Pediatrics Exam

Somogyi Effect

Phenomenon of hyperglycemia in the morning in response to child with diabetes having hypoglycemia at night ("rebound high") Taking insulin prior to bed which may lower blood glucose too much and triggers liver to release stored glycogen for energy leading to rebound high

The nurse is discussing obesity with the parents of a 5 year old child. There is a history of Type 2 diabetes in the family. What statement by the parents indicates a good understanding of how to address this issue a. It will be important for us to make changes along with our daughter, such as diet and exercise. b. Our daughter will need to count calories and exercise for at least 60 minutes per day. c. Our daughter has to understand why her weight is a problem. d. We must get our child to lose at least 10 pounds so she never gets Type 2 DM.

a. It will be important for us to make changes along with our daughter, such as diet and exercise.

3. During her hospital stay, Mia insists on having the nurse perform every assessment and intervention on her imaginary friend first. She then agrees to have the assessment or intervention done to herself. The nurse identifies this preschooler's behavior as: a. Normal for this stage of growth and development. b. Problematic; the child is old enough to begin to have a basis in reality. c. Normal, because the child is hospitalized and out of her routine. d. Problematic, as it interferes with needed nursing care.

a. Normal for this stage of growth and development.

A child requires supplemental oxygen therapy at 8 liters per minute. Which delivery device would the nurse most likely expect to be used? a. Simple mask b. Oxygen hood c. Venturi mask d. Nasal cannula

a. Simple mask

The nurse is examining a 5-year-old boy. Which sign or symptom is a reliable first indication of respiratory illness in children? a. Tachypnea b. A bluish tinge to the lips c. Increasing lethargy d. Slow, irregular breathing

a. Tachypnea

During the discussion with her preceptor, the new nurse identifies that a hospital environment may trigger anxiety and frustration for their adolescent patient with ASD. The new nurse knows that all of the following interventions may be beneficial except: a. Use humor to engage the patient. b. Provide continuity of hospital staff. c. Label room objects with words or pictures. d. Encourage family to stay.

a. Use humor to engage the patient.

A nurse is caring for an adolescent who has spina bifida and is paralyzed from the waist down. Which of the following statements by the client should indicate to the nurse a need for further teaching? a. "I do wheelchair exercises while watching TV." b. "I only need to catheterize myself twice every day." c. "I use a suppository every night to have a bowel movement." d. "I carry a water bottle with me because I drink a lot of water."

b. "I only need to catheterize myself twice every day."

A nurse is orienting a newly licensed nurse on the care of pediatric patients with myelomeningocele. They are assigned a 1-day old female who was prenatally diagnosed with myelomeningocele. The patient is currently NPO while awaiting surgery. The mother had complications during delivery and remains in the post-partum unit. Which of the following actions by the new nurse indicates that the training has been effective? a. Places the infant in a side-lying position. b. Takes an axillary temperature. c. Maintains a dry dressing over the sac. d. Performs range of motion on the infant's hips.

b. Takes an axillary temperature.

A nurse is teaching a child who has Type 1 diabetes mellitus about self-care. Which of the following statements by the child indicates understanding of the teaching? a. I should never mix my insulins in the same syringe. b. I should increase my insulin with exercise. c. I should skip breakfast when I am not hungry. d. I should drink a glass of milk when I am feeling irritable.

d. I should drink a glass of milk when I am feeling irritable.

The nurse is conducting a physical examination of a child with a suspected cardiovascular disorder. Which finding would the nurse most likely expect to assess if the child had transposition of the great vessels? a. Abrupt cessation of chest output with an increase in heart rate/filling pressure b. No changes, condition usually resolves on its own c. Soft systolic ejection murmur d. Significant cyanosis

d. Significant cyanosis

Bacterial pneumonia is suspected in a 4-year-old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? a. Oxygen saturation level of 96% b. Pale skin color c. Fever d. Tachypnea with retractions

d. Tachypnea with retractions

The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation? a. I don't notice any rapid breathing patterns. b. My baby does not make any grunting noises. c. The baby usually drinks all of her bottle. d. The baby seems more comfortable over my shoulder.

d. The baby seems more comfortable over my shoulder.

4. A nurse is assessing a family as a system. Which of the following factors should the nurse include when assessing sociocultural context? a. The future goals of the family. b. The roles of family members. c. The sense of self among individual family members. d. The family's religious practices.

d. The family's religious practices.

Dawn Phenomenon

High blood sugar between 5 and 6 am due to release of growth hormone at night, which elevates blood glucose

Honeymoon Phase

Short period of time after diagnosis of T1DM when about 10% of the child's beta cells produce a small amount of insulin before shutting down.

A nurse is caring for a child with Type 1 DM. Which of the following are manifestations of diabetic ketoacidosis? Select all that apply. a. Mental confusion b. Blood glucose of 58. c. Fruity breath d. Dehydration e. Weight gain

a, c, d

A 6-year-old is admitted to the hospital because of a possible seizure. The child's mother calls the nurse to the room because the child is "jerking all over" and won't respond when she calls the child's name. The nurse is creating a plan of care for the remainder of this patient's hospitalization. Which of the following interventions should the nurse include? Select four that apply. a. Provide a suction setup at the bedside. b. Provide restraints at the beside. c. Keep an oxygen setup at the bedside. d. Elevate the side rails near the head when the child is in bed. e. Place the bed in the lowest position.

a, c, d, e

A nurse is teaching an adolescent who has DM about manifestations of hypoglycemia. Which of the following findings should the nurse include in the teaching? Select all that apply. a. Irritability b. Increased urination c. Sweating & pallor d. Kussmaul respirations e. Poor skin turgor f. Hunger

a, c, f

8. A school age child is hospitalized. Which of the following describe their level of understanding of illness and impact of hospitalization? Select all that apply. a. Able to describe their pain b. Limited ability to follow directions c. Fears are related to magical thinking. d. Can experience stress related to loss of control and interruption of normal routine e. Can sense when they are not being told the truth

a, d, e

Mitchell, 4 months old, is brought to the hospital by his mother. He presents with difficulty gaining weight. His mother states, "He just gets so tired when he eats, and sometimes when he is nursing he has a blue color around his lips." The nurse is preparing to measure Mitchell's vital signs. The nurse should use which of the following sites to assess a heart rate in this age group? a. Apical pulse b. Carotid pulse c. Brachial pulse d. Radial pulse

a. Apical pulse

A home health nurse is developing a plan of care for a child who has hemiplegic cerebral palsy. Which of the following goals is the priority for the nurse to include in the plan of care? a. Assess the safety of the home environment. b. Foster self-care activities. c. Provide respite services for the parents. d. Improve the client's communication skills.

a. Assess the safety of the home environment.

The nurse is discussing discharge instructions with the parents of a 6-year-old who had a tonsillectomy. What is the most important thing to stress? a. Inspect the throat for bleeding. b. Administer analgesics. c. Encourage the child to drink liquids. d. Apply an ice collar.

a. Inspect the throat for bleeding.

A 6-year-old is admitted to the hospital because of a possible seizure. The child's mother calls the nurse to the room because the child is "jerking all over" and won't respond when she calls the child's name It is determined that this child will need to be discharged home with a new prescription for phenytoin to help manage the seizures. Which of the following statements by the mother indicates a need for further teaching? a. "I will notify her doctor before giving her any other medications." b. "I'll be glad when I can stop giving her this medication next month." c. "I know that I cannot switch brands of this medication." d. "I have made an appointment for her to see her dentist next week."

b. "I'll be glad when I can stop giving her this medication next month."

The nurse is caring for a 4-year-old boy who has undergone an appendectomy. The child is unwilling to use the incentive spirometer. Which approach would be most appropriate to elicit the child's cooperation? a. "If you don't try, I will have to get the doctor." b. "Let's blow this cotton ball across the tray." c. "Can you cough for me please?" d. "You must blow in this or you might get pneumonia."

b. "Let's blow this cotton ball across the tray."

The mother of a 4-week-old infant is tearful. She reports the healthcare provider has told her that her son has a small ventricular septal defect. She reports she is worried and asks the nurse more about the condition. Which statement by the parents best indicates an understanding of the nurse's teaching? a. "This greatly places my son at risk for cardiac failure." b. "Most of the time this condition spontaneously resolves." c. "Since the surgery to correct this condition can be risky my son will need to be at least 40 pounds." d. "I'm scared because my baby will need surgery soon."

b. "Most of the time this condition spontaneously resolves."

Case Scenario for questions 1-3: Mia, a 4-year-old girl, is admitted to your unit for pneumonia not improving at home on oral antibiotics. Orders for Mia include an IV insertion to begin IV antibiotics. 1. Mia's mother expresses concern that Mia will be scared. Which response by the nurse would be most appropriate? a. "Our practice of atraumatic care will eliminate all pain and stress for your child." b. "We will do our best to minimize the stress that your child experiences." c. "It will probably be upsetting for you as well, so you should stay home." d. "Don't worry; we practice family-centered and atraumatic care here."

b. "We will do our best to minimize the stress that your child experiences."

7. What type of family structure has both a biological mother and biological father raising their children? a. A step-family structure b. A nuclear family structure c. A same-sex couple family structure d. An extended-family structure

b. A nuclear family structure

2. When providing atraumatic care to Mia, which action would be the most appropriate? a. Limit the use of topical anesthetics for painful injections. b. Allow Mia and her parents to make an informed choice about being together. c. Keep the lights on in her room throughout the day and night. d. Apply restraints to Mia to help minimize movements when placing the IV

b. Allow Mia and her parents to make an informed choice about being together.

During a well-child physical, a 16-year-old girl has a normal history and physical except for an excessive amount of tooth enamel erosion and positive Russell's sign. Her body mass index is at the 80th percentile for age. Based on these findings, which disorder would the nurse suspect? a. Celiac Disease b. Bulimia nervosa c. Gastroesophageal reflux d. Anorexia nervosa

b. Bulimia nervosa

Case Scenario for Questions 1-3: The school nurse is caring for a 12-year-old boy with type 1 diabetes (DM). The child is new to the school and has a recent diagnosis of type 1 DM. The family is meeting with the school nurse to review his treatment plan. 1. When providing teaching to this child and family, which of the following should the nurse include in the teaching? a. Inject insulin in the deltoid muscle. b. Obtain an influenza vaccine annually. c. Take glyburide with breakfast. d. Administer glucagon for hyperglycemia.

b. Obtain an influenza vaccine annually.

Mitchell, 4 months old, is brought to the hospital by his mother. He presents with difficulty gaining weight. His mother states, "He just gets so tired when he eats, and sometimes when he is nursing he has a blue color around his lips." While assessing Mitchell, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? a. Administer a dose of IV morphine sulfate b. Place the infant in a knee-to-chest position c. Provide supplemental oxygen by mask d. Begin cardiopulmonary resuscitation

b. Place the infant in a knee-to-chest position

The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which test as most helpful in determining the extent of the child's hypoxia? a. Pulmonary function test b. Pulse Oximetry c. Peak expiratory flow d. Chest radiograph

b. Pulse Oximetry

Case Scenario for Questions 1-3: The school nurse is caring for a 12-year-old boy with type 1 diabetes (DM). The child is new to the school and has a recent diagnosis of type 1 DM. The family is meeting with the school nurse to review his treatment plan. 2. During the meeting, the student reports feeling shaky and is having difficulty speaking and concentrating on the questions the nurse is asking. The nurse checks the patient's blood glucose level and identifies a value of 55 mg/dL. Which of the following findings should the nurse expect? a. Dry, flushed skin b. Tachycardia c. Deep, rapid respirations d. Polyuria

b. Tachycardia

The nurse is caring for a school-age client who had an appendectomy after a ruptured appendix. What nursing intervention is a priority in the post-op period? a. Initiate full liquid diet b. Monitor vital signs Q1 hour x 12 hours c. Administer antibiotics d. Bedrest with bathroom privileges

c. Administer antibiotics

You are speaking with the mother of 12-year-old Owen who was diagnosed with Type 1 diabetes approximately 1 year ago. Mom calls because she has noticed that his sugars have been running "high" in the morning. Mom reports they keep a daily log of Owen's blood sugars and dose his insulin based on the doctor's orders. She states she doesn't understand why his sugars are high when they are following all the doctors' and nurses' orders. You realize mom needs which teaching intervention? a. You tell mom to have Owen skip breakfast until his blood sugars are lower. b. Teaching related to dawn phenomenon as Owen may be experiencing a growth spurt. c. You instruct mom to stop checking his sugars in the morning as this is normal. d. She doesn't need further teaching as this is normal for someone diagnosed within the past year.

b. Teaching related to dawn phenomenon as Owen may be experiencing a growth spurt.

Camille, a 3 month-old infant, presents to the pediatric clinic for a well-child check. Mother states that she is breastfeeding well. After obtaining the patient's length, weight, and head circumference, you plot the measurements on the appropriate growth chart. Camille's trend is steady and has remained in the same percentile levels for all measurements. Camille's mother has multiple questions about possible GERD. The nurse provides teaching to mom about GERD. Which of the following statements by the mother indicates an understanding of the teaching? a. "I will thicken Camille's formula with oatmeal until she outgrows her reflux." b. "I should position my baby side-lying during sleep." c. "Since she is growing well, I will continue to breastfeed and expect her to outgrow her reflux." d. "I will have to switch and feed Camille formula rather than breast milk."

c. "Since she is growing well, I will continue to breastfeed and expect her to outgrow her reflux."

A nurse is orienting a newly licensed nurse on the care of pediatric patients with myelomeningocele. They are assigned a 1-day old female who was prenatally diagnosed with myelomeningocele. The patient is currently NPO while awaiting surgery. The mother had complications during delivery and remains in the post-partum unit. The father asks if surgical repair of the newborn's myelomeningocele can be postponed until the mother is released from the hospital and able to visit with the patient. Which of the following is the correct response by the new nurse? a. "Surgery should occur within 24-72 hours to prevent paralysis." b. "Since she did not have fetal surgery to repair the defect, ye, surgery can be scheduled when your baby's mom is discharged." c. "Surgery should occur within 24-72 hours to reduce the risk of infection." d. "Surgery should occur within 24-48 hours to prevent hydrocephalus."

c. "Surgery should occur within 24-72 hours to reduce the risk of infection."

The nurse auscultating breath sounds of an infant with respiratory syncytial virus would immediately report the assessment of: a. heart rate decrease from 110 to 100 beats/min b. respiration rate decrease from 40 to 32 breaths/min. c. "quiet chest" from previous assessment of wheezing. d. oxygen saturation of 90%.

c. "quiet chest" from previous assessment of wheezing.

Which of the following patients would the nurse suspect to have pyloric stenosis? a. 7-month-old with gagging/choking episodes b. 7-week-old who spits up after every feed c. 5-week-old infant with projectile vomiting d. 11-month-old with an abdominal mass

c. 5-week-old infant with projectile vomiting

Case Scenario for Questions 1-3: The school nurse is caring for a 12-year-old boy with type 1 diabetes (DM). The child is new to the school and has a recent diagnosis of type 1 DM. The family is meeting with the school nurse to review his treatment plan. 3. On the first day of school, the nurse is reviewing the patient's insulin dosing for lunch. The dosing orders read: BS below 100: no addition insulin BS between 100 and 120: 2 units BS between 120 and 150: 3 units BS between 150 and 200: 4 units Carbohydrate count for lunch is 47. (Reminder 1 unit of insulin typically covers 15 grams of carbs)____________________________________________- Today, the patient's blood sugar before lunch is 139 with an expected intake of 47 carbohydrates at lunch and regular activity level the rest of day. Calculate the insulin dose to be administered. a. 1.8 (round to 2 units) b. 3.1 units (round to 3) c. 6.1 units (round to 6) d. 3 units

c. 6.1 units (round to 6)

Of the following statements, which is most characteristic of speech-language development among patients with Autism Spectrum Disorder (ASD)? a. ASD patients have advanced vocabulary and fluent speech but difficulty with two-way conversations b. ASD patients are able to conduct normal conversations but have singsong or quirky speech patterns c. ASD patients have significant variation in their speech-language development d. ASD patients are completely nonverbal or only speak in echolalia

c. ASD patients have significant variation in their speech-language development

Mitchell, 4 months old, is brought to the hospital by his mother. He presents with difficulty gaining weight. His mother states, "He just gets so tired when he eats, and sometimes when he is nursing he has a blue color around his lips." Mitchell is scheduled for a cardiac catheterization to define his underlying cardiac physiology and anatomy. After the procedure, what is the nursing priority? a. Encourage early activity and movement in the crib. b. Change the dressing to evaluate the site for infection. c. Assess the temperature and color of the extremity distal to the insertion site. d. Check pulses above the catheter insertion site for strength and quality.

c. Assess the temperature and color of the extremity distal to the insertion site.

A nurse identifies a nursing diagnosis of impaired urinary elimination related to urinary tract infection. When developing the plan of care, what would be most important for the nurse to do first? a. Monitor intake and output. b. Develop a schedule for bladder emptying. c. Assess usual voiding patterns. d. Encourage fluid intake.

c. Assess usual voiding patterns.

6. A nurse is assisting a group of parents of adolescents to develop skills that will improve communication within the family. The nurse hears one parent state, "My son knows he better do what I say." Which of the following parenting styles is the parent exhibiting? a. Permissive b. Indifferent c. Authoritarian d. Passive

c. Authoritarian

A mother brings her 6-month-old infant to the emergency room. The child has been vomiting since morning and has had diarrhea starting the day before. Her temperature is 101.4 F, pulse 140, and respiratory rate 38. She has lost 13 oz since her well-child visit 4 days ago. Her current weight is 7.6 kg. She cries before passing a bowel movement. She will not breastfeed today. What is the priority nursing diagnosis? a. Pain (abdominal) related to diarrhea b. Alteration in nutrition, less than body requirements, related to decreased oral intake c. Fluid volume deficit related to excessive losses and inadequate intake d. Thermoregulation alteration

c. Fluid volume deficit related to excessive losses and inadequate intake

Mitchell, 4 months old, is brought to the hospital by his mother. He presents with difficulty gaining weight. His mother states, "He just gets so tired when he eats, and sometimes when he is nursing he has a blue color around his lips." The nurse suspects that Mitchell may have a congenital heart defect. Which of the following defects is associated with decreased pulmonary blood flow? a. Patent Ductus Arteriosus b. Coarctation of the aorta c. Pulmonary valve stenosis d. Ventricular septal defect

c. Pulmonary valve stenosis

An infant is hospitalized with RSV bronchiolitis. The priority nursing diagnosis is: a. risk for fluid volume deficit related to tachypnea and decreased oral intake b. fear and/or anxiety related to dyspnea and hospitalization c. ineffective breathing pattern related to airway inflammation and increased secretions d. fatigue related to increased work of breathing

c. ineffective breathing pattern related to airway inflammation and increased secretions

A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which finding? a. Children's demand for oxygen is lower than that of adults. b. Children's bronchi are wider in diameter than those of an adult. c. An increase in oxygen saturation leads to a much larger decrease in pO2. d. Children develop hypoxemia more rapidly than adults do.

d. Children develop hypoxemia more rapidly than adults do.

After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow? a. Transposition of the great vessels b. Hypoplastic left heart syndrome c. Tetralogy of Fallot d. Ventricular septal defect

d. Ventricular septal defect