HURST QUESTIONS [PEDIATRICS]

The nurse is to administer a fluid bolus to a 25 pound (11.36 kg) child. The primary healthcare provider prescribes a bolus of 20 mL/kg. 1. 500 mL isotonic solution 2. 500 mL hypotonic solution 3. 227 mL isotonic solution 4. 227 mL hypotonic solution

3.Correct: 11.34 x 20 = 226.8 mL Ok I know I'm going to be giving 227mL. WHY is the answer isotonic???- Think back to your fluid and electrolyte lecture: I want the fluid to go into the vascular space and stay there so I want an isotonic solution like NS 1. Incorrect: 11.34 x 20 = 226.8 mL Ok I know I'm going to be giving 227mL. WHY is the answer isotonic???- Think back to your fluid and electrolyte lecture: I want the fluid to go into the vascular space and stay there so I want an isotonic solution like NS 2. Incorrect: 11.34 x 20 = 226.8 mL Ok I know I'm going to be giving 227mL. WHY is the answer isotonic???- Think back to your fluid and electrolyte lecture: I want the fluid to go into the vascular space and stay there so I want an isotonic solution like NS 4. Incorrect: 11.34 x 20 = 226.8 mL Ok I know I'm going to be giving 227mL. WHY is the answer isotonic???- Think back to your fluid and electrolyte lecture: I want the fluid to go into the vascular space and stay there so I want an isotonic solution like NS

A pediatric nurse plans care for a child diagnosed with acute post-streptococcal glomerulonephritis. Which assessment findings should the nurse anticipate? Select all that apply. 1. Edema 2. Proteinuria 3. Hematuria 4. Anasarca 5. Decreased urine specific gravity

1., 2. & 3. Correct: The nurse should anticipate that the child may be edematous and exhibit signs of proteinuria and hematuria. Glomerulonephritis results in a decrease in kidney filtration of the blood, which leads to fluid retention (edema), leakage of protein from the blood into the urine (proteinuria), and leakage of a large number of red blood cells into the urine. 4. Incorrect: Anasarca is total body edema. It is much greater than edema of the extremities. The entire body is edematous.This would be seen with nephrotic syndrome. 5. Incorrect: Urine specific gravity (density as compared to water) increases because of the inability of the kidney to filter out particulates.

A nurse is assigned a 4 year old client who is one day post VP shunt placement. Client assessment shows a fever of 104º F (40ºC), vomiting, irritability, headache and dilated scalp veins. What interventions should the nurse take? Select all that apply. 1. Notify the surgeon 2. Monitor for seizures 3. Administer antipyretic 4. Monitor potassium level 5. Increase IV fluids

1., 2., & 3. Correct: What are the hints? Elevated temp, vomiting, irritability, headache, dilated scalp veins. All symptoms of increased ICP!!! What is the problem: The VP shunt has malfunctioned and there's a possible infection because they have developed a high temp. We need to decrease ICP, so call the surgeon to fix the malfunctioning shunt. Monitor for seizures, and treat the fever. Remember your adult neuro lecture all of that content we learned applies here. A peds specific intervention would be to measure head circumference, although that intervention is not applicable here. 4. Incorrect: Do we really care what their potassium level is when we have increased ICP??? 5. Incorrect: And y'all increasing IV fluids is just wrong with increased ICP! I'm scared if you picked this!!

A mother brings her 6 week old infant to the ED and reports that the baby isn't gaining weight, and has not wet a diaper in 12 hours. The baby vomits after every feeding. Which nursing interventions would help this infant? Select all that apply. 1. Upright position with feedings and at night 2. Small frequent feedings that are thickened 3. Supine position for sleeping 4. Administration of H2 blockers 5. Give Pedialyte only until vomiting stops

1., 2., & 4. Correct: These interventions will promote stomach emptying and prevent gastric reflux. 3. Incorrect: First, did you recognize that this infant has Gastric Reflux? And the ideal position for sleeping with Gastric reflux is HOB elevated 30 degrees and the prone position. Y'all elevated and prone will help to improve stomach emptying, not supine. 5. Incorrect: We definitely don't want to give this baby thin liquids, they need thickened feedings. This is really important to decrease chance of aspiration.

What should be the priority nursing actions when caring for a child following a tonsillectomy and adenoidectomy? Select all that apply. 1. Encourage oral intake of fluids. 2. Suction the mouth and throat as needed. 3. Administer pain medication around the clock. 4. Apply ice collar to the front of the neck as needed. 5. Encourage coughing and deep breathing every two hours.

1., 3. & 4. Correct: Following tonsillectomy and adenoidectomy, the nurse should encourage the oral intake of fluids, administer pain medication around the clock, and apply an ice collar to the front of the neck if needed. Oral fluid intake prevents dehydration, weight loss, and local infection. Pain medication, such as acetaminophen with or without codeine, administered at regular intervals controls pain more effectively than PRN administration. An ice collar that is applied to the front of the neck decreases pain as well as the risk for hemorrhage. 2. Incorrect: Oral suctioning puts stress on the tonsillectomy site and causes bleeding. 5. Incorrect: Coughing should be discouraged as this puts stress on the tonsillectomy site and causes bleeding.

Following vaginal birth, a neonate has a large area of diffuse swelling over the left occiput that crosses the sagittal suture line. When discussing this finding with the neonate's parents, which statements by a nurse are accurate? Select all that apply. 1. "No treatment will be required to resolve swelling." 2. "Due to the swelling, hyperbilirubinemia may occur." 3. "The swelling lies above the periosteum that covers the skull bone." 4. "Pressure on the fetal head before delivery caused the swelling." 5. "Your infant has a collection of blood under the skull bone."

1., 3. & 4. Correct: Swelling over the left occiput that crosses the sagittal suture (caput succedaneum) requires no treatment, is swelling that overlies the periosteum, and is caused by pressure on the fetal head before delivery. 2. Incorrect: Caput succedaneum is a collection of serosanguineous fluid, not blood. Hyperbilirubinemia is associated with cephalohematoma. 5. Incorrect: Caput succedaneum is a collection of serosanguineous fluid, not blood. Cephalohematoma is a collection of blood under the skull bones and does not cross the suture lines.

The nurse is planning discharge teaching for the family of a 6 month old client with heart failure. is in the hospital. Which instructions about feeding should the nurse include in discharge teaching? Select all that apply. 1. Feed when baby wakes up 2. Let the baby cry so you know the baby is hungry 3. Report to the primary healthcare provide if baby sweats during feedings 4. Feed large thickened feeding every 3 hours to increase calorie intake 5. Feed when baby is well rested 6. Use a special cardiac nipple with a small opening

1., 3., & 5. Correct. Feeding when baby awakens and when well rested will decrease workload of the heart. If baby starts to sweat, then baby is having to work too hard for feeding. 2. Incorrect: Would increase the workload of the heart. You want to minimize crying, feed before crying. 4. Incorrect: Small frequent feedings are best to increase caloric intake without overstimulating the baby.

Which interventions would the nurse initiate in a 1 year old with Sickle Cell Crisis? Select all that apply. 1. IV hydration 2. PCA pump for pain relief 3. Exercise 4. Analgesics 5. Antibiotics 6. Strict neutropenic precautions

1., 4., & 5. Correct: The client with Sickle Cell Crisis is dehydrated. Increasing hydration will improve ability of RBCs flow through the vascular system. Analgesics are needed for pain control. Antibiotics are needed to fight infection. 2. Incorrect: False, the client is not old enough to manage a PCA pump 3. Incorrect: False, during a crisis we want to promote rest to limit oxygen needs 6. Incorrect: False, sickle cell clients aren't neutropenic from sickle cell, and in order to pick an answer like this for a sickle cell client, the nurse would need to know what the client ANC (absolute neutrophil count) is. Y'all what are neutrophils? They are part of the WBC count, so if a client is on neutropenic precautions their neutrophil count is low and we are worried about them getting an infection. The client in this scenario has sickle cell, so the problem is the RBCs, we would be looking for anemia, not neutropenia.

Which signs, if observed in a child, should a clinic nurse associate with Kawasaki disease? Select all that apply. 1. Productive cough 2. Strawberry tongue 3. High and persistent fever 4. Enlarged cervical lymph nodes 5. Erythema of the palms and soles

2., 3., 4. & 5. Correct: The nurse should recognize strawberry tongue, high and persistent fever, enlarged cervical lymph nodes, and redness of the palms of the hands and soles of the feet as signs of Kawasaki disease. Kawasaki disease is an autoimmune disease in which the medium-sized blood vessels throughout the body become inflamed. Many organ systems, mainly those including the blood vessels, skin, mucous membranes, and lymph nodes, are affected. The most prominent signs are a high and persistent fever that is not responsive to normal treatment with acetaminophen or ibuprofen, extreme irritability, and the presence of a "strawberry tongue" caused by necrotizing microvasculitis. 1. Incorrect: Coughing is not a typical sign of Kawasaki disease.

The nurse admits a child with a history of cystic fibrosis (CF) with vomiting for 3 days, headache, and unusual behavior. What does the nurse anticipate the lab values will show? 1. Hypernatremia 2. Hypercalcemia 3. Hypocalcemia 4. Hyponatremia

4. Correct: CF kids are always losing sodium! That's why mom will often say they taste "salty" when she kisses them and why the sweat chloride test is diagnostic. They are looking for sodium chloride when they do the test. So when they are sick their risk for becoming hyponatremic goes up even more because they are stressed. And we know the brain doesn't like for our Na to be messed up. Did you pick out these Key words: Vomiting x3 days, headache, and unusual behavior. 1. Incorrect: CF kids are always losing sodium! Also, when you vomit, you lose all electrolytes. 2. Incorrect: CF kids are always losing sodium! Calcium is not the problem here. 3. Incorrect: CF kids are always losing sodium! Calcium is not the problem here.