Ped questions
A pregnant client who is HIV positive asks the nurse if she will be able to breastfeed the newborn. Which response by the nurse is most appropriate?
"Breastfeeding will increase your newborn's risk of contracting HIV."
A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective?
"The sickle shape of red blood cells decreases oxygen to tissues."
What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent?
Body appearance changes very little.
The nurse has received morning report on a group of pediatric clients. Which pediatric client will the nurse see first?
a child with hemophilia reporting knee pain and edema
The nurse recommends rotavirus vaccine for which group of clients?
infants
A client's mother asks the nurse, "When should my daughter have a pelvic examination?" Which response by the nurse is most appropriate?
"A pelvic exam is necessary at 18 to 20 years of age." A pelvic exam is unnescessary for girls who have not yet reached adolescence. A pelvic exam should be part of routine health care around the age of 18 to 20 years or at the point when she becomes sexually active.
A 2-year-old client is at the office for a follow-up visit. The client has had excessive hormone levels in recent bloodwork and the parents question why this was not found sooner. What is the best response by the nurse?
"As endocrine functions become more stable throughout childhood, alterations become more apparent."
A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate?
"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."
The nurse is caring for a 6-month-old infant with Wiskott-Aldrich syndrome. Which teaching does the nurse provide the parent?
"Do not insert anything in the rectum." Children with Wiskott-Aldrich syndrome should not be given rectal suppositories or temperatures since these children are at a high risk for bleeding. Tub baths are not contraindicated. Pacifiers are not contraindicated in Wiskott-Aldrich but should be kept as sanitary as possible to avoid oral infections.
The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching?
"During exercise we should wait to check blood sugars until after our child completes the activity."
To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant?
"Has she ever had penicillin before?"
The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning?
"I mix ferrous sulfate with milk in a bottle." Explanation: Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.
A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?
"Kids can usually be managed with an oral agent, meal planning, and exercise."
The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?
"She has been down, but playing in soccer camp will cheer her up."
After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question?
"So, hypothyroidism can be treated by exposing our baby to a special light, right?"
The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply.
"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats."
The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate?
"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."
The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond?
"You will most likely have a blood test to check for certain antibodies."
A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which foods would the nurse most likely include? Select all that apply.
- Shrimp - Peanuts - Eggs
A nurse is providing care to a child who is to receive a blood transfusion. The health care provider has prescribed the infusion to run at a rate of 5 ml/kg/hour. The child weighs 55 lb (25 kg). At what rate should the nurse set the infusion pump? Record your answer using a whole number.
125
When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels?
220 mg/dL
The infant is listless with sunken fontanels (fontanelles) and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number.
48
A nurse is reviewing the medical records of several children who have undergone lead screening. The nurse would identify the child with which lead level as requiring no further action?
8 mcg/dL
A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result?
8.5% Explanation: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.
The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of congenital aganglionic megacolon?
A partial or complete intestinal obstruction occurs.
A nurse is assessing a child with cancer and suspects that the child has developed sepsis based on what findings? Select all that apply.
Absolute neutrophil less than 500 Increased bun Hyperkalemia Decreased platelets Metabolic acidosis
When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence?
Acute lymphoblastic leukemia (ALL)
Which nursing intervention is priority when caring for a child with HIV?
Administer the prescribed medications
Prior to discharging an infant with congenital hypothyroidism to home with the parents, what should the nurse emphasize regarding the care that this child will need going forward?
Administration of levothyroxine indefinitely
The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child?
Bleeding from intravenous sites
How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old?
Call it a tumor of muscle tissue A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children.
The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system?
Child reports of facial palsy and vision problems
The parents of a 3-month-old infant report concerns the infant is irritable, feeds poorly, and has a rash. The nurse notes weeping, crusty lesions on the infant's cheeks and neck. Which action by the nurse is most appropriate?
Contact the health care provider to request treatment. Infants that feed poorly, are irritable, and have a weeping, crusty rash on the checks and neck, may have atopic dermatitis (infantile eczema). The nurse should contact the healthcare provider to request treatment, which may include methods to avoid allergens. Although reducing exposure to identified allergens is important, a 3-month-old infant should not be eating peanuts, so this information would not be appropriate at this time.
Test for DIC (disseminated intravascular coagulopathy/PE)
D-dimer
A parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse?
Demonstrate love and acceptance at home.
An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making?
Encourage the adolescent to select hats or wigs to fit one's personality.
The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism?
Enlarged tongue Observation of an enlarged tongue along with an enlarged posterior fontanel and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin.
The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority?
Ensure neutropenic precautions are in place.
The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of:
Ewing sarcoma
The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition?
Ewing sarcoma
A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). The child experiences the typical signs and symptoms of this disorder. Which concern will the nurse include in care planning?
Excess fluid volume
A 15-year-old client diagnosed with von Willebrand disease has reached menarche, Based on this fact, what information is most important for the nurse to convey to the client?
Expect menstrual bleeding to be heavy.
A 16-year-old girl visits her gynecologist with a complaint of metrorrhagia, or bleeding between menstrual periods, since her last visit 3 months ago. On consulting the client's chart, the nurse learns that she was prescribed an oral contraceptive at her last visit. Which intervention should the nurse implement in this situation?
Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that. Metrorrhagia is bleeding between menstrual periods. This may occur in teenagers taking oral contraceptives (breakthrough bleeding) during the first 3 or 4 months of use. If metrorrhagia occurs for more than one menstrual cycle in a teenager who is not taking oral contraceptives (which is not the case here), she be referred to her primary care provider for examination, because abnormal vaginal bleeding is an early sign of uterine or cervical carcinoma or an ovarian cyst. Endometrium ablation, used with premenopausal women to halt metrorrhagia, is not recommended for adolescents. There is no need at this point for the client to change prescriptions, as the bleeding will likely go away in the next month or so as the client's body adapts to the current contraceptive.
A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?
Factor VIII
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?
Following guidelines for protective isolation The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for protective isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age-appropriate activities are important, but psychological issues are a lower priority than physical
A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching?
Give the crushed medication in a syringe mixed with a small amount of formula.
A 12-year-old child has hyperthyroidism. The nurse understands that the most common cause of hyperthyroidism in children is:
Graves disease
During an assessment of an adolescent child, the nurse notes that the child has a protuberant tongue, fatigued appearance, poor muscle tone, and exophthalmos. What medical diagnosis would the nurse expect the child to have?
Graves disease
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?
Hard, moveable "olive-like mass" in the upper right quadrant
The nurse is caring for a child diagnosed with hydronephrosis, Which manifestation is consistent with complications of the disorder?
Hypertension Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.
The parrents of a 6-year-old child with idiopathic thrombocytopenic purpura (IP) ask the nurse Conducting an assessment of the child what causes the disease. What is the nurse's best response?
Immune
A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching?
Immunosuppression is common after a kidney transplant. A child is placed on medications for immunosuppression after the transplant to prevent the body from rejecting the allograft.
A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child?
Implement strategies to address the child's pain.
The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux?
In this disorder the sphincter that leads into the stomach is relaxed.
A 16-year-old adolescent tells the nurse about having severe dysmenorrhea. Which action would be the best health teaching measure?
Take over-the-counter ibuprofen for its prostaglandin action.
The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)?
Macrocytic red blood cells (RBCs) When the MCV is elevated, the RBCs are larger and referred to as macrocytic. The WBC count does not affect the MCV. The platelet count and Hgb are within normal ranges for a 7-year-old child
The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor?
Observation reveals nystagmus and head tilt
The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered?
Oral calcium Explanation: Medical management for hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed. IV diuretics is used in treatment of hyperparathyroidism. Oral corticosteroids and oral potassium are not used in the treatment of hypoparathyroidism.
A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a fingerstick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention?
Prevention of hypoglycemia
The nurse is providing education regarding 2030 Health Goals to reduce the incidence of acquired immunodeficiency syndrome (AIDS) within the community. Which goal will the nurse choose as a primary prevention strategy?
Provide education to sexually active females about proper condom usage.
The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia?
Pubic hair and hirsutism
The nurse is providing care to a child with acute kidney injury, What assessment is priority for the nurse to determine if this child is developing hyperkalemia?
Pulse rate and rhythm
A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client?
Reassess the client's testes at 6 months of age.
Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura?
Risk for bleeding related to insufficient platelet formation
The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action?
Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone.
A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse?
The foreskin is needed for repair.
A nurse is discussing with a family the various causes of their child's vulvovaginitis. What would be included in the education?
The use of cleansing towelettes may have caused the vulvovaginitis.
A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse?
There is a chance the testicles will descend on their own.
What occurs in the gastrointestinal system of the child with Hirschsprung disease?
There is a partial or complete mechanical obstruction in the intestine.
The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication?
This medication must be given by injection.
A 6-year-old boy has a moon-face, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child?
Tumor of the adrenal cortex
The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately?
Weigh the old dialysate The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.
In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care?
Weighing on the same scale each day
The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis?
projectile vomiting
A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?
a fasting blood glucose greater than 126 mg/dl
A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction?
urine output
A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema?
weight, daily The classic sign of nephrotic syndrome is edema. It is usually generalized but may be manifested as ascites or be periorbital depending on the seriousness of the disease. The easiest way to determine edema is by weighing the child. The child should be weighed on the same scale, at the same time daily and with the same amount of clothing. The abdomen would only need to be measured if ascites was suspected or known. Measuring urine output will not determine edema, although it should be done to determine if urine is being produced in adequate amounts. Measuring the amount of protein in the urine will also not determine edema. The measurement is important to determine the progress of the disease, however.
Macrocytic red blood cells are routinely seen in
Pernicious anemia, liver disease, and in response to anemic stress.
The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition?
Mother age 42 with pregnancy
The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is:
Steatorrhea
A pediatric client is scheduled for an intravenous pyelogram (IP) of the kidney this afternoon. Which situation would require immediate attention by the nurse?
No iv
An adolescent has hepatitis B. What would be the most important nursing action?
Strict enforcement of standard precautions
The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion?
Sudden onset of severe scrotal pain with significant hemorrhagic swelling
Pauciarticular jia
type of juvenile rheumatoid arthritis that affects 4 or fewer joints; usually girls (age 2); have joint narrowing
The nurse is teaching the parents of a child with a suspected diagnosis of juvenile idiopathic arthritis about the disease. Which statement by the parents demonstrates the need for further teaching?
"If our child does not have a positive rheumatoid factor, our child does not have the disease."
The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor?
"I will make sure there is plenty of orange juice available. It's her favorite juice."
The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea?
"Emotional stress can be a cause of this disorder."
The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching?
"I can tape a quarter over the hernia to reduce it." The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates incarceration, which although rare with umbilical hernias, can occur. She needs to understand the signs of strangulation and understand that some children have self-esteem issues related to the large protrusion of the unrepaired umbilical hernia. Physical needs of the child have priority over any types of potential psychosocial issues. Self-esteem issues may arise due to a large protrusion of an unrepaired umbilical hernia.
The nurse is caring for a child following surgery due to a motor vehicle accident. The child suffered extensive damage to the small intestine resulting in short bowel syndrome. The parents voice concern to the nurse that their child will "never be the same." Which is the best response by the nurse?
"I cannot imagine what you are going through. We are here to support and educate you on your child's condition and treatments."
The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. which instructions would the nurse include in the discharge teaching plan for the parents?
"Let's meet with the dietitian and plan some meals."
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron- deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate?
"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."
The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed?
"Our child should not participate in sports or physical activity."
A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate?
"Preterm infants are at risk for iron-deficiency anemia."
The nurse is caring for a 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation?
"The MRI uses radio waves and magnets to produce a computerized image of the body."
The caregiver of a 1-year-old boy calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment?
"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."
A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response?
"The surgery creates an opening between the stomach and abdominal wall."
The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?
"The treatment for the disorder will be a surgical procedure."
The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for?
"This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."
A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement By the parents indicates that the teaching was successful?
"We should not stop this medication abruptly."
A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?
"We'll need to have a match to a donor."
A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address?
hypocalcemia
An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic, The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits?
An enlarged spleen Explanation: The child with thalassemia major may have both an enlarged spleen and liver due to excessive iron deposits and fibrotic scarring in the liver and the spleen's increased attempts to destroy defective RBCs.
A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode?
Apply heat to the site of bleeding.
A child allergic to insect stings presents to the school nurse stating, "A bee stung me on the playground." Which action by the nurse is priority?
Assess the client's airway and breathing rate
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition?
Barium enema A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.
A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate?
Creatinine clearance rate The glomerular filtration rate is measured by creatinine clearance rate, or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.
Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism?
Early identification The most important nursing objective is early identification of the disorder. Nurses caring for neonates must be certain that screening is performed, especially in neonates who are preterm, discharged early, or born at home. Promoting bonding, allowing rooming in, and encouraging fluid intake are all important but are less important than early identification.
The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?
Effortless vomiting just after the child has eaten Almost immediately after feeding, the child with gastroesophageal reflux vomits the contents of the stomach. The vomiting is effortless, not projectile in nature.
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?
iliac crest
The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority?
Include the child when discussing foods that contain peanuts. Ya
Most urinary tract infections seen in children are caused by:
Intestinal bacteria Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections
A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver?
Metformin
An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection?
Metronidazole
The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate?
Prepare the child for admission to the hospital
Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant?
Risk for infection related to immunocompromised state Children are administered anti-immune therapies to lower immune system response and help prevent rejection following a transplant; this leaves them susceptible to infection.
A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms?
SIADH
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?
Slightly yellow sclera
A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting?
The child has been sexually abused, maybe on the fishing trip
The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history?
The child recently had an ear infection. Explanation: In the child with acute glomerulonephritis presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.
A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described?
Vomiting immediately after feeding
A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from, adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer?
bladder
A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer?
a simple blood test to diagnose hypothyroidism is required in most states.
A nurse caring for an 8-year-old child with a bleeding disorder documents the following nursing diagnosis: Ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This nursing diagnosis would be most appropriate for a child diagnosed with which condition?
disseminated intravascular coagulation
The nurse is teaching a child with type 1 diabetes mellitus to administer insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when the child:
draws up the short-acting insulin into the syringe first.
A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question?
elevate head of bed 90 degrees
The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child?
fever
A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect?
gastroenteritis
Why are infants more susceptible to dehydration?
greater baseline fluid requirements, high evaporative losses, inability to communicate thirst of seek fluid
The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone?
growth hormone
The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated?
inguinal hernia
A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)?
lethargy, bruises, and lymphadenopathy
The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess?
leukocyte count
which condition is a risk factor for the development of pelvic inflammatory disease (PID)?
multiple sexual partners
The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes?
recent weight loss
A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer?
regular insulin
Systemic jia
salmon-colored rash; non-pruritic, usually on trunk and proximal extremities hepatosplenomegaly, lymphadenopathy, pulmonary disease ANA negative
A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?
Detect Helicobacter pylori Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.
The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder?
Diabetes Insipidus (DI)
During a visit to the clinic, the adolescent client with hypothyroidism tells the nurse that she takes her levothyroxine "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse?
"I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism."
The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond?
"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."
After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition?
Diabetic ketoacidosis Explanation: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis, a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.
A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." What would be the most appropriate response by the nurse?
"There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally oral contraceptive pills are prescribed to prevent ovulation.
A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client?
Dehydration Explanation: If there is a complete blockage of cortisol formation, aldosterone production will also be deficient. Without adequate aldosterone, salt is not retained by the body, so fluid is not retained. Almost immediately after birth, affected infants begin to have vomiting, diarrhea, anorexia, loss of weight, and extreme dehydration. If these symptoms remain untreated, the extreme loss of salt and fluid can lead to collapse and death as early as 48 to 72 hours after birth. The salt-losing form must be detected before an infant reaches an irreversible point of salt depletion. This disorder does not cause hypoglycemia, excessive bleeding, or excessive cortisone secretion.
A child has been prescribed desmopressin acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse?
Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output.
The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of greatest concern?
Elevated blood pressure Explanation: Renal complications may result from lupus. This may be accompanied by hypertension making monitoring of blood pressure of the highest importance.
The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder?
Esophageal atresia Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.
The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as:
Petechiae Explanation: Petechiae are pinpoint hemorrhages that occur anywhere on the body and do not blanch with pressure. Purpura are larger areas of hemorrhage in which blood collects under the tissues and appear purple in color. Ecchymosis refers to areas of bruising. Poikilocytosis refers to the variation in the size and shape of the red blood cells commonly found in children with thalassemia.
The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider?
Positive culture for group A streptococcus
The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism?
Testis cannot be "milked" down inguinal canal
An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care?
The adolescent will become fatigued easily.
The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis:
The child can live a more normal lifestyle. The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home
A nurse is performing assessments during a well child visit. Which assessment is most important for screening for a malignancy?
plot and analyze height and weight
Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply
polyuria, polydipsia, polyphagia
The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during:
sexual contact
The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis?
tea colored urine
Polyarticular JIA
JIA that affects 5 or more joints in 1st 6 months of disease tends to be biphasic = 2-4 yrs then again at 6-12 yrs RF + = girls in late childhood or early adolescence tend to develop rheumatoid nodules and deformities similar to adult rheumatoid arthritis; risk for iritis RF - = involvement of fewer joints and a better overall outcome
When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?
Monitor the site dressing and vital signs.
A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse?
The child has mild to moderate iron deficiency
A nurse is providing teaching to a child receiving chemotherapy and the parents. The nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if which occurs?
The child has redness or swelling at the central venous access site.
The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child?
painless enlarged lymph node
The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is:
painless rectal bleeding
A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition?
testicular torsion
A child needs to undergo peritoneal dialysis. What type of education would the nurse provide to the family about this process?
the peritoneal dialysis should help the child with his or her growth and blood pressure The advantages of peritoneal dialysis over hemodialysis include improved growth as a result of more dietary freedom, increased independence in daily activities, and a steadier state of electrolyte balance. However, the risk for infection (peritonitis and sepsis) is a continual concern with peritoneal dialysis.
The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply.
• Bananas • Skim milk • Applesauce
The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred?
"I have to be careful because I am prone to not absorbing nutrients."
The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm°, hemoglobin 7.9 g/dI (79 g/L), hematocrit 28%, platelets 151,000/mm?. Which nursing action is priority?
1 unit blood
The nurse is reviewing the medical history of a 4-year-old child. What would the nurse identify as potentially indicative of a primary immunodeficiency? Select all that apply.
• Acute otitis media, one episode every 3 to 4 weeks over the past year. • Recurrent deep abscess of the thigh • Oral thrush, persistent over the past 6 to 7 months Warning signs associated with primary immunodeficiency include four or more new episodes of acute otitis media in 1 year, recurrent deep skin or organ abscesses, persistent oral thrush or skin candidiasis after 1 year of age. A history of infections requiring IV antibiotics to heal and two or more episodes of pneumonia in 1 year are also warning signs.
An 8-year-old girl presents to the clinic for moodiness and irritability. The child has begun to develop breasts and pubic hair and the parents are concerned that the child is at too early age for this to begin. The nurse knows that these symptoms may be indicative of what disorder?
Precotcious puberty
The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child's heart is beating very fast. What action by the nurse is indicated?
Instruct the child be brought to the emergency department promptly. Myasthenia gravis is an autoimmune disorder that is characterized by weakness and fatigue. There is no cure. The disease may be aggravated by stress, exposure to extreme temperatures, and infections, resulting in a myasthenic crisis. Myasthenic crisis is a medical emergency with symptoms including sudden respiratory distress, dysphagia, dysarthria, ptosis, diplopia, tachycardia, anxiety, and rapidly increasing weakness. The symptoms reported are consistent with a crisis and prompt care is indicated. Waiting 24 hours to have the child seen by the physician is not appropriate. Questions about changes in routine and medication compliance may be asked but the first priority is to have the child seen.
nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread?
• Perinatally from mother to fetus • Sharing contaminated needles • Transfusion of contaminated blood • Through breastfeeding • Exposure to blood and body fluids through sexual contact HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding
