NCLEX: Pediatric Nursing CH 30-31: Metabolic, Endocrine, Gastrointestinal Disorders

The mother of a 6 year old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? 1. Hold the next dose of insulin 2. Come to the clinic immediately 3. Encourage the child to drink liquids 4. Administer an additional dose of regular insulin

Encourage the child to drink liquids

A mother brings her 3 week old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 0 mg/dL. (0 mcmol/L). The nurse reviews this result and makes which interpretation? 1. It is negative 2. It is a concern 3. It is inconclusive 4. It requires rescreening at age 6 weeks

It is negative

An infant returns to the nursing unit after the surgical repair of a cleft lip located on the right side of the lip. Which is the best position to place this infant at this time? 1. A flat position 2. A prone position 3. On his or her left side 4. On his or her right side

On his or her left side

The nurse is reviewing the record of a child with a diagnosis of pyloric stenosis. Which data should the nurse expect to note as having been documented in the child's record? 1. Watery diarrhea 2. Projectile vomiting 3. Increased urine output 4. Vomiting large amounts of bile

Projectile vomiting

The nurse reinforces home-care instructions to the parents of a child with celiac disease. Which food item should the nurse advise the parents to include in the child's diet? 1. Rice 2. Oatmeal 3. Rye toast 4. Wheat bread

Rice

The nurse is monitoring for signs of dehydration in a 1 year old child who has been hospitalized for diarrhea and prepares to take the child's temperature. Which method of temperature measurement should be avoided? 1. Rectal 2. Axillary 3. Electronic 4. Tympanic

Rectal

The nurse has just administered ibuprofen to a child with a temperature of 38.8 C (102 F). The nurse should also take which action? 1. Withhold oral fluids for 8 hours 2. Sponge the child with cold water 3. Plan to administer salicylate in 4 hours 4. Remove excess clothing and blankets from the child

Remove excess clothing and blankets from the child

The nurse reinforces home-care instructions to the parents of a child with hepatitis regarding the care of the child and the prevention of the transmission of the virus. Which statements by a parent indicates a need for further teaching? 1. "Frequent hand washing is important." 2. "I need to provide a well-balanced, high-fat diet to my child." 3. "I need to clean contaminated household surfaces with bleach." 4. "Diapers should not be changed near any surfaces that are used to prepare food."

"I need to provide a well-balanced, high-fat diet to my child."

The nursing instructor asks a nursing student about phenylketonuria (PKU). Which statement made by the student indicates a need for further teaching? 1. "PKU is an autosomal-recessive disorder." 2. "PKU primarily affects the gastrointestinal system." 3. "Treatment of PKY includes the dietary restriction of phenylalanine." 4. "All 50 states require routine screening of all newborns for PKU."

"PKU primarily affects the gastrointestinal system."

The nurse is caring for an 18 month old child who has been vomiting. Which is the appropriate position to place the child during naps and sleep time? 1. A supine position 2. A side-lying position 3. Prone, with the head elevated 4. Prone, with the face turned to the side

A side-lying position

A mother of a child with a diagnosis of intussusception calls the nurse into the hospital room because the child is screaming in pain. Which manifestations of perforation should the nurse report immediately? (Select all that apply) 1. Fever 2. Ribbon-like stools 3. Increased heart rate 4. Hypoactive bowel sounds 5. Profuse projectile vomiting 6. Change in the level of consciousness

A. Fever B. Increased heart rate C. Change in the level of consciousness

The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? (select all that apply) 1. Administer regular insulin 2. Encourage the child to ambulate 3. Give the child a teaspoon of honey 4. Provide electrolyte replacement therapy intravenously 5. Wait 30 minutes and confirm the blood glucose reading 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs

A. Give the child a teaspoon of honey B. Prepare to administer glucagon subcutaneously if unconsciousness occurs

The nurse is assigned to care for a child who is scheduled for an appendectomy. Which prescriptions does the nurse anticipate to be prescribed? (select all that apply) 1. Administer a fleet enema 2. Initiate an intravenous line 3. Maintain nothing by mouth status 4. Administer intravenous antibiotics 5. Administer preoperative medications 6. Place a heating pad on the abdomen to decrease pain

A. Initiate an intravenous line B. Maintain nothing by mouth status C. Administer intravenous antibiotics D. Administer preoperative medications

The nurse is reviewing the postoperative primary health care provider's (PHCP's) prescriptions for a 3 week old infant with Hirschsprung's disease admitted to the hospital for surgery. Which prescriptions documented in the child's record should the nurse question? (select all that apply) 1. Measure abdominal girth daily 2. Monitor strict intake and output 3. Take temperature measurements rectally 4. Start clear liquid diet after 8 hours postoperative 5. Maintain IV fluids until the child tolerates oral intake 6. Monitor the surgical site for redness, swelling, and drainage

A. Take temperature measurements rectally B. Start clear liquid diet after 8 hours postoperative

A child has fluid volume deficit. The nurse collects data and determines that the child is improving and the deficit is resolving if which finding is noted? 1. The child has no tears 2. Urine specific gravity is 1.030 3. Capillary refill is less than 2 seconds 4. Urine output is less than 1 mL/kg/hour

Capillary refill is less than 2 seconds

A health care provider prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? 1. Obtains a weight 2. Takes the temperature 3. Takes the blood pressure 4. Checks the amount of urine output

Checks the amount of urine output

A nurse reviews the record of an infant who is seen in the clinic. The nurse notes that a diagnosis of esophageal atresia with tracheoesophageal fistula (TEF) is suspected. The nurse expects to note which most likely clinical manifestation of this condition in the medical record? 1. Incessant crying 2. Coughing at nighttime 3. Choking with feedings 4. Severe projectile vomiting

Choking with feedings

A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? 1. Potassium infusion 2. NPH insulin infusion 3. 5% dextrose infusion 4. Normal saline infusion

Normal saline infusion

A child with a diagnosis of a hernia has been scheduled for a surgical repair in 2 weeks. The nurse reinforces instructions to the parents about the signs of possible hernial strangulation. The nurse tells the parents that which manifestation requires primary health care provider (PHCP) notification by the parents? 1. Pain 2. Diarrhea 3. Constipation 4. Increased flatus

Pain

A child is brought to the emergency room and the mother reports that the child accidentally swallowed paint thinner after mistaking it for water. The nurse should perform which action first? 1. begin resuscitation 2. terminate exposure to the poison 3. take measures to prevent absorption of the poison 4. check the circulation, airway, and breathing status of the child

check the circulation, airway, and breathing status of the child

An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? 1) sweating and tremors 2) hunger and hypertension 3) cold, clammy skin and irritability 4)

fruity breath and decreasing level of consciousness

A school age child with type 1 diabetes mellitus has soccer practice three afternoons a week. The nurse reinforces instructions regarding how to prevent hypoglycemia during practice. Which should the nurse tell the child? 1. Drink a half a cup of orange juice before soccer practice 2. Eat twice the amount that is normally eaten at lunchtime. 3. Take half of the amount of prescribed insulin on practice days 4. Take the prescribed insulin at noontime rather than in the morning

Drink a half a cup of orange juice before soccer practice

The nurse reinforces instructions to the mother about dietary measures for a 5 year old child with lactose intolerance. The nurse should tell the mother that which supplement will be required as a result of the need to avoid lactose in the diet? 1. Fats and vitamin A 2. Zinc and vitamin C 3. Calcium and vitamin D 4. Thiamine and vitamin B

Calcium and vitamin D