GI Peds GI, GU, Musc (CP, Duchenne's)

25. Which is a major complication in a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

A newborn's failure to pass meconiumwithin 24 hours after birth may indicatewhich of the following? a.Aganglionic Mega colon b. Celiac disease c. Intussusception d. Abdominal wall defect

Failure to pass meconium of Newborn during thefirst 24 hours of life may indicate Hirschsprungdisease or Congenital Aganglionic Megacolon, ananomaly resulting in mechanical obstruction due toinadequate motility in an intestinal segment. B, C,and D are not associated in the failure to passmeconium of the newborn

Difference between osteosarcoma and Ewing's sarcoma?

Osteosarcoma mostly occurs in the metaphysis of long bones (FEMUR); treatment frequently includes amputation or limb salvage procedure and chemo Ewings sarcoma occurs in long shafts of bones and of trunk bones; treatment is radiation to tumor site and chemo, NOT amputation

Which diagnostic exam does the nurse know will best aid in the diagnosis of Duchenne muscular dystrophy? 1) EEG 2) CT Scan 3) MRI 4) EMG

4.

A pediatric nurse specialist provides a teaching session to the nursing staff regarding osteogenic sarcoma. Which statement by a member of the nursing staff indicates a need for clarification of the information presented? 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."" (CORRECT ANSWER--Need for further clarification). Osteogenic sarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur (omit #1). Osteogenic sarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site (correct answer: #2). By the time these children receive medical attention, they may be in considerable pain from the tumor. All options: 1, 3, 4 are accurate regarding osteogenic sarcoma.

A child is admitted to the hospital with a diagnosis of Wilm's tumor, Stage II. Which of the following statements most accurately describes this stage? A) The tumor is less than 3 cm. in size and requires no chemotherapy. B) The tumor did not extend beyond the kidney and was completely resected. C) The tumor extended beyond the kidney but was completely resected. D) The tumor has spread into the abdominal cavity and cannot be resected.

1. Answer: C The staging of Wilm's tumor is confirmed at surgery as follows: Stage I, the tumor is limited to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V, bilateral renal involvement is present at diagnosis.

18. A two-year-old child has sustained an injury to the leg and refuses to walk. The nurse in the emergency department documents swelling of the lower affected leg. Which of the following does the nurse suspect is the cause of the child's symptoms? Possible fracture of the tibia. Bruising of the gastrocnemius muscle. Possible fracture of the radius. No anatomic injury, the child wants his mother to carry him.

18. A The child's refusal to walk, combined with swelling of the limb is suspicious for fracture. Toddlers will often continue to walk on a muscle that is bruised or strained. The radius is found in the lower arm and is not relevant to this question. Toddlers rarely feign injury to be carried, and swelling indicates a physical injury. 20. A

19. A toddler has recently been diagnosed with cerebral palsy. Which of the following information should the nurse provide to the parents? Note: More than one answer may be correct. Regular developmental screening is important to avoid secondary developmental delays. Cerebral palsy is caused by injury to the upper motor neurons and results in motor dysfunction, as well as possible ocular and speech difficulties. Developmental milestones may be slightly delayed but usually will require no additional intervention. Parent support groups are helpful for sharing strategies and managing health care issues.

19. A, B, D Delayed developmental milestones are characteristic of cerebral palsy, so regular screening and intervention is essential. Because of injury to upper motor neurons, children may have ocular and speech difficulties. Parent support groups help families to share and cope. Physical therapy and other interventions can minimize the extent of the delay in developmental milestones.

A nurse admits a child who has a history cerebral palsy. Which assessment finding by the nurse is most concerning? 1) The mother reports the child had a seizure 5 hours ago. 2) The child has a fever of 100.3. 3) The child is standing on his toes. 4) The mother reports the child's twisting movements seem to have worsened since arriving at the clinic.

2) This fever could indicate aspiration pneumonia, and this needs to be investigated further immediately with questioning of coughing, respiratory difficulty, or sputum production. Seizures are common with cerebral palsy. The child's symptoms have likely worsened because of the stress due to a clinic visit. Standing on the toes or scooting on the back (instead of crawling on the abdomen) are both commonly seen in a patient with cerebral palsy.

A nurse prepares to care for a patient diagnosed with athetoid, or dyskinetic, cerebral palsy. Which of the following does the nurse expect to see? Select all that apply: 1) Hypertonicity of affected extremities 2) Drooling 3) Worsening of symptoms when the child gets stressed 4) Worm-like writhing 5) Exaggerated deep tendon reflexes

2, 3, 4 Others are characteristic of spastic cerebral palsy. The infant may also appear limp or flaccid with the face, neck, and tongue possibly affected.

The pediatric nurse knows that which of the following medications are commonly used for patients with cerebral palsy? Select all that apply: 1) Docusate sodium 2) Diazepam 3) Dantrolene sodium 4) Baclofen 5) Atropine

2, 3, 4, 5 Can also use botulinum toxin, but this is administered by a nurse practitioner or physician.

A nurse has just finished providing discharge teaching to the family of a child going home with a cast that was applied 30 minutes prior. Which statement by the family indicates that further teaching is necessary? Select all that apply: 1) "For the next couple of days, we should keep the casted arm above the level of the heart and apply ice." 2) "If my child's arm starts to itch, we can apply lotion if we can reach into the cast." 3) "We will tape a plastic bag around his cast before he takes a bath." 4) "If my child gets his cast wet, we'll blow dry it with the lowest heat setting on our blow dryer." 5) "We will make sure we regularly press the skin back around the edge of the cast." 6) "We will make sure our child does not eat anything messy while he has this cast on."

2, 4, 6 Nothing should be inserted into the cast, and lotions and powders should not be used. If the cast gets wet, a blow dryer with COLD air should be used. There is no need to adjust the child's diet, but the cast should be covered while the child eats or drinks.

2. A teen patient is admitted to the hospital by his physician who suspects a diagnosis of acute glomerulonephritis. Which of the following findings is consistent with this diagnosis? Note: More than one answer may be correct. Urine specific gravity of 1.040. Urine output of 350 ml in 24 hours. Brown ("tea-colored") urine. Generalized edema.

2. A, B, and C Acute glomerulonephritis is characterized by high urine specific gravity related to oliguria as well as dark "tea colored" urine caused by large amounts of red blood cells. There is periorbital edema, but generalized edema is seen in nephrotic syndrome, not acute glomerulonephritis.

A nurse is assigned to the pediatric rheumatology clinic and is assessing a child who has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate? 1. The child has a poor chance of recovery without joint deformity. 2. Most children progress to adult rheumatoid arthritis. 3. Nonsteroidal anti-inflammatory drugs are the first choice in treatment. 4. Physical activity should be minimized.

3 Nonsteroidal anti-inflammatory drugs are important first line treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Half of children with the disorder recover without joint deformity, and about a third will continue with symptoms into adulthood. Physical activity is an integral part of therapy.

While caring for a 9-year-old female in Buck's traction, which of the following actions by the nurse is correct? 1) The nurse encourages the child's 3 year-old sibling to sit on the bed and visit with the child. 2) The nurse helps the child learn how to raise and lower the head of her bed so she can complete her homework. 3) The nurse checks the capillary refill on the child's extremities every 4 hours. 4) The nurse teaches the child's mother to place the weights on the bedside table before the child uses the bedpan.

3) Extra visitors should not be invited on the bed- especially a toddler who may think the weights at the end of the bed are toys. The head of the bed should only be raised or lowered with physician's orders, and this should be done minimally. The weights should ALWAYS be hanging freely.

3. Which of the following conditions most commonly causes acute glomerulonephritis? A congenital condition leading to renal dysfunction. Prior infection with group A Streptococcus within the past 10-14 days. Viral infection of the glomeruli. Nephrotic syndrome.

3. B Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection, resulting in scant, dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.

A concerned mother calls the and tells you the following pieces of information about her 2-year-old son. Which statement by the mother most concerns you? 1) "I noticed that when my son is standing, his knees touch but his feet seem really far apart." 2) "My son's feet are so flat, even though he's been waking for 9 months now." 3) "My baby really hates it when I try to feed him broccoli and keeps spitting it out onto his plate." 4) "This morning when I was trying to dress him, my son cried nonstop when I tried to put his shirt on."

4) This could indicate a sprain or fracture, and nursemaid's elbow is common in toddlers and preschoolers. This statement should be further investigated since it indicates pain/discomfort. It is not uncommon for infants to have flat feet, although the arch of the foot should begin to form after walking begins. However, some infants never develop an arch and have flat feet as adults. Genu valgum, or "knock knees", are commonly seen around the ages 2-3, and this will often resolve by ages 7-8. It is not uncommon for a toddler to dislike broccoli. Who does like broccoli.

15. Which is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. Popcorn b. Pancakes c. Muffins d. Ripe bananas

ANS: A Popcorn is a high-fiber food. Pancakes and muffins do not have significant fiber unless made with fruit or bran. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.

How does a newborn with Hirschsprung Disease present? Select all that apply. a. failure to pass meconium b. abdominal distention c. bilious emesis d. fever e. refusal to eat f. bloody diarrhea

A, B, C, E A failure to pass meconium within 24-48 hrs is the cardinal sign. No nerve in rectum to signal need for defecation to child. Fever, bloody diarrhea and (enterocolitis) are complications of HD.

Which issue is important to discuss when educating a family about nocturnal enuresis? Select all that apply a. Have the child double-void before going to bed. b. Counseling for the child and family c. Promote regular BMs d. Limiting daytime fluids

A, C Have the child double-void before going to bed. Rationale: Counseling is not always indicated. Promoting regular stools and having the child double-void before bed are appropriate interventions. Limiting daytime fluids has not been shown to be effective.

What are the symptoms of pinworm infestation? Selct all that apply. a. pruritis b. diarrhea c. fatigue d. enuresis e. nausea/vomiting

A, D Intense nocturnal perianal pruritis, irritability, restlessness, enuresis, Vaginal/vulvar pruritis, vaginal discharge are all symptoms of pinworm infestation.

A nurse is teaching a parent for a kid on chemo for bone cancer. What should be included? SELECT ALL a. signs of infection b. bleeding precautions c. hand hygiene d. home schooling e. nutritional requirements

A,B,C,E

In which hereditary disorder is intussusception most commonly seen? a. Cystic fibrosis b. Asthma c. Hirsprung's disease d. Omphalocele

A. Increased risk of occurrence in CF due to stickiness and thickness of secretions, improper balance of sodium chloride.

The nurse teaches the mother of a young child with Duchenne's muscular dystrophy about the disease and its management. Which of the following statements by the mother indicates successful teaching? a)my son will probably be unable to walkindependently by the time he is 9 to 11 years old b) muscle relaxants are effective for some children;I hope they can help my son c) when my son is a little bit older, he can havesurgery to improve his ability to walk d) I need to help my son be as active as possible toprevent progression of the disease

A. Muscular dystrophy is an X-linked recessive disorder.The gene is transmitted through female carriers toaffected sons 50% of the time. Daughters have a 50%chance of being carriers. It is a progressive disease.Children who are affected by this disease usually areunable to walk independently by age 9-11 years. There isno effective treatment for the disease. Acharacteristic manifestation is Gower's sign -- the childwalks the hands up the legs in an attempt to rise fromsitting to standing position.

20. A child has recently been diagnosed with Duchenne's muscular dystrophy. The parents are receiving genetic counseling prior to planning another pregnancy. Which of the following statements includes the most accurate information? a. Duchenne's is an X-linked recessive disorder, so daughters have a 50% chance of being carriers and sons a 50% chance of developing the disease. b. Duchenne's is an X-linked recessive disorder, so both daughters and sons have a 50% chance of developing the disease. c. Each child has a 1 in 4 (25%) chance of developing the disorder. d. Sons only have a 1 in 4 (25%) chance of developing the disorder.

A. The recessive Duchenne's gene is located on one of the two X chromosomes of a female carrier. If her son receives the X bearing the gene he will be affected. Thus, there is a 50% chance of a son being affected. Daughters are not affected, but 50% are carriers because they inherit one copy of the defective gene from the mother. The other X chromosome comes from the father, who cannot be a carrier.

The nurse is performing a pH dipstick test on a urine specimen. Which is the average pH expected for this test? (Record answer in a whole number.)

ANS: 6 The average pH for urine is 6, and its normal range is 4.8 to 7.8. Abnormal pH levels are associated with urinary infection and metabolic alkalosis or acidosis.

12. The nurse explains that the treatment of choice for a child with intussusception is: a. a barium enema. b. immediate surgery. c. IV fluids until the spasms subside. d. gastric lavage.

ANS: A A barium enema is the treatment of choice for intussusception because the passage of the barium frequently "un-telescopes" the bowel. Surgery is scheduled only if reduction is not achieved.

28. An infant is admitted to the hospital with severe dehydration. Laboratory results show pH 7.32, PaCO2 40, HCO3- 21. The nurse interprets these values as: a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

ANS: A A pH lower than 7.35 indicates acidosis. If the child's pH falls in the same line as the HCO3-, the problem is metabolic (see Table 27-4).

5. An appropriate intervention for a 3-month-old infant who has gastroesophageal reflux is to: a. position the infant in the crib on his or her abdomen, with the head elevated. b. administer medication as ordered to stimulate the pyloric sphincter. c. give thin rice cereal with formula before feeding solid foods. d. place the infant in an infant seat after feedings.

ANS: A After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure.

11. Intussusception would be suspected when parents describe the child's stools as: a. currant jelly. b. black and tarry. c. green liquid. d. greasy and foul-smelling.

ANS: A Bowel movements of blood and mucus that contain no feces ("currant jelly" stools) are common about 12 hours after the onset of the obstruction.

9. Which is instituted for the therapeutic management of minimal change nephrotic syndrome? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis

ANS: A Corticosteroids are the first line of therapy for minimal change nephrotic syndrome. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.

9. The instruction the nurse would give to parents about preventing the spread and reinfection of pinworms is to: a. keep children's nails short. b. dress child in loose-fitting underwear. c. clean the bathroom with bleach solution. d. wash bed linens in cold water.

ANS: A One intervention to prevent the further spread of pinworms is to keep the child's fingernails short. Pinworms are not spread from person to person.

1. Which condition in a child should alert a nurse for increased fluid requirements? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure (ICP)

ANS: A Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

12. A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate nursing goal related to this? a. Prevent infection. b. Stimulate appetite. c. Detect evidence of edema. d. Ensure compliance with prophylactic antibiotic therapy.

ANS: A High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

12. A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child should begin with: a. intravenous (IV) fluids. b. ORS. c. clear liquids, 1 to 2 ounces at a time. d. administration of antidiarrheal medication.

ANS: A In children with severe dehydration, IV fluids are initiated. ORS is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.

11. 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. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with minimal change nephrotic syndrome. The child will most likely have neurologic signs and symptoms.

20. The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor? a. Abdominal swelling b. Weight gain c. Hypotension d. Increased urinary output

ANS: A The initial assessment finding with a Wilms (kidney) tumor is abdominal swelling. Weight loss, not weight gain, may be a finding. Hypertension occasionally occurs with a Wilms tumor. Urinary output is not increased, but hematuria may be noted.

22. The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

ANS: A The principal feature of acute renal failure is oliguria; hypertension is a nonspecific clinical manifestation. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure.

21. A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis. The priority goal of the infant's care is to prevent: a. fluid and electrolyte imbalance. b. nutritional deficiency. c. skin breakdown. d. malabsorption.

ANS: A The priority goal of care in gastroenteritis is preventing fluid and electrolyte imbalance.

24. When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as: a. uremia. b. oliguria. c. proteinuria. d. pyelonephritis.

ANS: A Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urinary output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.

25. The statement by a mother that may indicate a cause of her son's vitamin C deficiency is: a. "We get our fruits from homemade preserves." b. "We use milk from our own goats." c. "We grow all our own vegetables." d. "We're not big meat eaters."

ANS: A Vitamin C is destroyed by heat.

3. On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment? a. Weight loss of 4 ounces b. Dry mucous membranes c. Decreased skin turgor d. Depressed fontanelle

ANS: A Weight loss is the most significant indicator of dehydration because an infant's weight is comprised of 77% water.

7. A mother reports that her child has been scratching the anal area and complaining of itching. Based on this information, the nurse might suspect this child has: a. pinworms. b. giardiasis. c. ringworm. d. roundworm.

ANS: A With pinworms, the nurse or parent may notice that the child scratches the anal area and complains of itchiness. The other choices do not cause this reaction.

33. What sign(s) indicate(s) moderate dehydration? Select all that apply. a. 10% weight loss b. Dry mucous membranes c. Normal anterior fontanel d. Increased urinary output e. Lethargy

ANS: A, B, C The child that is moderately dehydrated will have lost 10% of his body weight, will have dry mucous membranes, normal (nonsunken) anterior fontanelle, decreased urine output, and will be irritable.

A nurse is caring for a child who sustained a fracture. What are appropriate nursing interventions? Select all that apply. a. Elevate the affected limb b. Assess neurovascular status frequently c. Stabilize the injury d. Apply a cold pack on the site of the injury to reduce swelling e. Establish IV access

ANS: A, B, C, D IV needs an order, it is a collaborative intervention.

32. What assessment(s) would lead a nurse to suspect Hirschsprung's disease in a 1-month-old infant? Select all that apply. a. Ribbon-like stools b. Fever c. Failure to thrive d. Vomiting e. Diminished peristalsis

ANS: A, B, C, D, E All options are significant indicators of Hirschsprung's disease.

2. A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.) a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

ANS: A, D, E Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.

14. Which best describes acute glomerulonephritis? a. Occurs after a urinary tract infection b. Occurs after a streptococcal infection c. Associated with renal vascular disorders d. Associated with structural anomalies of genitourinary tract

ANS: B Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A â-hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies.

15. A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). After gastric lavage is completed, the nurse might expect this child to receive: a. activated charcoal. b. N-acetylcysteine. c. vitamin K. d. syrup of ipecac.

ANS: B Gastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen.

17. A frightened mother calls the pediatrician's office because her child swallowed dishwashing detergent. The most appropriate action is to: a. induce vomiting by giving the child syrup of ipecac. b. take the child to the local emergency department. c. give the child activated charcoal mixed with juice. d. give the child milk to soothe affected mucous membranes.

ANS: B Inducing vomiting is no longer recommended because it may pose additional problems. The child should be taken immediately to the nearest emergency department along with the packaging of the ingested substance.

17. Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. The enema solution should be: a. tap water. b. normal saline. c. oil retention. d. phosphate preparation.

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Phosphate enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the phosphate enema can result in diarrhea, which can lead to metabolic acidosis.

36. A school-age child with acute renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer? a. Spironolactone (Aldactone) b. Sodium polystyrene sulfonate (Kayexalate) c. Lactulose (Cephulac) d. Calcium carbonate (Calcitab)

ANS: B Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels.

13. Which is included in the diet of a child with minimal change nephrotic syndrome? a. High protein b. Salt restriction c. Low fat d. High carbohydrate

ANS: B Salt is usually restricted (but not eliminated) during the edema phase. The child has little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.

23. The nurse would expect a child admitted to the hospital for nonorganic failure to thrive to: a. cry to be picked up. b. be limp like a rag doll. c. be responsive to cuddling. d. weigh in the 10th percentile for age.

ANS: B Some children with failure to thrive have rag-doll limpness (hypotonia) and appear wary of their caregivers.

18. A child has been diagnosed with ascariasis (roundworm). The statement made by her mother that may suggest a cause for her condition is: a. "I've been airing out the house on these nice breezy days." b. "My child often goes out to the garden and pulls up a carrot to eat." c. "She runs barefoot so much I have to wash her feet at least twice a day." d. "We just remodeled our bathroom at home."

ANS: B The child can ingest roundworm eggs from contaminated soil.

8. Which is an objective of care for a 10-year-old child with minimal change nephrotic syndrome? a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid.

ANS: B The objectives of therapy for the child with minimal change nephrotic syndrome include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimization of complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Excretion of urinary protein and fluid retention are part of the disease process and must be reversed.

15. A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show: a. bacteriuria, hematuria. b. hematuria, proteinuria. c. bacteriuria, increased specific gravity. d. proteinuria, decreased specific gravity.

ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

6. The nurse interviewing parents of an infant with pyloric stenosis would expect the parents to report if the infant has had: a. diarrhea. b. projectile vomiting. c. poor appetite. d. constipation.

ANS: B Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting.

31. When feeding a child with pyloric stenosis, what interventions will the nurse perform? Select all that apply. a. Give a formula thinned with water. b. Burp the infant before and during feeding. c. Give the feeding slowly. d. Refeed if the infant vomits. e. Position infant on left side after feeding.

ANS: B, C, D Children with pyloric stenosis are given formula thickened with cereal; the infant is burped before and during feeding to get rid of any gas in the stomach; the infant is fed slowly and refed if vomiting occurs. The infant is positioned on the right side to allow the weight of the feeding to stay in the stomach against the pyloric valve.

3. A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that apply.) a. Weight loss b. Facial edema c. Cloudy smoky brown-colored urine d. Fatigue e. Frothy-appearing urine

ANS: B, D, E A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome.

19. The nurse would expect the stools of a child with celiac disease to have which appearance? a. Ribbon like b. Hard, constipated c. Bulky, frothy d. Loose, foul-smelling

ANS: C Celiac disease causes malabsorption. Stools that are large, bulky, and frothy may indicate malabsorption.

27. One reason that infants are more vulnerable to fluid and electrolyte imbalances than adults is that: a. they have a smaller surface area than adults in proportion to body weight. b. water needs and losses per kilogram are lower than those for adults. c. a greater percentage of body water in infants is extracellular. d. infants have a lower metabolic turnover of water.

ANS: C A greater percentage of body water is contained in the extracellular compartment of children under 2 years of age.

22. The nurse, speaking to the parent of a 3-year-old child who has mild diarrhea, would advise the dietary modification of: a. soft foods with rice, bananas, toast, and applesauce. b. small amounts of clear fluids such as gelatin. c. an oral rehydrating solution, such as Pedialyte. d. chicken soup because it is high in sodium.

ANS: C An oral rehydrating solution is recommended to replace fluids and electrolytes lost from frequent bowel movements.

14. Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. The nurse should suspect that the constipation is most likely caused by: a. diet. b. allergies. c. antihistamines. d. emotional factors.

ANS: C Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known change in her habits, the addition of antihistamines is most likely the cause of the diarrhea. With a change in bowel habits, the role of any recently prescribed medications should be assessed.

10. A mother reports that her 2-year-old child experiences constipation frequently. The nurse would recommend to the mother to include what food in the child's diet? a. Cooked vegetables b. Pretzels c. Whole-grain cereal d. Yogurt

ANS: C Dietary modifications for constipation include eating more high-roughage foods such as whole-grain breads and cereals.

18. The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. "You will need to decrease the number of calories in your child's diet." b. "Your child's diet will need an increased amount of protein." c. "You will need to avoid adding salt to your child's food." d. "Your child's diet will consist of low-fat, low-carbohydrate foods."

ANS: C For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

13. Parents ask the nurse how their infant developed a Meckel's diverticulum. The nurse's response is based on the knowledge that this condition occurs when: a. the yolk sac remains connected to the intestine. b. there is inflammation of the ileocecal valve. c. a pouch forms when the vitelline duct fails to disappear. d. there is a weakness in the abdominal wall.

ANS: C If the vitelline duct fails to disappear completely after birth, a blind pouch may form.

8. Which is a parasite that causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C G. lamblia is a parasite that represents 10% of non-dysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens.

19. Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a. Risk for Injury related to malignant process and treatment b. Fluid Volume Deficit related to excessive losses c. Fluid Volume Excess related to decreased plasma filtration d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces

ANS: C Glomerulonephritis has a decreased filtration of plasma, which results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration.

19. The nurse is explaining to a parent how to care for a school-age child with vomiting associated with a viral illness. Which action should the nurse include? a. Avoid carbohydrate-containing liquids. b. Give nothing by mouth for 24 hours. c. Brush teeth or rinse mouth after vomiting. d. Give plain water until vomiting ceases for at least 24 hours.

ANS: C It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Ad libitum administration of glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrate to spare body protein and avoid ketosis.

2. A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that melena, the passage of black, tarry stools, suggests bleeding from which area? a. Perianal or rectal area b. Hemorrhoids or anal fissures c. Upper gastrointestinal (GI) tract d. Lower GI tract

ANS: C Melena is denatured blood from the upper GI tract (ie an ulcer from NSAID use) or bleeding from the right colon. Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright red.

10. Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration? a. Clear liquids b. Adsorbents, such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric

ANS: C ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended. Antidiarrheals are not recommended because they do not get rid of pathogens.

3. The nurse is conducting an assessment on a school-age child with acute glomerulonephritis. Which assessment finding should the nurse expect? a. Fever with a positive blood culture b. Proteinuria and edema c. Oliguria and hypertension d. Anemia and thrombocytopenia

ANS: C Oliguria and hypertension are symptoms of acute glomerulonephritis (AGN). Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome (HUS). Symptoms of urosepsis include a febrile UTI coexisting with systemic signs of bacterial illness. Proteinuria and edema are symptoms of minimal change nephrotic syndrome (MCNS).

4. The nurse is aware that rapid respirations are a possible cause of dehydration because they: a. prevent the child from drinking. b. increase circulation, thus increasing urine production. c. cause evaporation of fluid on the mucous membranes. d. often lead to vomiting.

ANS: C Rapid respirations cause increased insensible fluid loss.

7. Which pathogen is the viral pathogen that frequently causes acute diarrhea in young children? a. Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

ANS: C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. Giardia (parasite) and Salmonella are bacterial pathogens that cause diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States.

21. Which is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

ANS: D The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

18. A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a. not necessary because of child's age. b. not necessary because colostomy is temporary. c. necessary because it will be an adjustment. d. necessary because the child must deal with a negative body image.

ANS: C The child's age dictates the type and extent of psychological preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms, with the use of visual aids. It is necessary to prepare a 3-year-old child for procedures. The preschooler is not yet concerned with body image.

2. The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? a. pH b. Osmolality c. Creatinine d. Protein level

ANS: C The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.

8. The nurse that is teaching a parent about pyrvinium (Povan) would include the information that the drug will cause: a. diarrhea. b. skin rash. c. red stool. d. metallic taste.

ANS: C The nurse should advise parents that pyrvinium stains clothing and turns stools red.

16. The nurse, planning a parent education program about lead poisoning prevention, would include the information that the sources of lead in the community are most likely: a. increased lead content of air. b. use of aluminum cookware. c. deteriorating paint in older buildings. d. inhaling smog.

ANS: C The primary source of lead is paint from old, deteriorating buildings.

17. The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a. poor appetite. b. increased potassium intake. c. reduction of edema. d. restriction to bed rest.

ANS: C This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 pounds in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

5. A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber? (Select all that apply.) a. White rice b. Avocados c. Whole grain breads d. Bran pancakes e. Raw carrots

ANS: C, D, E High-fiber foods include whole grain breads, bran pancakes, and raw carrots. Unrefined (brown) rice is high in fiber but not white rice. Raw fruits, especially those with skins or seeds, other than ripe banana or avocado are high in fiber.

26. The nurse instructing a mother how to administer oral nystatin suspension prescribed to treat thrush would teach her to: a. pour the prescribed amount into a nipple and have the infant suck the medication. b. squirt the prescribed dose into the back of the mouth and have the infant swallow. c. give the medication mixed with a small amount of juice in a bottle. d. use a sterile applicator to swab the medication on the oral mucosa.

ANS: D An appropriate way to administer nystatin is to moisten a sterile applicator with the medication and then swab it on the inside of the mouth.

16. A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a. blood pressure will stabilize. b. the child will have more energy. c. urine will be free of protein. d. urinary output will increase.

ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

26. Which clinical manifestation would be seen in a child with chronic renal failure? a. Hypotension b. Massive hematuria c. Hypokalemia d. Unpleasant breath odor

ANS: D Children with chronic renal failure have a characteristic "uremic" breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urinary output occurs. Hyperkalemia is a concern in chronic renal failure.

23. The nurse is caring for a child with acute renal failure. Which clinical manifestation should the nurse recognize as the most common threat to the life of the child? a. Dyspnea b. Seizure c. Oliguria d. Cardiac arrhythmia

ANS: D Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiograph anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia.

16. Which therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel

ANS: D Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary.

Which medications will be used in the treatment of pinworms?

Mebendazole, pyrantel pamoate and piperazine citrate (Vermox, Antimith); Treat all family members simultaneously; Repeat tx in 2-3 week

20. After reviewing dietary restrictions for celiac disease, the nurse determines that a parent understands the information when she states that a grain that can be eaten by a child with celiac disease is: a. wheat. b. oats. c. barley. d. rice.

ANS: D Rice is a gluten-free grain that can be eaten by children afflicted with celiac disease. These children will have a lifelong restriction of wheat, oats, barley, and rye.

14. An infant is admitted to the hospital with severe isotonic dehydration. In planning the infant's care, the nurse is aware the infant is at risk for: a. metabolic alkalosis. b. hypocalcemia. c. sepsis. d. shock.

ANS: D Shock is the greatest threat to life in isotonic dehydration.

29. Following surgery for pyloric stenosis an infant awoke from anesthesia hungry and crying. The nurse should: a. delay feeding the child for 6 hours. b. offer regular formula thinned with water. c. give small amounts of regular formula thickened with cereal. d. allow one ounce of glucose water at frequent intervals.

ANS: D Small oral feedings of glucose water are given after recovery from anesthesia. Feedings are gradually increased to larger amounts of regular formula.

30. The nurse is aware that the 18-pound child must take in _____ mL of oral fluid to make up the fluid loss from one stool of diarrhea. a. 18 b. 36 c. 64 d. 81

ANS: D The formula for oral fluid replacement is 10 mL/kg. 18 pounds = 8.1 kg 10 = 81 mL.

24. Nursing interventions for the mother of a 10-month-old infant with nonorganic failure to thrive would include: a. pointing out errors that the nurse observes when the mother is caring for the infant. b. discussing negative characteristics of the infant with the mother. c. having the nurse provide as much of the infant's care as possible. d. teaching the mother about the developmental milestones to expect in the next few months.

ANS: D The nurse can increase parent's knowledge of growth and development by providing anticipatory guidance about normal developmental milestones.

The ingestion of a Shiga toxin produced by Escherichia coli 0157:H7 can cause a sometimes fatal illness called hemolytic-uremic syndrome (HUS). Select the client at highest risk: a. An individual who consumed undercooked hamburger during a backyard BBQ b. An individual who properly washed her hands after using the restroom c. An individual who consumed fully cooked hamburger during a backyard BBQ d. An individual who consumed pasteurized apple juice

An individual who consumed undercooked hamburger during a backyard BBQ

6.Which of the following should the nurse do first after noting that a child with Hirschsprung disease has a fever and watery explosive diarrhea? a. Notify the physician immediately b. Administer antidiarrheal medications c. Monitor child every 30 minutes d. Nothing, this is characteristic ofHirschsprung disease

Answer A. For the child with Hirschsprung disease, fever andexplosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physicianshould be notified immediately. Generally, becauseof the intestinal obstruction and inadequatepropulsive intestinal movement, antidiarrheals arenot used to treat Hirschsprung disease. The child isacutely ill and requires intervention, with monitoringmore frequently than every 30 minutes.Hirschsprung disease typically presents withchronic constipation.

When assessing a 12 year old child withWilm's tumor, the nurse should keep in mindthat it most important to avoid which of thefollowing? a)measuring the child's chestcircumference b) palpating the child's abdomen c) placing the child in an uprignt position d) measuring the child's occipitofrontalcircumference

Answer B The abdomen of the child with Wilm's tumorshould not be palpated because of the dangerof disseminating tumor cells. The child withWilm's tumor should always be handled gentlyand carefully

The nurse is assessing an infant withhirschspung's disease. The nurse can expect the infant to: a.Weight less than expected for height and age b. Have infrequent bowel movements c. Exhibit clubbing of fingers and toes d. Have hyperactive deep tendon reflexes

Answer B The infant with hirschsprung's disease will have infrequent bowel movements.

The nurse is caring for a 4-year oldwith cerebral palsy. Which nursingintervention will help ready the child forrehabilitative services? a.Patching one of the eyes to strengthen the muscles b. Providing suckers and pinwheels to strengthen tongue movement c. Providing musical tapes to provide auditory training d. Encouraging play with a video game to improve muscle coordination

Answer B The nurse can help ready the child with cerebralpalsy for speech therapy by providing activitiesthat help the child develop tongue control.

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

Answer C Because intussusception is not believed to have a familial tendency, obtaining a family history would provide the least amount of information. Stooli nspection, pain pattern, and abdominal palpation would reveal possible indicators of intussusception. Currant jelly-like stools (bloody and mucoid) are an indication of intussusception. Acute, episodic abdominal pain is characteristic of intussusception. A sausage-shaped mass may be palpated in the right upper quadrant.

20. A school-aged client admitted to thehospital because of decreased urine outputand periorbital edema is diagnosed withglomerulonephritis. Which of the followinginterventions would receive the highestpriority? a)assessing vital signs every four hours b) monitoring intake and output every 12hours c) obtaining daily weight measurements d) obtaining serum electrolyte levels daily

Answer C The child will glomerulonephritis experiences aproblem with renal function that ultimatelyaffects fluid balance. Because weight is thebest indicator of fluid balance, obtaining dailyweights would be the highest priority.

During an examination of a 2 year-old child with a tentative diagnosis of Wilm's tumor, the nurse would be most concerned about which statement by the mother? A) My child has lost 3 pounds in the last month. B) Urinary output seemed to be less over the past 2 days. C) All my child's pants have become tight around the waist. D) The child prefers some salty foods morethan others.

Answer C: Clothing that has become tight around the waist. is often recognized (as a result of the increasing abdominal girth) first. This is an early sign of Wilm's tumor, a malignant tumor of the kidney.

Which nursing action is a priority in the plan of care developed for a 7 year old child hospitalized for acute glomerulonephritis? A)Assess for generalized edema B) Monitor for increased urinary output C) Encourage rest during hyperactive periods D) Note patterns of increased blood pressure

Answer D Note patterns of increased blood pressure. Hypertension is a key assessment in the course of the disease.

Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy? 1. Measure abdominal girth 2. Calculate BMI 3. Ask the client about his/her height and weight 4. Weigh and measure the client on the day of medication administration

Answer: 4 To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total Body surface area(BSA) which requires accurate height and weight before each med administration. Simply asking the client about height/weight may lead to inaccuracies in determining BSA. Calculating BMI and measuring abdominal girth does not provide the data needed.

The 7 year old patient has had a cast on to heal his fracture of his arm. After the expected time period, the nurse is teaching a child about what to expect when removing his cast. Which of the following teaching points should the nurse include? Select All that Apply: A) "The cast could begin to feel really warm as the striker saw is taking the cast off" B) "The striker saw will be very loud" C) "Look, see, the saw won't be able to cut your skin" D) "Once the cast is removed we will soak your leg in warm water" E) "you will still need to keep your leg very still even after the cast is removed"

Answer: A, B, C, and D. The cast/extremity under the cast could begin to feel warm during the cast removal process. The saw could be loud, but the nurse should demonstrate on him/herself that the saw can't won't cut the child. Once the cast is removed, it will be soaked and washed in warm soapy water, and it should be soaked in warm water daily. All of these need to be communicated to the child on the level of their understanding. The child should be told to start increasing activity the limb to regain strength and range of motion.

The nurse is caring for the patient with Russel's traction. Which of the following should the nurse include in this patients plan of care? SATA: A) Weight should remain off of the floor at all times B) Place a foot support to prevent foot drop C) Release traction for 5 minutes of every hour to provide skin care D) Ensure heel is resting on bed at all times E) Assess neurovascular status q 4 hours

Answer: A, B, and E. With all traction, the weights should remain off of the floor at all times and should not be released periodically or stopped for any reason unless emergent. A foot support will be needed for this patient because foot drop could develop related to the heel being elevated without support. The heel should be off of the bed at all times, not resting on it. Neurovascular status should be assessed often on this patient (as often as vitals are done).

Which of the following symptoms would the nurse expect to possibly see in the child with Duchenne muscular dystrophy? Select all that apply a) Protuberant belly b) Diminished intelligence c) Walking on the toes or balls of feet d) Gower's sign e) Spinal curvatures

Answer: A, C, D, and E. To protect balance, which is impaired in this disorder, the child may often have their belly sticking out with their shoulders pulled back. They often have a waddling gait and walk on the toes or on the balls of the feet. Gower's sign is the use of a special technique in order to rise off of the floor. Spinal curvatures often occur as the muscles in the body atrophy (including lordosis, kyphosis, and scoliosis). Intelligence is rarely affected by this disorder.

The nurse is providing discharge instructions to the family and the 5 year old child who has received a cast for his broken lower leg. Which statement, if made by the legal guardian would indicate the need for further teaching? A) I can place ice on the affected leg for the first 2 days for an hour at a time B) I should make sure that the leg is elevated C) We can use a blow dryer to help relieve the itching inside the cast D) We should call in if my kid complains of severe, unrelieved pain in his leg

Answer: A. Ice should only be used for periods of 20-30 minutes. All other pieces of information are correct (page 844).

The nurse is providing discharge instructions to the family and the 9 year old child who has received a Gore-tex cast for his broken lower leg. The mother states to the nurse, "how do I know if something is going wrong with the cast?" The nurse should teach the mother to call the physician in which case? Select all that apply. A) The cast gets wet B) The toes become cold to the touch C) The child has a fever of 100 degrees for a couple hours D) The "petals" on the edge of the cast fall off E) The child feels extreme itchiness inside the cast

Answer: B, C, and E. Because this is a Gore-tex cast, it is allowed to get wet and would not be a cause for concern. Any decrease in the neurovascular status of the limb should be reported including coolness of the toes. A temperature of 101.5 degrees or higher for 24 hours or longer should be reported. Because this is a gore-tex cast, no petals should be placed around the edges of the cast (page 843). Extreme itchiness within the cast would be reason to call.

A nurse is assessing a 3 year old child in the pediatrics wellness clinic, which of the following would be least concerning to the nurse? a) The child is holding his right arm close to his chest and refusing to use it b) When the child stands with his knees together, his ankles are far apart c) The child's pelvis drops slightly whenever he walks d) The child is in the shortest percentile for his age group

Answer: B. This condition, known as genu valgum or knock-knees, a common finding in children aged 2-3 and would not be concerning to the nurse. Refusal to use a limb could be a sign of damage or fracture to that limb. Trendelenberg's sign, or the drop of the pelvis when walking, could be a sign of hip dysplasia. Being in the shortest percentile for his age group could be a sign of a growth delay possibly caused by an underlying condition.

You are the nurse taking care of the infant just diagnosed with cerebral palsy. The mother of the child asks you, "What does this mean for my child?" What is the best response by the nurse? A) This means that you child will gradually lose more and more muscle mass until eventually they will be unable to sustain their respiratory function B) This is a disorder related to how your child was born - it's likely they sustained injury during the birthing process. C) There really is no specific way to tell how this disease will affect your child other than it will affect the muscle tone and control in some way. D) I can't give you a definitive answer; I'll mention your concerns to the physician.

Answer: C. Cerebral Palsy is a term used to describe a range of nonspecific clinical symptoms characterized by abnormal motor pattern and postures caused by nonprogressive abnormal brain function.

Tommy is a young child who is started walking early in life and usually is very active and happy. His mother tells you of a slow change that has happened to her son, and that he is less active than he has been. He now seems tired a lot and has difficulty doing things he used to do, such as running and playing. Which of the following would the nurse want to assess first? a) Check the child's back for dimpling or a tuft of hair at the base of the spine b) Assess the child's pain level and level of consciousness c) The child's ability to stand up and walk d) The presence of infantile reflexes

Answer: C. This child is presenting signs that most line up with a form of progressive muscular dystrophy, and it would be important for the nurse to follow up on the mother's claims that the child has difficulty ambulating and playing.

How is hydration and nutrition status maintained during treatment period of gastroschisis or omphalocele? Select all that apply. a. TPN b. OG feeding c. IVF d. NPO e. Hypertonic enema

Anticipate NPO, IVF, and TPN

What are the cardinal signs of hemolytic-uremic syndrome? Select all that apply. a. diarrhea b. thrombocytopenia c. kidney failure d. oliguria e. anemia

B, C, D, E Oliguria is a symptom of renal failure

What finding would cause the nurse to suspect a diagnosis of spastic cerebral palsy? A. Tremulous movementsat rest and with activity B. Sudden jerking movement caused by stimuli C. Writhin, uncontrollable, involuntary movements D. Clumsy, uncoordinated movements

B. Sudden jerking movement caused by stimuli

A nurse is caring for kid with osteosarcoma. WHat action should the nurse take? a. ensure the kid has a referral to psychiatrist visit b. prepare teaching plan to educate them in detail about condition and tx c. spend time w/ the kid to answer questions d. preform a mental examination to assess though process

C answer questions

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

CORRECT c. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. a. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. b. Infiltration and extravasations are always a risk, especially with peripheral veins. d. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward.

David, age 15 months, is recovering from surgery to remove Wilms' tumor. Which finding best indicates that the child is free from pain? a. Decreased appetite b. Increased heart rate c. Decreased urine output d. Increased interest in play

Correct: D Answer D. One of the most valuable clues to pain is a behavior change: A child who's pain-free likes to play. A child in pain is less likely to consume food or fluids. An increased heart rate may indicate increased pain; decreased urine output may signify dehydration

Which is not a finding of compartment syndrome? Select all that apply. a. Increased pain that is unrelieved with elevation or analgesics b. Intense pain when passively moved c. Paresthesia/numbness d. Weak pulse distal to the fracture e. Reduced ability to move digits

D, E Findings of compartment syndrome include: increasing pain, unrelieved with elevation or analgesics; intense pain when passively moved; paresthesia/numbness; no pulse distal to the fracture; inability to move digits; warm digits with skin that is tight and shiny; pallor.

When assessing the development of a 15month old child with cerebral palsy, which of thefollowing milestones would the nurse expect atoddler of this age to have achieved? a)walking up steps b) using a spoon c) copying a circle d) putting a block in cup

D. Delay in achieving developmental milestones is a characteristic of children with cerebral palsy. A 15month old child can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months. A child usually is able to use a spoon at 18 months. The ability to copy a circle is achieved at approximately 3 to 4 years of age.approximately 3 to 4 years of age.

Immediately after the delivery of an infant with omphalocele, the nurse would take which action? A. Weigh the infant B. Insert an orogastric tube. C. Call the blood bank for 2 units of blood D. Cover the sac with moistened sterile gauze

D. Cover the sac with moistened sterile gauze

What family teaching is appropriate for treatment of pinworms?

Educate: handwashing, thumbsucking, short nails, launder linens / clothes daily, wash toilet seat

A nurse is assessing a 3-year-old for hemolytic uremic syndrome (HUS). Which assessment finding would be most characteristic of HUS? a. Oliguria b. Severe cough c. Fever d. Diarrhea

Oliguria Rationale: HUS is characterized by the classic triad of symptoms: thrombocytopenia, hemolytic anemia, and acute renal failure. Severe cough, fever, or diarrhea alone is not a sign of HUS. The problem usually is preceded by a urinary tract infection, upper respiratory infection, or acute gastroenteritis 1 to 2 weeks prior to the HUS.

Which issue is important to discuss when educating a family about nocturnal enuresis? a. Have the child double-void before going to bed. b. Refer the child and family for counseling. c. Limit all daytime fluids. d. Limit fluids four hours before bed.

a. Have the child double-void before going to bed. Rationale: Counseling is not always indicated. Promoting regular stools and having the child double-void before bed are appropriate interventions. Limiting daytime fluids has not been shown to be effective.

A child with nephrotic syndrome is placed on corticosteroids. The nurse should educate the family about which side effects of corticosteroids? a. Moon face b. Impaired balance c. Hair loss d. Anorexia

a. Moon face Rationale: Side effects of corticosteroids include moon face, increased hair growth, increased appetite, and mood swings. Impaired balance is not associated with corticosteroids.

How does an older child with Hirschsprung Disease present? a. failure to gain weight b. chronic, progressive constipation c. abdominal distention d. fecal impaction e. pencil thin stools

all are correct Failure to gain weight due to vomiting & diarrhea. pencil thin stools are because stool is leaking out from pressure of the fecal impaction.

What is the antidote to acetylsalicylic acid (Aspirin)? a. Activated charcoal b. Vitamin K c. IV fluids d. Sodium bicarbonate.

b No aspirin for children at all due to risk of Reye's syndrome. If given, antidote is vitamin K. The other options form part of treatment: Activated charcoal is given through an OG tube, and fluids, volume expanders, electrolytes and bicarb are given as ordered.

What is the main difference between Gastroschisis & Omphalocele? a. Gastroschisis is the outpouching of the bowels being covered in a membranous sac; in omphalocele there is no sac visible b. Gastroschisis is to the side of umbilicus. Omphalocele protrudes through umbilicus c. Gastroschisis can also involve stomach or liver; Omphalocele can also involve the colon and gonads. d. Omphalocele represents a greater risk to the infant.

b. Gastroschisis is to the side of umbilicus, there is no sac visible and covering organs, usually the small intestine and ascending colon but gonads may be involved. The lack of peritonuim can lead to hypothermia faster than omphalocele. Omphalocele protrudes through umbilicus, an outpouching of the bowels being covered in a membranous sac. Usually involves intestine though may include stomach and/or liver

Why is heat loss a concern with gastroschisis? a. The condition is physically stressful and raises the basal metabolic rate. b. Area of infant is increased; infants lose heat through herniated viscera. c. It is not specific to gastroschisis; all infants have poor thermoregulation. d. Volume of infant is increased; infants lose heat through herniated viscera.

b. Surface area of the infant is increased; infants lose heat through herniated viscera. First action is to cover the organs with sterile, moistened (with NS) gauze and place infant in bowel bag (sislastic silo sac) up to nipples.

Which collaborative interventions should the nurse expect in the case of hemolytic-uremic syndrome? a. diuretics b. dialysis c. IV fluids d. pain control

b. hemodialysis/peritoneal dialysis, possibly blood products will be ordered.