NCLEX Style Pediatrics Renal and Gastrointestinal

The nurse is assigned to care for a child who is scheduled for an appendectomy. Select the prescriptions that the nurse anticipates will be prescribed. Select all that apply. 1. Initiate an IV line. 2. Maintain an NPO status. 3. Administer a Fleet enema. 4. Administer intravenous antibiotics. 5. Administer preoperative medications. 6. Place a heating pad on the abdomen to decrease pain.

1.2.4.5 Appendicitis is an inflammation of the appendix. When the appendix becomes inflamed or infected, perforation may occur within a matter of hours, leading to peritonitis, sepsis, septic shock, and potential death. IV fluids would be started, and the child would be NPO while awaiting surgery. Usually antibiotics are administered because of the risk of perforation. Prescribed preoperative medications most likely would be administered on call to the operating room. In the preoperative period, enemas or laxatives should not be administered. Additionally, heat is not applied to the abdomen. Any of these interventions can cause rupture of the appendix and resultant peritonitis.

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1. Diarrhea 2. Metabolic acidosis 3. Metabolic alkalosis 4. Hyperactive bowel sounds

3. Vomiting causes the loss of hydrochloric acid and subsequent metabolic alkalosis. Metabolic acidosis would occur in a child experiencing diarrhea because of the loss of bicarbonate. Diarrhea might or might not accompany vomiting. Hyperactive bowel sounds are not associated with vomiting.

The nurse is reviewing the health care provider's prescriptions for a child hospitalized with nephrotic syndrome. Which food should the nurse tell the unlicensed assistive personnel to remove from the child's food tray? 1. Pickle 2. Wheat toast 3. Baked chicken 4. Steamed vegetables

1. A no-added-salt diet is indicated. High-sodium foods such as pickles, chips, and cured meats should be avoided. The items in the remaining options can be consumed.

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? Select all that apply. 1. Pallor 2. Edema 3. Anorexia 4. Proteinuria 5. Weight loss 6. Decreased serum lipids

1.2.3.4 Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.

The nurse is reviewing the record of a child diagnosed with nephrotic syndrome. The nurse should expect to note which finding documented in the child's record? 1. Polyuria 2. Weight gain 3. Hypotension 4. Grossly bloody urine

2. Massive edema resulting in dramatic weight gain is a characteristic finding in nephrotic syndrome. Urine is dark, foamy, and frothy, but only microscopic hematuria is present; frank bleeding does not occur. Urine output is decreased, and hypertension is likely to be present.

The parents of a newborn with a cleft lip are concerned and ask the nurse when the lip will be repaired. With which statement should the nurse respond? 1. Cleft lip cannot be repaired. 2. Cleft-lip repair is usually performed by 6 months of age. 3. Cleft-lip repair is usually performed during the first weeks of life. 4. Cleft-lip repair is usually performed between 6 months and 2 years.

3. Cleft-lip repair is usually performed during the first few weeks of life. Early repair may improve bonding and makes feeding much easier. Revisions may be required at a later age. All other options are incorrect.

The parents of a newborn have been told that their child was born with bladder exstrophy, and the parents ask the nurse about this condition. Which explanation, given by the parents, indicates understanding of this condition? 1. "It's a hereditary disorder that occurs in every other generation." 2. "It is caused by the use of medications taken by the mother during pregnancy." 3. "It is a condition in which the urinary bladder is abnormally located in the pelvic cavity." 4. "It's an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall."

4. Bladder exstrophy is a congenital anomaly characterized by extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause is not known, and a higher incidence is seen in male newborns. The explanations in the remaining options reflect inaccurate understanding.

An infant born with an imperforate anus returns from surgery after requiring a colostomy. The nurse assesses the stoma and notes that it is red and edematous. Based on this finding, which action should the nurse take? 1. Elevate the buttocks. 2. Document the findings. 3. Apply ice immediately. 4. Call the health care provider.

2. A fresh colostomy stoma would be red and edematous, but this would decrease with time. The colostomy site then becomes pink without evidence of abnormal drainage, swelling, or skin breakdown. The nurse should document these findings because this is a normal expectation. Options 1, 3, and 4 are inappropriate and unnecessary interventions.

The nurse recognizes that clinical manifestations of nephrotic syndrome include which findings? 1. Hematuria, bacteriuria, weight gain 2. Gross hematuria, albuminuria, fever 3. Hypertension, weight loss, proteinuria 4. Massive proteinuria, hypoalbuminemia, edema

4. Nephrotic syndrome is a kidney disorder. Clinical manifestations of nephrotic syndrome include edema, proteinuria, hypoalbuminemia, and hypercholesterolemia in the absence of hematuria and hypertension. No fever, bacteriuria, or weight loss would be noted with this syndrome.

The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What should the nurse expect to note as the most likely finding in this infant? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

2. Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis as a result of the vomiting that occurs in this disorder. Additional findings include decreased serum potassium and sodium levels, increased pH and bicarbonate levels, and decreased chloride level. The remaining options are incorrect.

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension 2. Generalized edema 3. Increased urinary output 4. Frank, bright red blood in the urine

2. Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

The nurse provides home care instructions to the mother of a child who had a cleft palate repair 4 days ago. Which statement by the mother indicates the need for further instruction? 1. "I will use a short nipple on the bottle." 2. "I need to buy some straws for drinking." 3. "I can give my child the pacifier in 2 weeks." 4. "I may give my baby food mixed with water."

2. The mother needs to be instructed that straws, pacifiers, spoons, and fingers must be kept away from the child's mouth for 7 to 10 days. Additionally, the mother should be advised to avoid taking an oral temperature. The remaining options are accurate measures to implement after cleft palate repair.

The nurse is writing out discharge instructions for the parents of a child diagnosed with celiac disease. The nurse should focus primarily on which aspect of care? 1. Restricting activity 2. Following a gluten-free diet 3. Following a lactose-free diet 4. Giving medication to manage the condition

2. The primary nursing consideration in the care of a child with celiac disease is to instruct the child and parents regarding proper dietary management. Although medications may be prescribed for the client with celiac disease, treatment focuses primarily on maintaining a gluten-free diet. The remaining options are not directly related to the care of a child with celiac disease.

The mother of a child with hepatitis A tells the home care nurse that she is concerned because the child's jaundice seems worse. What is the nurse's best response? 1. "You need to change the child's diet." 2. "The child probably is infectious again." 3. "You need to call the health care provider." 4. "The jaundice may worsen before it resolves."

4. The parents of the child should be told that jaundice may appear to worsen before it resolves. The remaining options are incorrect and inappropriate responses.

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

1. Celiac disease also is known as gluten enteropathy or celiac sprue and refers to intolerance to gluten, the protein component of wheat, barley, rye, and oats. The important factor to remember is that all wheat, rye, barley, and oats should be eliminated from the diet and replaced with corn, rice, or millet. Vitamin supplements—especially the fat-soluble vitamins, iron, and folic acid—may be needed to correct deficiencies. Dietary restrictions are likely to be lifelong.

The nurse is reviewing the laboratory test results for an infant suspected of having hypertrophic pyloric stenosis. The nurse should expect to note which value as the most likely laboratory finding in this infant? 1. Blood pH of 7.50 2. Blood pH of 7.35 3. Blood bicarbonate of 22 mEq/L (22 mmol/L) 4. Blood bicarbonate of 27 mEq/L (27 mmol/L)

1. Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis due to vomiting. These include increased blood pH and bicarbonate level, decreased serum potassium and sodium levels, and a decreased chloride level. The normal pH is 7.35 to 7.45. The normal bicarbonate is 21 to 28 mEq/L (21 to 28 mmol/L).

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1. Prone position 2. On the stomach 3. Left lateral position 4. Right lateral position

3. A cleft lip is a congenital anomaly that occurs as a result of failure of soft tissue or bony structure to fuse during embryonic development. After cleft lip repair, the nurse avoids positioning an infant on the side of the repair or in the prone position because these positions can cause rubbing of the surgical site on the mattress. The nurse positions the infant on the side lateral to the repair or on the back upright and positions the infant to prevent airway obstruction by secretions, blood, or the tongue. From the options provided, placing the infant on the left side immediately after surgery is best to prevent the risk of aspiration if the infant vomits.

The nurse is initiating nasogastric tube feedings in a child. What is the nurse's best action? 1. Microwave the formula. 2. Place the child in a prone position. 3. Encourage the child to point the head downward. 4. Position the child with the head slightly hyperflexed.

4. When initiating nasogastric tube feedings in a child, the child should be positioned so that the head is slightly hyperflexed or in a sniffing position with the nose pointed toward the ceiling. The formula should be warmed to room temperature, and a microwave should not be used.

The nurse is collecting data on an infant with a diagnosis of suspected Hirschsprung's disease. Which question to the mother will most specifically elicit information regarding this disorder? 1. "Does your infant have diarrhea?" 2. "Is your infant constantly vomiting?" 3. "Does your infant constantly spit up feedings?" 4. "Does your infant have foul-smelling, ribbon-like stools?"

4. Chronic constipation, beginning in the first month of life and resulting in pellet-like or ribbon stools that are foul-smelling, is a clinical manifestation of Hirschsprung's disease. Delayed passage or absence of meconium stool in the neonatal period is the primary sign. Bowel obstruction, especially in the neonatal period; abdominal pain and distension; and failure to thrive are also clinical manifestations. The remaining options are not specific clinical manifestations of this disorder.

The nurse has provided dietary instructions to the mother of a child with celiac disease. The nurse determines that the mother understands the instructions when the mother states to include which food in the child's diet? 1. Corn 2. Wheat cereal 3. Rye crackers 4. Oatmeal biscuits

1. Dietary management is the mainstay of treatment in celiac disease. All wheat, rye, barley, and oats should be eliminated from the diet and replaced with corn and rice. Vitamin supplements, especially fat-soluble vitamins and folate, may be needed in the early period of treatment to correct deficiencies. These are likely to be lifelong restrictions, although small amounts of grains may be tolerated after the ulcerations have healed.

The nurse is developing a plan of care for a 5-week-old infant being admitted with hypertrophic pyloric stenosis who is scheduled for pyloromyotomy. In the preoperative period, the nurse should place the infant in which best position? 1. In an infant seat placed in the crib 2. Prone with the head of the bed elevated 3. Supine with the head at a 90-degree angle 4. Supine with the head of the bed at a 15-degree angle

1. In the preoperative period, the infant is positioned with the head of the bed elevated to reduce the risk of aspiration. To assist a 5-week-old to maintain this position, it is best to place the infant in an infant seat. If placed in a crib without an infant seat, towel or blanket rolls should be placed around the head of the infant to maintain this position. A 15-degree angle is too low, while a 90-degree angle is too high for a 5-week-old to maintain the position.

The nurse is assisting the pediatrician in performing an assessment on a newborn suspected of having imperforate anus. Which finding would be noted in this disorder? 1. Presence of an anal membrane 2. An elevated rectal temperature 3. Widening of the anal rectal canal 4. Meconium stool passing from the rectum

1. An imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. A membrane is noted over the anal opening with a normal anus just above the membrane. Other assessment findings include failure to pass meconium, absence or stenosis of the anal rectal canal, and an external fistula to the perineum.

The nurse is caring for a newborn infant after surgical intervention for imperforate anus. The nurse should place the infant in which position in the postoperative period? 1. Supine with no head elevation 2. Side-lying with the legs flexed 3. Side-lying with the legs extended 4. Supine with the head elevated 30 degrees

2. After surgical intervention for imperforate anus, a side-lying position with the legs flexed or a prone position to keep the hips elevated can reduce edema and pressure on the surgical site. The remaining options are incorrect positions.

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension 2. Generalized edema 3. Increased urinary output 4. Frank, bright red blood in the urine

2. Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

Parents bring their child to the emergency department and tell the nurse that the child has been complaining of colicky abdominal pain located in the lower right quadrant of the abdomen. The nurse suspects that the child has which disorder? 1. Peritonitis 2. Appendicitis 3. Intussusception 4. Hirschsprung's disease

2. The most common symptom of appendicitis is a colicky, periumbilical, or lower abdominal pain located in the right quadrant. Peritonitis is a complication that can follow organ perforation or intestinal obstruction. The classic signs and symptoms of intussusception are acute, colicky abdominal pain with currant jelly-like stools. Clinical manifestations of Hirschsprung's disease include constipation, abdominal distension, and ribbon-like, foul-smelling stools.

A 2-year-old child with acute diarrhea has been diagnosed with mild dehydration. Which rehydration methods would the nurse expect the health care provider to prescribe? 1. Increase intake of water with a diet high in carbohydrates. 2. Consume oral rehydration fluid, advancing to a regular diet. 3. Begin fluid replacement immediately with intravenous fluids. 4. Begin a diet of bananas, rice, apples, pears, and toast with juice.

Mild dehydration is usually treated at home and consists of age-appropriate diet along with oral rehydration fluids. Bananas, rice, apples, pears, and toast with juice can be irritating to the gastrointestinal (GI) tract and does not provide the rehydration needed in a child who is dehydrated. Water does not provide electrolyte fluid replacement, a need during dehydration. Hospitalization and intravenous fluids is not required with mild dehydration.

A nurse is assessing the status of jaundice in a child with hepatitis. Which anatomical areas will provide the best data regarding the presence of jaundice? Select all that apply. 1. The sclera 2. The nail beds 3. The mucous membranes 4. The skin in the sacral area 5. The skin in the abdominal area

1.2.3 Jaundice, if present, is best assessed in the sclera, nail beds, and mucous membranes. Generalized jaundice will appear in the skin throughout the body.

The nurse is developing a plan of care for a 6-year-old child diagnosed with acute glomerulonephritis. The nurse should include which priority intervention in the plan of care? 1. Encourage limited activity and provide safety measures. 2. Catheterize the child to monitor intake and output strictly. 3. Encourage the child to talk about feelings related to illness. 4. Encourage classmates to visit and to keep the child informed of school events.

1. Glomerulonephritis is a term that refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. In glomerulonephritis, activity is limited, and most children, because of fatigue, voluntarily restrict their activities during the active phase of the disease. Catheterization may cause infection. A 6-year-old should not be encouraged to talk about feelings and may not understand the illness. The child should be allowed to express feelings in other ways, such as play. Visitors should be limited to allow for adequate rest.

A child is diagnosed with Hirschsprung's disease. The nurse is teaching the parents about the cause of the disease. Which statement, if made by the parent, supports that teaching was successful? 1. "Special cells are not present in the rectum, which caused the disease." 2. "The protein part of wheat, barley, rye, and oats is not being digested fully." 3. "The disease occurs from increased bowel motility that leads to spasm and pain." 4. "The disease occurs because of inability to tolerate sugar found in dairy products."

1. Hirschsprung's disease also is known as congenital aganglionosis or megacolon. It results from the absence of ganglion cells in the rectum and, to various degrees, up into the colon. Intolerance of wheat, barley, rye, and oats describes celiac disease. Intestinal spasm and pain describe irritable bowel syndrome. Irritability caused by dairy products describes lactose intolerance.

A 3-year-old child is seen in the health care clinic, and a diagnosis of encopresis is made. The nurse expects to provide teaching about which client problem? 1. Odor 2. Nausea 3. Malaise 4. Diarrhea

1. Encopresis is the repeated voluntary or involuntary passage of feces of normal or near-normal consistency in places not appropriate for that purpose according to the individual's own sociocultural setting. Signs include evidence of soiled clothing, scratching or rubbing the anal area because of irritation, fecal odor without apparent awareness by the child, and social withdrawal.

The mother of an 18-month-old child tells the clinic nurse that the child has been having some mild diarrhea and describes the child's stools as "mushy." The mother tells the nurse that the child is tolerating fluids and solid foods. The most appropriate suggestion regarding the child's diet would be to give the child which items? 1. Applesauce, bananas, wheat toast 2. Mashed potatoes with baked chicken 3. Gelatin, strained cabbage, and custard 4. Fluids only until the "mushy" stools stop

2. The continued feeding of a normal diet can prevent dehydration, reduce stool frequency and volume, and hasten recovery. Common foods that are especially well tolerated during diarrhea are bland but nutritional foods, including complex carbohydrates (rice, wheat, potatoes, cereals), yogurt containing live cultures, cooked vegetables, and lean meats. The foods in options 1 and 3 may worsen the diarrhea. Fluids only will affect nutritional status.

The nurse is reviewing the plan of care for a child with a diagnosis of suspected appendicitis. The nurse would question which intervention if noted in the plan of care? 1. Taking the child's temperature with an oral thermometer 2. Applying a heating pad to abdomen to promote pain relief 3. Palpating between the right anterior superior iliac crest and umbilicus 4. Obtaining blood for complete blood count while starting an intravenous line

2. Whenever appendicitis is suspected, the nurse should be aware of the danger of administering laxatives or enemas or applying heat to the area. Such measures stimulate bowel motility and increase the risk of perforation. The nurse can determine the most intense site of pain, located at McBurney's point, by palpation. McBurney's point is midway between the right anterior superior iliac crest and the umbilicus. It is usually the location of greatest pain in the child with appendicitis. There is no contraindication to using an oral thermometer in a child with suspected appendicitis. Obtaining blood for a complete blood count is important to determine the white blood cell count.

The nurse is reviewing the health care provider's documentation in the record of a child admitted with a diagnosis of intussusception. The nurse expects to note that the health care provider has documented which manifestation? 1. Scleral jaundice 2. Projectile vomiting 3. Currant jelly stools 4. Pale-colored and hard stools

3. In the child with intussusception, bright red blood and mucus are passed through the rectum, resulting in what is commonly described as currant jelly stools. The child classically presents with severe abdominal pain that is crampy and intermittent, causing the child to draw the knees in to the chest. Vomiting may be present, but not projectile. Scleral jaundice and pale-colored, hard stools are not manifestations of this disorder.

The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan? 1. "Caution should be used when straddling the infant on a hip." 2. "Vital signs should be taken daily to check for bladder infection." 3. "Catheterization will be necessary when the infant does not void." 4. "Circumcision has been delayed to save tissue for surgical repair."

4. Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant should not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. Options 1, 2, and 3 are unrelated to this disorder.

The nurse has been assigned to care for a neonate just delivered who has gastroschisis. Which concern should the nurse address in the client's plan of care? 1. Infection 2. Poor body image 3. Decreased urinary elimination 4. Cracking oral mucous membranes

1. Gastroschisis occurs when the bowel herniates through a defect in the abdominal wall to the right of the umbilical cord. There is no membrane covering the exposed bowel. Surgical repair will be done as soon as possible because of the risk of infection in the unprotected bowel. Therefore, the greatest risk immediately after delivery is infection. Because the client is a neonate, poor body image is not an immediate problem. Impaired urinary elimination is unlikely because the gastrointestinal tract is affected, not the genitourinary system. Gastroschisis involves the lower gastrointestinal system, so the oral mucous membranes are not affected.

The nurse is caring for a child who was brought to the clinic complaining of severe abdominal pain and is suspected of having acute appendicitis. The child is lying on the examining table, with the knees pulled up toward the chest. What is the priority nursing action? 1. Collect urine sample for urinalysis 2. Perform a pain assessment using the FACES scale 3. Prepare the child for magnetic resonance imaging 4. Notify health care provider of white blood cell count above 10,000 mm3 (10 × 109/L)

2. A pain assessment is priority to assess for increased or reduced pain, which can indicate peritonitis. A reported sudden relief from pain may indicate perforation. If perforation occurs, increasing pain then ensues. Perforation can lead to peritonitis, an urgent condition to be treated immediately. Computed tomography has become the imaging technique of choice, although ultrasonography may also be helpful in diagnosing appendicitis. Urinalysis is analyzed to rule out a urinary tract infection but is not the priority of care. A white blood cell count above 10,000 mm3 (10 × 109/L) is an expected finding in appendicitis.

The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the parent about the child's symptoms? 1. Watery diarrhea 2. Projectile vomiting 3. Increased urine output 4. Vomiting large amounts of bile

2. In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. Clinical manifestations of pyloric stenosis include projectile vomiting, irritability, hunger and crying, constipation, and signs of dehydration, including a decrease in urine output.

The nurse is caring for an infant with cryptorchidism. The nurse anticipates that the most likely diagnostic study to be prescribed would be the one that assesses which item? 1. Babinski reflex 2. DNA synthesis 3. Urinary function 4. Chromosomal analysis

3. Cryptorchidism (undescended testes) may occur as a result of hormone deficiency, intrinsic abnormality of a testis, or a structural problem. Diagnostic tests for this disorder are performed to assess urinary and kidney function because the kidneys and testes arise from the same germ tissue. Babinski reflex reflects neurological function. Assessing DNA synthesis and a chromosomal analysis are unrelated to this disorder.

A 4-year-old child with acute glomerulonephritis is admitted to the hospital. The nurse identifies which client problem in the plan of care as the priority? 1. Infection related to hypertension 2. Injury related to loss of blood in urine 3. Excessive fluid volume related to decreased plasma filtration 4. Retarded growth and development related to a chronic disease

3. Glomerulonephritis is a term that refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. The child with acute glomerulonephritis will have an excessive accumulation of water and retention of sodium, leading to circulatory congestion and edema. Excessive fluid volume would be a focus for this disease process. No risk for infection is associated with this disease; it is a postinfectious process, usually from a pneumococcal, streptococcal, or viral infection. Hematuria is present, but the loss of blood is not enough to constitute a risk for injury. The disease is acute as opposed to chronic, and almost all children recover completely.

The nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which question to the mother should elicit data associated with the cause of this disease? 1. "Has your child had any nausea or diarrhea?" 2. "Have you noticed any rashes on your child?" 3. "Did your child recently complain of a sore throat?" 4. "Did your child sustain any injuries to the kidney area?"

3. Group A beta-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, the child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The questions to the mother in the remaining options are unrelated to a diagnosis of glomerulonephritis.

A mother brings her child to the well-child clinic and expresses concern to the nurse because the child has been playing with another child diagnosed with hepatitis. The nurse prepares to perform an assessment on the child, knowing that which finding would be of least concern for hepatitis? 1. Jaundice 2. Hepatomegaly 3. Dark-colored, frothy urine 4. Left upper abdominal quadrant pain

4. Assessment findings in a child with hepatitis include right upper quadrant tenderness and hepatomegaly. The stools will be pale and clay-colored, and urine will be dark and frothy. Jaundice may be present and will be best assessed in the sclerae, nail beds, and mucous membranes.

The mother of a newborn infant with hypospadias asks the nurse why circumcision cannot be performed. Which is the most appropriate response by the nurse? 1. "Circumcision will cause an infection." 2. "Circumcision is not performed in a newborn." 3. "Circumcision will cause difficulty with urination." 4. "Circumcision has been delayed to save tissue for surgical repair."

4. The infant should not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. This defect will most likely be corrected during the first year of life to limit the psychological effects on the child. The remaining options are inaccurate statements.

The nurse is caring for an infant after repair of an inguinal hernia. Which of these assessment findings indicates that the surgical repair was effective? 1. A clean, dry incision 2. Abdominal distension 3. An adequate flow of urine 4. Absence of inguinal swelling with crying

4. With an inguinal hernia, inguinal swelling occurs when the infant cries or strains. Absence of this swelling would indicate resolution of this problem. A clean, dry incision refers to absence of wound infection after surgery. Abdominal distension indicates a continuing gastrointestinal problem. The flow of urine is not specific to an inguinal hernia.

An 18-month-old child is being discharged after surgical repair of hypospadias. Which postoperative nursing care measure should the nurse stress to the parents as they prepare to take their child home? 1. Leave the diapers off to allow the site to heal. 2. Avoid tub baths until the stent has been removed. 3. Encourage toilet training to ensure that flow of urine is normal. 4. Restrict fluid intake to reduce urinary output for the first few days.

2. After hypospadias repair, the parents are instructed to avoid giving the child a tub bath until the stent has been removed, to prevent infection. Diapers are placed on the child to prevent contamination of the surgical site. Toilet training should not be an issue during this stressful period. Fluids should be encouraged to maintain hydration.

A child is suspected of suffering from intussusception. The nurse should be alert to which clinical manifestation of this condition? 1. Tender, distended abdomen 2. Presence of fecal incontinence 3. Incomplete development of the anus 4. Infrequent and difficult passage of dry stools

1. Intussusception is an invagination of a section of the intestine into the distal bowel. It is the most common cause of bowel obstruction in children aged 3 months to 6 years. A tender, distended abdomen is a clinical manifestation of intussusception. The presence of fecal incontinence describes encopresis. Encopresis generally affects preschool and school-aged children. Incomplete development of the anus describes imperforate anus, and this disorder is diagnosed in the neonatal period. The infrequent and difficult passage of dry stools describes constipation. Constipation can affect any child at any time, although the incidence peaks at age 2 to 3 years.

The clinic nurse is assessing jaundice in a child with hepatitis. Which anatomical area would provide the best data regarding the presence of jaundice? 1. The nail beds 2. The skin in the sacral area 3. The skin in the abdominal area 4. The membranes in the ear canal

1. Jaundice, if present, is best assessed in the sclera, nail beds, and mucous membranes. Generalized jaundice appears in the skin throughout the body. Option 4 is an inappropriate area to assess for the presence of jaundice.

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which should the nurse most likely expect to note? 1. Hematuria 2. Proteinuria 3. Bacteriuria 4. Glucosuria

3. Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic facilitates entry of bacteria into the urine. Hematuria, proteinuria and glucosuria are not characteristically noted in this condition.

The nurse has provided dietary instructions to the mother of a child with celiac disease. The nurse determines that further instruction is needed if the mother states that she will include which food item in the child's nutritional plan? 1. Corn 2. Chicken 3. Oatmeal 4. Vitamin supplements

3. Dietary management is the mainstay of treatment for the child with celiac disease. All wheat, rye, barley, and oats should be eliminated from the diet and replaced with corn and rice. Vitamin supplements, especially fat-soluble vitamins and folate, may be needed in the early period of treatment to correct deficiencies.

The nurse is preparing a plan of care for an infant who will be returning from the recovery room following the surgical repair of a cleft lip located on the right side of the lip. On return from the recovery room, the nurse should plan to place the infant in which position? 1. Prone and flat 2. Supine and flat 3. On the left side 4. On the right side

3. Following cleft lip repair, the infant should be positioned supine or on the side lateral to the repair to prevent the suture line from contacting the bed linens. Immediately after surgery, it is best to place the infant on the left side rather than supine to prevent aspiration if the infant vomits.

The nurse is caring for a 7-year-old child with glomerulonephritis and is preparing to discuss the plan of care with the parents. In anticipating this encounter, the nurse recognizes that which is a common reaction of parents to the diagnosis of glomerulonephritis? 1. Fear of the complicated treatment regimen 2. Anger at the child for requiring hospitalization 3. Guilt that they did not seek treatment more quickly 4. Depression that the child may not be able to play sports

3. Guilt is a common reaction of the parents of a child diagnosed with glomerulonephritis. Parents blame themselves for not responding more quickly to the child's initial symptoms, or they may believe they could have prevented the development of glomerular damage. The remaining options may be associated with the parents' reaction to the diagnosis, but they are not common parental reactions.

The nurse is preparing to care for a newborn infant following creation of a colostomy for the treatment of imperforate anus. In the immediate postoperative period, the nurse plans to inspect the stoma and expects to note which finding in the colostomy? 1. Bleeding 2. Gray in color 3. Dark blue in color 4. Red and edematous

4. A fresh colostomy stoma will be red and edematous, but this will decrease with time. The colostomy site will then be pink, without evidence of abnormal drainage, swelling, or skin breakdown. The colostomy should not be bleeding. A gray or dark blue stoma indicates insufficient circulation and should be reported to the health care provider immediately.

An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder? 1. "Does the child have any food allergies?" 2. "What do the bowel movements look like?" 3. "Has the child eaten any food in the last 24 hours?" 4. "Can you describe the type of pain that the child is experiencing?"

4. A report of severe colicky abdominal pain in a healthy, thriving child between 3 and 17 months of age is the classic presentation of intussusception. Typical behavior includes screaming and drawing the knees up to the chest. The remaining options are important aspects of a health history but are not specific to the diagnosis of intussusception.

The nurse is providing discharge instructions to the parents of an infant who underwent surgical repair of bladder exstrophy. The parents ask if the infant will be able to control their bladder as they get older. How should the nurse respond? 1. "Your child will need catheterization until bladder control is gained." 2. "Your child will be able to control their bladder like other children are." 3. "You should potty train your child starting at the same time you normally would." 4. "Your child will not have a sphincter mechanism for the first 3 to 5 years, so urine will drain freely."

4. Bladder exstrophy is a defect where the infant is born with the bladder on the outside of the body. This defect requires surgical repair, which takes place within the first 1 to 2 days of life. During the next 3 to 5 years, urine drains freely from the urethra as there is no sphincter mechanism. This time period allows the bladder to gain capacity while the child grows. Then, subsequent surgical repair is done to create a sphincter mechanism. Therefore, options 1, 2, and 3 are incorrect.

After hydrostatic reduction for intussusception, the nurse should expect to observe which client response? 1. Abdominal distension 2. Currant jelly-like stools 3. Severe colicky-type pain with vomiting 4. Passage of barium or water-soluble contrast with stools

4. Intussusception is the telescoping of one portion of the bowel into another. Hydrostatic reduction may be necessary to resolve the condition. After hydrostatic reduction, the nurse observes for the passage of barium or water-soluble contrast material with stools. Abdominal distension and currant jelly-like stools are clinical indicators of intussusception. Colicky pain and vomiting are signs of an unresolved gastrointestinal disorder.

The nurse is providing discharge instructions to the mother of a child with herpetic gingivostomatitis. Which response by the mother indicates the need for further teaching? 1. "I will offer my child soft, bland foods." 2. "I will encourage my child to drink plenty of fluids." 3. "I will give my child frozen ice pops to assist with fluid intake." 4. "I will not give my child anything to eat for 2 days to allow healing."

4. Parents need to be reassured that a few days without solid food will not harm the child as long as fluid intake is adequate, but an NPO (nothing by mouth) status is not appropriate. Parents should also be taught to contact the health care provider if the child develops signs of dehydration. The child would not be kept NPO; in fact, dehydration is a concern with these children. Small feedings of soft, bland foods should be offered to the child. Fluid intake is very important, and the child must be encouraged to drink. Frozen ice pops, noncitrus juices, and flat soft drinks are best.

The nurse is preparing an infant for surgery to treat Hirschsprung's disease. Which assessment finding is priority to identify and treat? 1. Vomiting and irritability 2. Malnourishment and lethargy 3. Abdominal distension and tenderness 4. Decreased blood pressure and tachycardia

4. Hirschsprung's disease is also known as congenital aganglionosis or megacolon. It is the result of an absence of ganglion cells in the rectum and, to varying degrees, upward in the colon. Nursing care management includes assessing for signs of enterocolitis, shock, fluid and electrolyte problems, and signs of bowel perforation. While all of the answer options are concerning, low blood pressure and tachycardia are signs of shock. Shock results in decreased perfusion and oxygenation to major organs and is the priority of care.

An infant is seen in the health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and is gaining weight but seems never to get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child? 1. Monitor intake and output. 2. Administer predigested formula. 3. Administer omeprazole before feeding. 4. Prepare the family for surgery for the child.

4. Infants with projectile vomiting after feeding that are fussy should be suspected of pyloric stenosis. The treatment for this diagnosis is surgery. The other options are treatment measures that may be prescribed for gastroesophageal reflux.

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? 1. Restrict fluids as prescribed. 2. Care for the arteriovenous fistula. 3. Encourage foods high in potassium. 4. Administer analgesics as prescribed.

1. Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis).

The clinic nurse is obtaining data about a child with a diagnosis of lactose intolerance. Which data should the nurse expect to obtain on assessment? 1. Reports of frothy stools and diarrhea 2. Reports of foul-smelling ribbon stools 3. Reports of profuse, watery diarrhea and vomiting 4. Reports of diffuse abdominal pain unrelated to meals or activity

1. Lactose intolerance causes frothy stools and diarrhea. Abdominal distension, crampy abdominal pain, and excessive flatus also may occur. Foul-smelling ribbon stool is a clinical manifestation of Hirschsprung's disease. Profuse, watery diarrhea and vomiting are clinical manifestations of celiac disease. Diffuse abdominal pain is a clinical manifestation of irritable bowel syndrome.

Which is a priority problem for a child with severe edema caused from nephrotic syndrome? 1. Risk for constipation 2. Risk for skin breakdown 3. Inability to regulate body temperature 4. Consumption of more calories or nutrients than the body requires

2. Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia (hypoproteinemia), and edema. A child with edema from nephrotic syndrome is at high risk for skin breakdown. Skin surfaces should be cleaned and separated with clothing to prevent irritation and resultant skin breakdown. The child will be anorexic, so "taking in more calories or nutrients than the body requires" is not a concern. A risk for constipation or inability to regulate body temperature is not a concern with nephrotic syndrome.

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which should the nurse most likely expect to note? 1. Hematuria 2. Proteinuria 3. Bacteriuria 4. Glucosuria

3. Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic facilitates entry of bacteria into the urine. Options 1, 2, and 4 are not characteristically noted in this condition.

The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder? 1. Bile-stained fecal emesis 2. The passage of currant jelly-like stools 3. Failure to pass meconium stool in the first 24 hours after birth 4. Sausage-shaped mass palpated in the upper right abdominal quadrant

3. Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. During the newborn assessment, this defect should be identified easily on sight. However, a rectal thermometer or tube may be necessary to determine patency if meconium is not passed in the first 24 hours after birth. Other assessment findings include absence or stenosis of the anal rectal canal, presence of an anal membrane, and an external fistula to the perineum. Options 1, 2, and 4 are findings noted in intussusception.

The mother of a child with an umbilical hernia calls the clinic and reports to the nurse that the child has been vomiting and is complaining of pain in the abdominal area. Which instruction to the mother is most appropriate? 1. Administer acetaminophen. 2. Keep the child on clear liquids. 3. Contact the health care provider. 4. Apply an ice pack to the abdomen.

3. Vomiting, pain, and irreducible mass at the umbilicus are signs of a strangulated hernia. The parents should be instructed to contact the health care provider immediately if strangulation is suspected. The remaining options are incorrect, can cause harm to the child, and delay emergency treatment measures that are required.

A 7-year-old child is seen in a clinic, and the health care provider documents a diagnosis of primary nocturnal enuresis. The nurse should provide which information to the parents? 1. Primary nocturnal enuresis does not respond to treatment. 2. Primary nocturnal enuresis is caused by a psychiatric problem. 3. Primary nocturnal enuresis requires surgical intervention to improve the problem. 4. Primary nocturnal enuresis is usually outgrown without therapeutic intervention.

4. Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.

The parents of a child with a cleft palate are concerned and ask the nurse when the palate will be repaired. The nurse should plan to base the response on which information about cleft palate repair? 1. A cleft palate cannot be repaired in children. 2. Repair usually is performed by age 8 weeks. 3. Repair usually is performed by 2 months of age. 4. Repair usually is performed between 6 months and 2 years.

4. Cleft palate repair is individualized and is based on the degree of deformity and size of the child. Cleft palate repair usually is performed between 6 months and 2 years of age, depending on the preference of the health care provider. Early closure facilitates speech development. The remaining options are incorrect.

The nurse is developing a plan of care for an infant after surgical intervention for imperforate anus. The nurse should include in the plan that which position is the most appropriate one for the infant in the postoperative period? 1. Prone position 2. Supine with no head elevation 3. Side-lying with the legs extended 4. Supine with the head elevated 45 degrees

1. The appropriate position following surgical intervention for an imperforate anus is a side-lying position with the legs flexed or a prone position to keep the hips elevated. These positions will reduce edema and pressure on the surgical site. The remaining options will promote pressure at the surgical site.

A nursing student caring for a 6-month-old infant is asked to collect a sample for urinalysis from the infant. How should the student collect the specimen? 1. Catheterizing the infant using the smallest available Foley catheter 2. Attaching a urinary collection device to the infant's perineum for collection 3. Obtaining the specimen from the diaper by squeezing the diaper after the infant voids 4. Noting the time of the next expected voiding and then preparing a specimen cup for the urine

2. Although many methods have been used to collect urine from an infant, the most reliable method is the urine collection device. This device is a plastic bag that has an opening lined with adhesive so that it may be attached to the perineum. Urinary catheterization is not to be done unless specifically prescribed because of the risk of infection. Urine for certain tests, such as specific gravity, may be obtained from a diaper by collection of the urine with a syringe. It is not reasonable to try to identify the time of the next voiding to attempt to collect the specimen.

The nurse reviews the record of a child who is suspected to have glomerulonephritis and expects to note which finding that is associated with this diagnosis? 1. Hypotension 2. Brown-colored urine 3. Low urinary specific gravity 4. Low blood urea nitrogen level

2. Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria resulting in dark, smoky, cola-colored, or brown-colored urine is a classic symptom of glomerulonephritis. Hypertension is also common. Blood urea nitrogen levels may be elevated. A moderately elevated to high urinary specific gravity is associated with glomerulonephritis.

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis? 1. "I'm so glad they didn't find any protein in his urine." 2. "I noticed his urine was the color of coca-cola lately." 3. "His health care provider said his kidneys are working well." 4. "The nurse who admitted my child said his blood pressure was low."

2. Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common due to fluid volume overload secondary to the kidneys not working properly.

The nurse is providing instructions to the parents of a child with a hernia regarding measures that will promote reducing the hernia. The nurse determines that the parents understand care for their child if they make which statement? 1. "We will encourage our child to cough every few hours on a daily basis." 2. "We will make sure that our child participates in physical activity every day." 3. "We will provide comfort measures to reduce any crying periods by our child." 4. "We will be sure to give our child a Fleet enema every day to prevent constipation."

3. A warm bath, avoidance of upright positioning, and other comfort measures to reduce crying are all simple measures to reduce a hernia. Coughing and crying increase the strain on the hernia. Likewise, physical activity and enemas of any type would increase the strain on the hernia.

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1. Watery diarrhea 2. Ribbon-like stools 3. Profuse projectile vomiting 4. Bright red blood and mucus in the stools

4. Intussusception is a telescoping of 1 portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. A child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but is not projectile. Bright red blood and mucus are passed through the rectum and commonly are described as currant jelly-like stools. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.

A 1-year-old child is diagnosed with intussusception, and the mother of the child asks the student nurse to describe the disorder. Which statement by the student nurse indicates correct understanding of this disorder? 1. "It is an acute bowel obstruction." 2. "It is a condition that causes an acute inflammatory process in the bowel." 3. "It is a condition in which a distal segment of the bowel prolapses into a proximal segment of the bowel." 4. "It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."

4. Intussusception occurs when a proximal segment of the bowel prolapses into a distal segment of the bowel. It is not an acute bowel obstruction, but it is a common cause of bowel obstruction in infants and young children. It is not an inflammatory process.

The nurse is planning discharge instructions for the mother of a child following orchiopexy, which was performed on an outpatient basis. Which is a priority in the plan of care? 1. Wound care 2. Pain control measures 3. Measurement of intake 4. Cold and heat applications

1. The most common complications associated with orchiopexy are bleeding and infection. Discharge instruction should include demonstrating wound cleansing and dressing and teaching parents to identify signs of infection, such as redness, warmth, swelling, or discharge. Testicles will be held in a position to prevent movement, and great care should be taken to prevent contamination of the suture line. Analgesics may be prescribed but are not the priority, considering the options presented. Measurement of intake is not necessary. Cold and heat application is not a prescribed treatment measure.

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention? 1. Cover the bladder with petroleum jelly gauze. 2. Cover the bladder with a nonadhering plastic wrap. 3. Apply sterile distilled water dressings over the bladder mucosa. 4. Keep the bladder tissue dry by covering it with dry sterile gauze.

2. In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The use of petroleum jelly gauze should be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucosa when removed.

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1. Incessant crying 2. Coughing at nighttime 3. Choking with feedings 4. Severe projectile vomiting

3. In esophageal atresia and tracheoesophageal fistula, the esophagus terminates before it reaches the stomach, ending in a blind pouch, and a fistula is present that forms an unnatural connection with the trachea. Any child who exhibits the "3 Cs"—coughing and choking with feedings and unexplained cyanosis—should be suspected to have tracheoesophageal fistula. Options 1, 2, and 4 are not specifically associated with tracheoesophageal fistula.

A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine if this child is experiencing a long-term effect of cleft palate, which question should the nurse ask? 1. "Was the child recently treated for pneumonia?" 2. "Does the child play with an imaginary friend?" 3. "Is the child unresponsive when given directions?" 4. "Has the child had any difficulty swallowing food?"

3. Unresponsiveness may be an indication of hearing loss. A child who has a history of cleft palate should be routinely checked for hearing loss. Pneumonia and dysphagia are unrelated to cleft palate after repair. Having an imaginary friend is normal behavior for a preschool child. Many preschoolers with vivid imaginations have imaginary friends.

The nurse provided discharge instructions to the parents of a 2-year-old child who had an orchiopexy to correct cryptorchidism. Which statement by the parents indicates the need for further instruction? 1. "I'll check his temperature." 2. "I'll give him medication so he'll be comfortable." 3. "I'll check his voiding to be sure there's no problem." 4. "I'll let him decide when to return to his play activities."

4. Cryptorchidism is a condition in which 1 or both testes fail to descend through the inguinal canal into the scrotal sac. Surgical correction may be necessary. All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury. This prevents dislodging of the suture, which is internal. Normally, 2-year-olds want to be active; allowing the child to decide when to return to his play activities may prevent healing and cause injury. The parents should be taught to monitor the temperature, provide analgesics as needed, and monitor the urine output.

An infant is seen in the health care provider's office for complaints of frequent vomiting and spitting up after feedings. Findings indicate that the infant is not gaining weight, and gastroesophageal reflux is suspected. Which would the nurse anticipate being prescribed initially in the care of this child? 1. Administer omeprazole before feeding. 2. Place in prone position after each feeding. 3. Instruct parents to keep a log of feedings and any reflux present. 4. Administer predigested formula and feed small, frequent feedings.

4. For infants with frequent vomiting and spitting up, the diagnosis of gastroesophageal reflux should be considered. The initial action is to alter the formula to a predigested formula and feed small, frequent feedings.After the formula is changed, the family will be instructed to keep a log of feedings and any reflux with the new formula. Medication is not started until after the formula is changed. A prone position increases the risk of reflux and thus aspiration.

Which interventions should the nurse include when creating a care plan for a child with hepatitis? Select all that apply. 1. Providing a low-fat, well-balanced diet 2. Teaching the child effective hand-washing techniques 3. Scheduling playtime in the playroom with other children 4. Notifying the health care provider (HCP) if jaundice is present 5. Instructing the parents to avoid administering medications unless prescribed 6. Arranging for indefinite home schooling because the child will not be able to return to school

1.2.5. Hepatitis is an acute or chronic inflammation of the liver that may be caused by a virus, a medication reaction, or another disease process. Because hepatitis can be viral, standard precautions should be instituted in the hospital. The child should be discouraged from sharing toys, so playtime in the playroom with other children is not part of the plan of care. The child will be allowed to return to school 1 week after the onset of jaundice, so indefinite home schooling would not need to be arranged. Jaundice is an expected finding with hepatitis and would not warrant notification of the HCP. Provision of a low-fat, well-balanced diet is recommended. Parents are cautioned about administering any medication to the child because normal doses of many medications may become dangerous owing to the liver's inability to detoxify and excrete them. Hand washing is the most effective measure for control of hepatitis in any setting, and effective hand washing can prevent the immunocompromised child from contracting an opportunistic type of infection.

The nurse in the hospital is giving at-home feeding instructions to a family whose child is being discharged after being born with a cleft lip. Which statement by the mother would indicate that further teaching is indicated? 1. "I am so glad that I am able to breast-feed my baby." 2. "I must always feed my baby with a syringe and not use a nipple." 3. "I will feed my baby while sitting in a chair and holding her more upright." 4. "I will burp my baby very frequently so that she does not swallow a lot of air."

2. Infants with a cleft lip are fed using a special nipple. Therefore, although all the interventions relate to feeding, option 2 should be clarified with the family because if they fed the baby using a syringe, the child's oral needs for sucking will not be met. Breast-feeding is always an option and should be done unless the child is having difficulty. Most children with a small cleft lip can be breast-fed. Newborns should be burped frequently and fed in a somewhat upright position. These interventions are applicable to the child with a cleft lip as well.

A child admitted to the hospital with a diagnosis of gastroenteritis and dehydration weighs 17 pounds 2 ounces (7.8 kg). The parents state that his preadmission weight was 18 pounds 4 ounces (8.3 kg). Based on weight alone, what type of dehydration does the nurse expect? 1. Mild dehydration 2. Moderate dehydration 3. Severe dehydration 4. Acute dehydration

2. Mild dehydration is a weight loss less than 5%; moderate dehydration is 5% to 10%; severe dehydration is greater than 10% weight loss. All types of dehydration are acute situations. The answer can be determined by calculating the percent of weight loss in dehydration. Because the math calculation determines more than a 5% weight loss but less than 10% weight loss, the correct answer is moderate dehydration. By calculating the percent of weight loss, the correct answer can be determined.

The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis? 1. Provide less frequent, larger feedings. 2. Burp the infant less frequently during feedings. 3. Thin the feedings by adding water to the formula. 4. Thicken the feedings by adding rice cereal to the formula.

4. Gastroesophageal reflux is backflow of gastric contents into the esophagus as a result of relaxation or incompetence of the lower esophageal or cardiac sphincter. Small, more frequent feedings with frequent burping often are prescribed in the treatment of gastroesophageal reflux. Feedings thickened with rice cereal may reduce episodes of emesis. If thickened formula is used, cross-cutting of the nipple may be required.

The nurse is providing discharge instructions to the mother of a child who had a cleft palate repair. Which statement should the nurse make to the mother? 1. "You should use a plastic spoon to feed the child." 2. "You need to use an orthodontic nipple on the child's bottle." 3. "You can allow the child to use a pacifier but only for 30 minutes at a time." 4. "You need to monitor the child's temperature for signs of infection using an oral thermometer."

2. An orthodontic nipple should be placed on the child's bottle, and the mother should be instructed to give the child baby food or baby food mixed with water. The mother should be instructed that straws, pacifiers, spoons, or fingers must be kept away from the child's mouth for 7 to 10 days after surgery. A pacifier should not be used for at least 2 weeks following the surgical repair. Additionally, the mother should be advised to avoid taking oral temperatures.

After performing an assessment of an infant with bladder exstrophy, the nurse prepares a plan of care. The nurse identifies which problem as the priority for the infant? 1. Urinary incontinence 2. Impaired tissue integrity 3. Inability to suck and swallow 4. Lack of knowledge about the disease (parents)

2. In bladder exstrophy, the bladder is exposed and external to the body. The highest priority is impaired tissue integrity related to the exposed bladder mucosa. Although the infant needs to be monitored for elimination patterns and kidney function, urinary incontinence is not a concern for this condition, as the infant is not yet toilet trained. Inability to suck and swallow is unrelated to the disorder. Lack of knowledge about the diagnosis and treatment of the condition will need to be addressed but again is not the priority.

A 12-year-old girl is admitted to the hospital with suspected appendicitis. What nursing interventions should be implemented preoperatively? 1. Applying a heating pad for 5-minute intervals as prescribed 2. Administering acetaminophen as needed for pain, as prescribed 3. Placing the adolescent in a fetal position, side-lying with legs drawn up to chest 4. Inserting a nasogastric tube and attaching it to low intermittent suction; measuring drainage as prescribed

3. A client with appendicitis is more comfortable when lying in what is traditionally known as the fetal position, with the legs drawn up toward the chest. This flexed positioning assists in decreasing the pain that comes with appendicitis by decreasing the pressure on the abdominal area. A heating pad is contraindicated because heat can lead to a ruptured appendix. Pain medications are not given to the client with acute appendicitis because they may mask the symptoms that accompany a ruptured appendix. A nasogastric tube may be necessary postoperatively for gastric decompression, or preoperatively if perforation occurs. There are no data in the question that support perforation.

When collecting the history about a child who presents with signs of glomerulonephritis, the nurse should report which most important finding to the health care provider? 1. Child fell off a bike onto the handlebars 2. Nausea and vomiting for the last 24 hours 3. Urticaria and itching for 1 week before diagnosis 4. Streptococcal throat infection 2 weeks before diagnosis

4. Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The assessment data in the remaining options are unrelated to a diagnosis of glomerulonephritis.

The nurse is caring for a 1-year-old child after cleft palate repair. On completion of feeding, the nurse should plan for which appropriate nursing action? 1. Rinsing the mouth with water 2. Cleaning the mouth with diluted hydrogen peroxide 3. Using a soft lemon and glycerin swab to clean the mouth 4. Using cotton swabs saturated with half-strength povidone-iodine to clean the mouth

1. After cleft palate repair, the mouth is rinsed with water after feedings to clean the palate repair site. Rinsing food and residual sugars from the suture line reduces the risk of infection. The remaining options are incorrect procedures. Hydrogen peroxide, lemon and glycerin, and povidone-iodine are not used because of their harmful effects on oral tissues and the suture site.

The nurse is creating a plan of care for a 10-year-old child diagnosed with acute glomerulonephritis. What is the priority nursing intervention? 1. Promoting bed rest 2. Restricting oral fluids 3. Allowing the child to play 4. Encouraging visits from friends

1. Bed rest is required during the acute phase, and activity is gradually increased as the condition improves. Fluids should not be forced or restricted. Providing for quiet play according to the developmental stage of the child is important. Visitors should be limited to allow for adequate rest.

The nurse is assigned to care for a child following surgery to correct cryptorchidism. Which priority action should the nurse include in the plan of care following this type of surgery? 1. Prevent tension on the suture. 2. Monitor urine for glucose and acetone. 3. Force oral fluids, and monitor intake and output. 4. Encourage coughing and deep breathing every hour.

1. When a child returns from surgery, the testicle is held in position by an internal suture that passes through the testes and scrotum and is attached to the thigh. It is important not to dislodge this suture, and it should be immobilized for 1 week. The most common complications are bleeding and infection. Testing urine for glucose and acetone also is not related to surgery. Although it is important to maintain adequate hydration, it is inappropriate and unnecessary to force fluids. Depending on the type of anesthesia used, coughing and deep breathing may be appropriate, but it is not the priority for this type of surgery.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? 1. Diarrhea 2. Projectile vomiting 3. Regurgitation of feedings 4. Foul-smelling ribbon-like stools

4. Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction, especially in the neonatal period; abdominal pain and distention; and failure to thrive are also clinical manifestations. Options 1, 2, and 3 are not associated specifically with this disorder.

The nurse is preparing to care for an infant who has esophageal atresia with tracheoesophageal fistula. Surgery is scheduled to be performed in 1 hour. Intravenous fluids have been initiated, and a nasogastric (NG) tube has been inserted by the health care provider. The nurse plans care, knowing that which intervention is of highest priority during this preoperative period? 1. Monitor the temperature. 2. Monitor the blood pressure. 3. Reposition the infant frequently. 4. Aspirate the NG tube every 5 to 10 minutes.

4. Esophageal atresia with tracheoesophageal fistula represents a critical neonatal surgical emergency. While the infant is awaiting transfer to surgery, management centers on prevention of aspiration. The infant is kept supine or prone with the head of the bed elevated to decrease the chance that gastric secretions will enter the lungs. Intravenous fluids are essential. An NG tube must be in place and aspirated every 5 to 10 minutes to keep the proximal pouch clear of secretions. Monitoring the temperature and monitoring blood pressure are standard nursing interventions.

A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition? 1. "Are the stools ribbon-like, and is the infant eating poorly?" 2. "Does the infant suddenly become pale, begin to cry, and draw the legs up to the chest?" 3. "Does the vomit contain sour, undigested food without bile, and is the infant constipated?" 4. "Does the infant cry loudly and continuously during the evening hours but nurses or takes formula well?"

3. Vomiting undigested food that is not bile stained and constipation are classic symptoms of pyloric stenosis. Stools that are ribbon-like and a child who is eating poorly are signs of congenital megacolon (Hirschsprung's disease). An infant who suddenly becomes pale, cries out, and draws the legs up to the chest is demonstrating physical signs of intussusception. Crying during the evening hours, appearing to be in pain, eating well, and gaining weight are clinical manifestations of colic.

Which question should the nurse ask the parents of a child suspected of having glomerulonephritis? 1. "Did your child fall off a bike onto the handlebars?" 2. "Has the child had persistent nausea and vomiting?" 3. "Has the child been itching or had a rash anytime in the last week?" 4. "Has the child had a sore throat or a throat infection in the last few weeks?"

4. Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The assessment data in options 1, 2, and 3 are unrelated to a diagnosis of glomerulonephritis.