Pedi Exam #3 ATI Practice Questions
a nurse is assessing a child who has nephrotic syndrome. which of the following findings should the nurse expect? select all that apply urine dipstick +2 protein edema in the ankles hyperlipidemia polyuria anorexia
A, B, C, E: a pt with nephrotic syndrome will have these sx
a nurse is assessing a school aged child after a ventriculoperitoneal (VP) shunt replacement. which of the following findings indicates a complication of this procedure? abdominal distention unequal peripheral pulses pinpoint pupils frontal bossing
A: a VP shunt allows excess fluid from the ventricles to drain into the peritoneal cavity and be reabsorbed. abd distention can indicate the presence of peritonitis d/t the draining CSF
a nurse is assessing an infant who is at risk for increased intracranial pressure. which of the following findings should indicate to the nurse that this complication is developing ? high pitched cry sunken fontanel tachycardia increased awake time
A: an infants high pitched cry is an indication of IICP. other indications include bulging fontanel and increased sleeping
a nurse is caring for a child who has acute post-strep glomerulonephritis (APSGN). which of the following manifestations should the nurse expect? select all that apply pale urine periorbital edema ill appearance decreased creatinine hypertension
B, C, E: all sx from inadequate function of the kidneys and edema
a nurse is caring for a child who has acute glomerulonephritis. which of the following actions should the nurse take? maintain the child on strict bed rest check the child's BP every 4 hours administer albumin to the child every 8 hours provide the child with a low carb diet
B: the nurse should check the child's BP every 4-6 hours to monitor for HTN
a nurse is reviewing the lab reports of a child with acute nephrotic syndrome who has been receiving prednisone by mouth for the past week. which of the following findings should the nurse report to the provider? serum sodium 142 serum potassium 4 WBC count 3,000 PLT count 298,000
C: the use of corticosteroids suppresses the child's immune system and increases the risk of infection. a WBC count of 3,000 is below the expected range and should be reported to the provider
a nurse is caring for a child who has type 1 DM. which of the following are sx of diabetic ketoacidosis (DKA)? select all that apply blood glucose 58 mg/dL weight gain dehydration mental confusion fruity breath
C,D,E: children who have DKA experience osmotic diuresis bc of the electrolyte shift (resulting in dehydration and mental confusion); children with DKA also have fruity breath d/t the body's attempt to elimninate ketones
a nurse is caring for an infant who is pre-op for the tx of an intact myelonemeningocele sac. in which of the following positions should the nurse place the infant? side lying supine prone semi-fowler's
C: this position reduces pressure and risk of trauma to the sac
a nurse is performing a nutritional screening for a 12 year old who weights 41 kg/90 lbs and has a height of 1.5 m/60 in. which of the following values is the client's BMI? 1.5 3.6 18.2 27.3
C: 41 lg/ square of 1.5 gives you 18.2
a nurse is planning care for an infant with unrepaired myelomeningocele. which of the following actions should the nurse take? fasten diaper loosely cleanse the sac with povidone-iodine daily palpate the abd for bladder distention cover sac with dry sterile gauze
C: a neurogenic bladder is a common complication of a myelomeiningocele
a parent of a school age child who has GH deficiency asks the nurse how long the child will need to take injections for growth delay. which of the following responses should the nurse make? injections are usually continued until age 10 for girls and age 12 for boys injections continue until your child reaches the fifth percentile on the growth chart injections might be stopped once your child grows less than 1 inch/year the injections will need to be administered throughout the child's entire life
C: tx usually stops when the child grows less than 1 in per year and has reached required bone maturity
a nurse is reviewing labs of an adolescent who has acute renal failure. which of the following findings should the nurse expect? hypokalemia hypercalcemia decreased creatinine metabolic acidosis
D: metabolic acidosis is an expected finding for clients who have acute renal failure
a nurse is planning care of a child who has a UTI. which of the following interventions should the nurse include? administer an antidiuretic restrict fluids evaluate the child's self esteem encourage frequent voiding
D: it's important to encourage frequent voiding as this aids in flushing the bacteria out through the urinary system
a nurse is assessing a 4 month old infant who has meningitis. which of the following manifestations should the nurse expect? depressed anterior fontanel constipation presence of rooting reflex high pitched cry
D: a high pitched cry is a finding associated with meningitis between ages 3 months to 2 yewars
a nurse is caring for an infant who has a myelomeningocele. which of the following actions should the nurse include in the pre-op care plan? assist the caregiver with cuddling the infant assess the infant's temp rectally place infant in a supine position apply a sterile, moist dressing on the sac
D: a sterile, moist, non-adhering dressing is placed on the sac to keep it moist until surgery. this should be in the pre-op plan of care
a nurse is preparing to obtain an ASO titer from a child who has acute glomerulonephritis. the child's parent asks the nurse to explain the purpose of the test. which of the following responses should the nurse provide? the test determines the level of antibiotics in the child's blood the test tells us if your child ever had measles the test verifies the amount of albumin in your child's blood the test shows us if your child had a recent strep infection
D: an ASO titer indicates the child had a recent strep infection
a nurse is assessing a school aged child who has acute glomerulonephritis. which of the following manifestations should the nurse expect? hypokalemia decreased BP increased urine volume periorbital edema
D: periorbital edema is a manifestation of acute glomerulonephritis. swelling is usually worse in the mornings and spreads throughout the day to the genitalia, abdomen, and extremities
a nurse is caring for an 8 year old child who has acute glomerulonephritis. which of the following findings should the nurse expect? hypotension stomatitis bloody diarrhea periorbital edema
D: periorbital edema is an expected finding for a child who has glomerulonephritis
a nurse is assessing a child who has a UTI. which of the following are manifestations of a UTI? select all that apply night sweats swelling of the face pallor pale colored urine fatigue
B, C, E: these all are manifestations of a UTI for a child
A nurse is reviewing sick day management with a parent of a child who has type 1 DM. which of the following should the nurse include in the teaching? Select all that apply monitor blood glucose levels every 3 hours discontinue taking insulin until feeling better drink 8 oz of fruit juice every hour test urine for ketones call the provider if blood glucose is greater than 240 mg/dl
A, D, E: frequent monitoring of blood glucose levels are done to ID hyper/hypo glycemic episodes; a child who is ill should test their urine for ketones to assist in early detection of ketoacidosis; a child with an illness should notify their dr with a glucose over 240 to obtain further instructions in caring for hyperglycemia
a nurse is teaching a group of caregivers about the RF for seizures. which of the following factors should the nurse include in the teaching? select all that apply febrile episodes hypoglycemia sodium imbalances low blood lead levels presence of diphtheria
A,B, C: febrile episodes can cx general tonic clonic seizures; seizures are a late sx of hypoglycemia; seizures are a manifestation of hypo/hypernatremia
a nurse is caring for a child who has absence seizures. which of the following findings should the nurse expect? loss of consciousness appearance of daydreaming dropping held objects falling to the floor having a piercing cry
A,B,C: LOC for 5-10 sec is a manifestation of an absence seizure; behavior that resembles daydreaming is a manifestation of an absence seizure; a child who is having absence seizures might drop a held object
a nurse is caring for a 2 day old infant who has myelomeiningocele. which of the following actions should the nurse take? monitor the infant's head circumference position the infant supine place the infant under a radiant warmer tape a piece of plastic over the protruding membranes
A: they have an increased risk of hydrocephalus; measuring their head circumference would help determine any increase in fluid
a nurse is caring for a child who is receiving treatment for DKA and has a current glucose level of 250 mg/dl. which of the following actions should the nurse take? administer 5% dextrose in 0.9% sodium chloride by continuous IV infusion give potassium as a rapid IV bolus administer 3 unites of ultralente insulin SC obtain a HbA1c level stat
A: when the child's glucose falls between 250-300 mg/dl, the nurse should begin IV infusion of 5-10% dextrose in 0.9% sodium chloride. the goal is to maintain blood glucose levels between 120-240. if dextrose isn't added, hypoglycemia might occur
a nurse is caring for a child who has IICP. which of the following actions should the nurse take? select all that apply suction the endotracheal tube every 2 hours maintain a quiet environment use 2 pillows to elevate the head administer a stool softener maintain body alignment
B, D, E: stimulation can cx IICP; therefore maintain a quiet environment; increased pressure in the abd with the valsalva's maneuver can increase ICP so you should give a stool softener; flexion and extension of the neck and hips increase ICP and therefore maintain body alignment
a nurse is assessing an infant who has a suspected UTI. which of the following are expected findings? select all that apply increase in hunger irritability decreased urination vomiting fever
B, D, E: these are all manifestations of a UTI in an infant
a nurse is developing an educational program about viral and bacterial meningitis. the nurse should include that the intro of which of the following immunizations decreased the incidence of bacterial meningitis in children? select all that apply inactivated polio vaccine pneumococcal conjugate vaccine diptheria and tetanus toxoids and acellular pertussis vaccine (DTaP) trivalent inactivated influenza vaccine
B,D: both decreased the incidence of bacterial meningitis
a nurse is caring for a child who has enuresis. which of the following is a complication of enuresis? UTIs emotional problems urosepsis progressive kidney disease
B: emotional problems are a complication of enuresis
a nurse is teaching a child who has type 1 DM about self care. which of the following statements by the child indicates understanding of the teaching? i should skip breakfast when I am not hungry i should increase my insulin with exercise i should drink a glass of milk when I am feeling irritable i should draw up the NPH insulin into the syringe before the regular insulin
C: an early sign of hypoglycemia is irritability so drinking a glass of milk (which is approx 15 g of carbohydrates) indicates an understanding of teaching
a nurse is teaching a school aged child and his parents how to self administer insulin. which of the following actions should the nurse take first? allow a parent to administer an injection to the nurse have the child teach the injection technique to parents have parent administer the insulin to the child demonstrate the injection technique on an orange
D: demonstrating the technique on an orange demonstrates no risk to the client and is the first action the nurse should take
a nurse is planning care for a child who has meningcoccal meningitis. which of the following isolation precautions should the nurse plan to implement? airborne contact protective droplet
D: disease transmission can occur through large droplet particles
a nurse is assessing a child who has chronic renal failure. which of the following findings should the nurse expect? flushed face hyperactivity wt gain delayed growth
D: expect the child to exhibit delayed growth
a nurse is caring for a school aged child who has acute post streptococcal glomerulonephritis.which of the following should the nurse expect? hypotension elevated serum lipid levels decreased serum potassium levels hematuria
D: hematuria can be detected visually in pts who have APSGN
a nurse is teaching a group of parents about characteristics of infants who have FTT. which of the following characteristics should the nurse include in the teaching? intense fear of strangers increased risk for childhood obesity inability to form close relationships with siblings developmental delays
D: these infants can exhibit developmental delays d/t decrease nutritional intake needed for brain development
a nurse is providing teaching about home care to the guardian of a school aged child who has seziures. which of the following statements by the guardian indicates am understanding of the teaching? i will call an ambulance if my child's seizure lasts more than 10 mins i will offer my child clear liquids immediately following a seizure i will tightly hold my child to restrain her during a procedure i will turn my child onto her side when a seizure begins
D: to reduce the risk of aspiration and to improve oxygenation, the guardian should place the child in a side lying position
a nurse is caring for a toddler who has a fever, high pitched cry, irritability, and vomiting. which of the following actions should the nurse take? administer 81 mg of aspirin give the toddler a cold bath place the toddler in a supine position pad the rails of the toddler's bed
D: when caring for a toddler who has manifestations of bacterial meningitis, the nurse should implement seizure precautions, which includes padding side rails of the bed
a nurse is caring for an infant who has a hydrocele. which of the following actions should the nurse take? prepare the child for surgery explain to the parents that the issue will self resolve retract the foreskin and cleanse several times daily refer the family for genetic counseling
B: hydrocele is fluid in the scrotum and resolves spontaneously in the majority of cases
a nurse is caring for a child who has short stature. which of the following diagnostic tests should be completed to confirm GH deficiency? CT scan of the head skeletal xrays GH stimulation test Blood IGF-1 DNA testing
A,B,C,D: CT scan is done to determine if there is a structural component to the short stature, skeletal xrays are used to determine the development of bones, a GH stimulation test is done to confirm a GH deficiency, and a blood IGF-1 is a preliminary test used to determine GH deficiency
a school nurse is providing dietary teaching to an adolescent who has type 1 DM. which of the following responses by the pt indicates an understanding of the teaching? select all that apply i should eat extra food on busy days when i am more active i should wait two hours after eating before going swimming with my friends i should increase my intake of sugar free fluids when i am sick i should eat a snack 30 min before my baseball games start i should have a 16 oz sports drink if i start to feel weird or shaky
A,C,D: exercise lowers blood glucose levels during n after activity (hence the increase in food before being active), fluids also flush out ketones and prevent dehydration when sick-should recommend water, broth, tea
a nurse is caring for a child who just experienced a generalized seizure. which of the following is a priority action for the nurse to take? position the child in a side lying position try to determine the trigger reoreint the child to the environment note the time of the postictal period
A: following a seizure, children often experience vomiting. using the airway, breathing, circulation priority setting framework, the first action is to place the child in a side lying position to maintain a patent airway and prevent aspiration of secretions
a nurse is teaching a newly hired nurse about caring for an infant who is post-op following myelomeningocele repair. the nurse should teach the newly hired nurse to monitor the infant for which of the following complications ? hydrocephalus congenital hypotonia otitis media osteomyelitis
A: pathway for CSF is altered, thus the infant is at an increased risk of hydrocephalus
a nurse is caring for an adolescent following a lumbar puncture. which of the following actions should the nurse take? initiate NPO for the adolescent place them in a supine position place a moist, warm pack on the adolescent's lower back apply a eutectic mixture of local anesthetics to the puncture site
B: RN should place the pt in a supine positon for 30 min to 1 hour following the lumbar puncture to decrease the risk of a post dural puncture headache
a nurse is caring for a school age child who has acute glomerularnephritis. which of the following findings should the nurse report to the provider? BUN 8mg/dl creatinine 1.3 mg/dl BP 100/74 urine output 550 Ml in 24 hours
B: creatinine of 1.3 is above the expected reference range for school age child and should report to the provider
a nurse is planning to teach a 9yo who has DM. the nurse should ID that the school age child is attempting to master which of the following developmental tasks? initiative v. guilt industry v. inferiority trust v. mistrust identity v. role confusion
B: during this stage the child enjoys to learn new skills and experience a sense of accomplishment that comes with a mastery of the skill
a nurse is providing teaching to a 13 year old who has DM1. which of the following statements indicates an understanding of DM management? i will need to avoid snacks between meals i should check my blood glucose levels more often when i am sick i will need to limit my exercise to 1 hour/day i should consume 30g of simple carbs if i feel shaky
B: hypoglycemia often occurs with an infection, thus a sick DM pt needs to check their glucose every 3 hours
a nurse is assessing a child who sustained a head injury. during the assessment, the nurse observes clear drainage leaking from the child's nose. which of the following actions should the nurse take? perform nasotracheal suctioning test the nasal secretions for glucose maintain direct lighting on the child lower the head of the bed
B: the nurse should test the nasal secretions for glucose to determine if the secretions are a leakage of CSF. the leakage of CSF is positive for glucose and occurs if the child has a skull fracture
a nurse is caring for a child who is taking mannitol for cerebral edema. which of the findings should the nurse monitor for as an adverse effect of mannitol? bradycardia wt loss confusion constipation
C: monitor the child for increased confusion and report this adverse effect to the provider. this could be an indication of electrolyte imbalance
a nurse is teaching the parents of an infant who has congenital hypothyroidism. which of the following directions should the nurse provide? your child will need to take estrogen daily when she reaches puberty your child will need monthly blood coagulation studies your child will need surgery to remove the diseased thyroid your child will need to take thyroid hormone replacement for her entire life
D: in congenital hypothyroidism, the child does not manufacture an adequate amount of thyroid hormone to maintain an appropriate metabolic rate. the child will require lifelong thyroid hormone replacement to support normal growth and development
a nurse is assessing a child who has short stature. which of the following findings would indicate a growth hormone deficiency? proportional ht and wt ht greater than wt oversized jaw early onset puberty
A: children who have a GH deficiency present with short stature with proportional ht and wt
a nurse is providing teaching to the parents of a child with DM 1 about managing hypoglycemia. which of the following responses by a parent indicates an understanding of the teaching? i will make sure my child drinks 8oz of milk as soon as possible i will give my child 2 units of regular insulin i will insist my child lay down for 30 min to rest i will check my child's urine for glucose twice daily
A: giving the child 10-15 g of simple carbs like 8oz of milk will elevate the blood glucose and alleviate hypoglycemia
a nurse is caring for a pt who has suspected meningitis and a decreased LOC. which of the following actions should the nurse take? place the client on NPO status prepare the pt for liver biopsy position the client dorsal recumbent put the client in a protective environment
A: place the pt on NPO d/t the pt's decreased LOC to prevent aspiration
a nurse is caring for a 2 yo child who has frequent UTIs. when educating the parents about thew prevention of UTIs, which of the following should the nurse include? teach the child to wipe front to back give the child frequent bubble baths urge the child to urinate every 6 hours administer oxybutynin daily
A: the child should be taught to wipe front to back in order to prevent bacterial contamination from the anal area to the urethra
a nurse is providing teaching to the guardians of a child who is to have an electroencephalogram (EEG). which of the following statements, by a guardian, indicates that the teaching was effective? my child should remain quiet and still during the procedure i cannot wash my child's hair prior to the procedure i should not give my child anything to eat prior to the procedure this procedure will be very painful to my child
A: the child should remain still and quiet during the test. excessive movements can cause false-positive results
a nurse in the emergency department is assessing a child following a motor vehicle crash. the child is unresponsive, has spontaneous respirations of 22/min, and has a laceration on the forehead that is bleeding. which of the following actions should be taken first? stabilize the child's neck clean the child's laceration with soap and water implement seizure precautions for the child initiate IV access
A: the greatest risk to a child following a motor vehicle crash is cervical injury. thus, keeping the neck stabilized until cervical injury can be ruled out is a priority action.
a nurse is assessing an infant who has untreated congenital hypothyroidism. which of the following manifestations should the nurse expect? constipation hyperreflexia oily skin hyperthermia
A: the nurse should expect an infant with untreated congenital hypothyroidism to exhibit constipation and an enlarged abdomen
a nurse is caring for a female adolescent who is being treated for frequent UTIs. which of the following statements by the adolescent indicates a possible cx of the UTIs? i have bowel movements every 4-5 days my mom taught me to wipe front to back after going to the bathroom i urinate every 2-3 hours during the day i dont wear nylon underwear
A: the nurse should identify that this frequency of UTIs indicates the adolescent is constipated. therefore, large stool masses might prevent complete emptying of the bladder and lead to urinary stasis and infection
a nurse is planning care for a 4yo child who has nephrotic syndrome. which of the following actions should the nurse take? provide thorough skin care test for blood type and cross match allow ample hydrating fluids maintain a low carb diet
A: the nurse should provide thorough skin care for this child who has nephrotic syndrome. skin care is especially important d/t edema and the risk of infection
a nurse is reviewing tx options with the guardian of a child who has worsening seizures. which of the following tx options should the nurse include in the discussion? select all that apply vagal nerve stimulator additional antiepileptic meds corpus callosotomy focal resection radiation therapy
A,B,C,D: implanting a vagal nerve stimulator is an option to provide seizure control; adding additional meds to the current med regime can help control seizures; a corpus callosotomy can be performed for uncontrolled seizures; a focal resection can be performed for uncontrolled seizures
a nurse is teaching the parent of a child who has a growth hormone deficiency. which of the following are complications of untreated growth hormone deficiency? delayed sexual development premature aging advanced bone age short stature increased epiphyseal closure
A,B,D: are all complications of untreated growth hormone deficiency
a nurse is caring for an adolescent who has a closed head injury. which of the following findings are indications of increased intracranial pressure? select all that apply report of HA alteration in pupillary response increased motor response increased sleeping increased sensory response
A,B,D: are all indications of IICP
a nurse is reviewing CSF analysis for a client who has suspected meningitis. which of the following findings should the nurse identify as indicating viral meningitis? select all that apply negative gram stain normal glucose content cloudy color decreased WBC normal protein content
A,B,E: all findings of viral meningitis
a nurse is caring for a make infant who has an epispadias. which of the following findings should the nurse expect? select all that apply bladder exstrophy inability to retract foreskin widened pubic symphysis urethral opening on the dorsal side of penis pain
A,C,D: these are all possible expected findings for a male infant who has an episadias
a nurse is assessing a child who has a concussion. which of the following findings should the nurse expect? select all that apply amnesia systemic HTN bradycardia respiratory depression confusion
A,E: are both manifestations of a concussion
a nurse is teaching an adolescent who has DM about sx of hypoglycemia. which of the following findings should the nurse include in the teaching? select all that apply increased urination hunger poor skin turgor irritability sweating and pallor kussmauls respirations
B, D, E: hunger, irritability and sweating/pallor are all sx of hypoglycemia
a nurse is caring for an infant who has obstructive uropathy. which of the following findings should the nurse expect? select all that apply decreased urine flow urinary tract infection intrauterine polyhydraminos concentrated urine hydronephrosis
B, E: are both manifestations of obstructive uropathy
a nurse is teaching a parent of a child who has a UTI. which of the following should the nurse include in the teaching? select all that apply wear nylon pants avoid bubble baths empty bladder completely with each void watch for sx of infection wipe perineal area back to front
B,C,D: discuss each of these things with the parent of a child with a UTI
a nurse is in a provider's office assessing a pt. the nurse determines the pt's body mass index is 21.2. this is classified as which of the following? underweight healthy weight overweight obese
B: BMI is a measurement os an individual's weight in relation to height. a BMI from 18.5-24.9 is in the healthy range. therefore, this pt is considered healthy
a nurse is providing discharge teaching to parent whose infant had a ventriculoperitoneal shunt placement for the treatment of hydrocephalus. which of the following statements by the parents indicates an understanding of the teaching? we will check his abd daily for sx of fluid accumulation we will notify the doctor right away if he has a fever we should keep a helmet on him when hes awake we can expect him to have occasional seizures
B: infection is a risk after VP shunt insertion, especially 1-2 months after placement. the parents should report fevers, V, seizure activity, and decreased responsiveness, as these findings can indicate infection
a nurse is reviewing the medical record of a pt who has reye syndrome. which of the following findings should the nurse identify as a risk factor for reye syndrome? recent hx of infectious cystitis cx by canidida recent hx of bacterial otitis media recent episode of gastroenteritis recent episode of haemophilus influenzae meningitis
C: identify that gastroenteritis is a viral illness, which is a risk factor for developing reye syndrome. reye syndrome typically follows a viral illness (influenza, gastroenteritis, or varicella)
a nurse is reviewing the labs for a 6 month old who has acute renal failure. which of the following should the nurse expect? BUN 5 Creatinine 0.2 sodium 125 potassium 4.2
C: nurse should expect that the infant with acute renal failure to have hyponatremia. a sodium level of 125 is below the expected reference range for an infant
a nurse is teaching a school aged child who has DM1. which of the following statements should the nurse make? if you take too much insulin, drink a sugar free cola you will need to decrease your insulin when you become a teenager you can use a vial of insulin for up to 30 days stop taking insulin if you are vomiting
C: the child can use a vial of insulin for 28-30 days if stored at room temperature or in the refrigerator
a nurse is admitting a child who has a hx of tonic clonic seizures. which of the following items is the priority to have in the child's room? pulse oximeter oxygen therapy bag valve mask suction equipment
D: if the child experiences a tonic clonic seizure, the child is at risk for aspiration and airway occlusion d/t secretions, food, fluids. the nurse should have suction equipment available to maintain a patent airway for effective respiration, administration of oxygen and use a bag valve mask if needed
a nurse is teaching a school age child who has diabetes mellitus about insulin administration. which of the following should the nurse include in the teaching? you should inject the needle at a 30 degree angle you should combine your glargine and regular insulin in the same syringe you should aspirate for blood before injecting the insulin you should give 4-6 injections in one area before switching sites
D: instruct the child to administer 4-6 injections in one anatomic area before switching to another site
a nurse is caring for a preschooler who has nephrotic syndrome. which of the following findings should the nurse report to the provider? blood protein 5.0 g/dl HgB 14.5 g/dl Hct 40% PLT count 200,000
A: blood protein 5.0 is out of the expected range for a preschooler and should be reported to the provider
a nurse is admitting a child who has a UTI and a hx of myelomeiningocele. after completing the admission hx, which of the following actions should the nurse plan to take? attach a latex allergy alert ID band initiate contact precautions post signs in the client's bathroom to strain their urine administer folic acid with meals
A: pts with this are at risk of latex allergy, thus the nurse should avoid using products with latex
a nurse is assessing a 6yo pt. which of the following findings requires further assessment by the nurse? presence of sparse, fine pubic hair decreased head circumference compared to full ht increased leg length in relation to ht presence of loose central incisor
A: the development of sexual characteristics prior to age 9 in boys and 8 in girls is an indication of precocious puberty and requires further evaluation
a nurse is teaching an adolescent who has DM1 about managing hypoglycemia. which of the following statements should the nurse include? you should drink 80z of a regular soft drink when you experience hypoglycemia you should drink 4oz of orange juice if you experience hypoglycemia you should take 2 glucose tabs if you experience hypoglycemia you should take 3 tsp of sugar if you experience hypoglycemia
B: nurse should tell pt to drink 4oz of OJ if hypoglycemia occurs
a nurse is caring for a school age child who begins to have a tonic clonic seizure when leaving the bathroom. which of the following actions should the nurse take first? obtain a portable suction machine and suction tubing ease the child to the floor in sims' position time the length of the seizure notify the child's parents
B: the greatest risk to the child is an injury resulting from a fall; therefore, the nurse should first gently ease the child to the floor to decrease the chance of injury and turn the child to the left side to prevent aspiration
a nurse is caring for an 18 year old adolescent who is up to date on immunizations and is planning to attend college. the nurse should recommend which of the following immunizations prior to moving into a campus dorm? pneumococcal polyscaccharide meningococcal polysaccharide rotavirus herpes zoster
B: the meningococcal ploysaccharide immunization is used to prevent infection by certain groups of meningococcal bacteria. College freshman are at at increased risk for this d/t crowded living
a nurse is teaching the parent of a child who has type 1 DM how to manage the child's disorder during an illness such as a cold. which of the following statements by the parent indicates an understanding of the teaching? i'll reduce my child's food intake i'll check his blood glucose more often i'll limit his fluid intake between meals i won't administer his long acting insulin dose
B: the parent should check the child's blood glucose every 3 hours during an illness because the level tends to rise even if the child eats less food
a nurse is caring for a newborn who has spina bifida. the newborn's parents are upset by the diagnosis. which of the following actions should the nurse take? discuss placement options for the newborn encourage the parents to touch and care for the newborn reassure the parents that everything will be fine avoid talking about the newborn's defect until the parents bring up the subject
B: touching and caretaking will help the parents bond with the newborn
a nurse is teaching the parent os a school aged child who has DM 1 how to recognize DKA> which of the following findings should the nurse identify as a manifestation of this complication? slow heart rate protruding eyeballs deep, rapid respirations decreased urinary output
C: deep and rapid respirations are known as kussamul's respirations which is a sx of DKA. the child's breath can be sweet smelling d/t body's attempt to eliminate ketones through the respiratory system
a nurse is obtaining a urine sample from a 5 month old infant by applying a urine collection bag. which of the following actions should the nurse take first? apply the bag to the skin at the area of the symphysis pubis apply the bag to the area of the perineum wash and dry the genitalia, perineum, and surrounding skin stroke the muscles on either side of the infant's spine
C: the first action the nurse should take is to wash and dry the genitalia, perineum, and skin in the area where the urine collection bag will be secured
a charge nurse on a pediatric unit receives lab results for several clients. which of the following results should the nurse report to the provider? a client who has bacterial pneumonia and a WBC of 15,800 a client who has chronic kidney disease and a calcium level of 8.7 a client who has DKA and a blood glucose of 375 a client who has leukemia and a hct of 32%
C: the initial goal of therapy for DKA is a blood glucose below 240, to accomplish this the pt should receive reg insulin via continuous IC infusion and =the nurse should monitor the blood glucose hourly. the nurse should report this result so that the provider can adjust the insulin dosage
a nurse is providing discharge teaching to the guardian of an infant following a hypospadias repair. which of the following instructions should the nurse include? clean the infant's catheter for 30 mins each day give the infant a tub bath once a day apply antibacterial ointment to the infant's penis once per day decrease the infant's fluid intake for three days
C: the nurse should instruct the guardian to apply an antibacterial ointment to the infant's penis once daily to decrease the risk of infection
a nurse is caring for a child who has glomerulonephritis. which of the following actions should the nurse take? monitor the child's BP twice per day maintain the child on bedrest for 3 days weight the child once each day increase the child's daily intake of sodium
C: the nurse should weigh the child at the same time each day to monitor fluid balance
a nurse is providing discharge teaching to the parents of a child who has nephrotic syndrome. which of the following instructions should the nurse include in the teaching? restrict the child's potassium intake administer acetaminophen twice daily weigh the child once a week keep the child way from people who have an infection
D: children who have nephrotic syndrome are at an increased risk for infection and should avoid contact with people who have infections
