginning the transfusion, the child develops pruritus and urticaria. Some wheezing is noted. Which action would the nurse take first?

Discontinue the transfusion

The nurse cares for adolescents with cancer. Which recommended psychosocial interventions will the nurse use to help the adolescents cope with their disease? Select all that apply.

Encourage adolescents to engage in their usual activities. Encourage the adolescents to make plans for the future. Control the amount of information given out about an adolescent's condition. Be an advisor as well as a friend to the adolescents to promote cooperation in the care plan.

Parents of a 7-year-old with spina bifida inform the nurse that they never go out unless one parent is home with the child because they are afraid to leave the child with anyone. What intervention can the nurse provide to assist them with this issue?

Encourage the parents to express their anxieties about leaving the child with someone else.

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure?

He gets sweaty when he eats

A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client?

Hemoglobin level

The nurse is conducting a health assessment of a 6-year-old girl with spinal bifida. During the interview, the girl keeps interrupting and shouting to get her mother's attention. The mother instantly responds to every interruption and attempts to placate her with promises of a trip to the ice cream store. Which response by the nurse would be most appropriate to address the mother's response to her daughter's demands?

How do you feel when your daughter interrupts you?

A nurse is providing care to a child hospitalized with a hematologic disorder. Which nursing intervention(s) will provide support for the family? Select all that apply.

Include the family in client care conferences. Provide information on community resources related to the child's disorder. Create opportunities for the family to participate in the child's care.

A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching?

Our family is taking a hiking trip up in the mountains next week

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

Pale, cool, or blue skin coloration is to be expected

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first?

Prepare to administer factor replacement meds

Which health teaching concept should the nurse emphasize when instructing the parents of a child with polycythemia caused by a congenital heart disorder?

Prevent dehydration

The nurse enters the hospital room of a child undergoing tests for a possible malignancy. The parent is sitting alone in the corner crying softly. Which therapeutic action(s) is appropriate in this situation? Select all that apply.

Pull up a chair and offer the parent a tissue. State to the parent that this must be very difficult. Offer to listen to the parent if the parent would like to talk.

A nurse is caring for a child who is experiencing heart failure. Which assessment data was most likely seen when initially examined?

Tachycardia

After teaching a group of nursing students about sprains and strains, the instructor determines that the teaching was successful when the students describe a strain as which of the following?

Tearing of the musculotendinous unit

A newborn has been diagnosed with congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis?

Tetralogy of fallot

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response?

The cause is unknown and there are many environmental factors

The nurse is caring for an 8-month-old infant in Bryant traction for developmental dysplasia of the hip (DDH) and is monitoring for complications. Which assessment finding most concerns the nurse?

a weak pedal pulse

The nurse is caring for an 8-year-old with Duchenne muscular dystrophy (DMD) who is experiencing cardiomyopathy. The provider has prescribed carvedilol as part of the child's treatment plan. Which assessment(s) would be important for the nurse to complete before administering this agent? Select all that apply

apical pulse blood pressure

The nurse is caring for a school-aged child who has been diagnosed with congestive heart failure. The child has been prescribed digoxin. Prior to administering a scheduled dose of the medication, the nurse should:

assess the child's apical heart rate for 1 min

A nurse is preparing a class on neural tube disorders to present to a community group. What information regarding prevention is most important for the nurse to include in the teaching?

dietary considerations

An important nursing intervention to institute with an infant prior to surgery for a Wilms tumor is to place a sign over his crib that reads:

do not palpate abdomen

After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with:

factor VIII

The nurse is assessing a 8-month-old infant who has symptoms of poor feeding, a poor gag reflex, listlessness and a weak cry. What is the most important question the nurse should ask the parent about these symptoms?

have you given your infant honey

A nurse is providing care to a hospitalized child diagnosed with cerebral palsy. The nursing is preparing the family for discharge. What action by the nurse will most ensure the family's success after discharge?

having the family meet with a case manager for discharge

A child with acute lymphoblastic leukemia (ALL) is starting treatment with methotrexate in an attempt to eradicate the leukemic cells. Which stage of therapy is the child undergoing?

induction stage

The nurse is caring for an 8-year-old newly diagnosed cancer client. Which of the following nursing interventions is the most helpful for the client at this time?

initiate palliative care for this client now

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant?

inspection of the cystic sac on the childs back for leakage

What is the priority nursing action for a dying child who is restless, moaning, and vomiting?

pain assessment and control

The nurse is caring for an infant with myelomeningocele prior to having repair surgery. What nursing intervention(s) is necessary to include in this infant's plan of care? Select all that apply.

positioning of paralyzed legs to prevent contractures protecting knees and elbows from skin breakdown keeping the skin clean and dry

An experienced nurse is orienting a new nurse to the oncology unit. Which action by the new nurse would require intervention?

pouring unused chemotherapy medicine into a sink drain

The nurse is caring for a client with terminal cancer who is experiencing dyspnea and increasing levels of pain. What would be the priority for pain management with this child?

preventing and alleviating pain

A nurse is providing teaching on the medication regimen for beta-thalassemia to an adolescent. What is the best way for the nurse to determine if the teaching was successful?

request that the adolescent teach the information to the nurse

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority?

risk for infection

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele?

risk for infection

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?

standing

An adolescent girl has spinal instrumentation surgery at 16 years of age. Immediately after this procedure, the nurse would teach her to:

wait to be log-rolled before turning from one side to the other

The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate?

these values will help us monitor the disease

A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast?

Assess the fingers for warmth, pain, and function

The pediatric nurse caring for orthopedic patients knows that priorities for care of a child with a splint or brace focus on ensuring that the device is fitted and used correctly and on maintaining skin integrity. Which of the following nursing interventions help to achieve this goal? Select all answers that apply.

Daily baths or skin care with thorough drying minimizes skin irritation. The Pavlik harness must be worn at all times for 4 to 6 weeks. A wrist or knee splint used during acute arthritic phases or after injury can be removed during periods of inactivity. A brace or splint can be removed for bathing, sleeping, or exercise.

A nurse is giving instructions to the father of a boy who is receiving chemotherapy (including methotrexate) regarding how best to care for the boy during this period of treatment. What should the nurse mention to him?

Keep him away from people with known infections