Pediatrics Unit 5 and 6 Test, GU, Endocrine etc

In dealing with a compound fracture, what should the nurse carefully assess for? A. Infection B.Osteoarthritis C. Epiphyseal Disruption D. Periosteum thickening

A. Because the skin has been broken, the child is at risk for organisms to enter the wound. Osteoarthritis and Epiphyseal Disruption are not increased with a compound fracture. Periosteum thickening is a sign of healing and not a complication.

A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports that he will not stop crying even after taking acetaminophen with codeine. He also will not straighten the fingers on his right arm. The nurse tells the mother to a. Take him to the emergency department. b. Put ice on the injury. c. Avoid letting him get so tired. d. Wait another hour; if he is still crying, call back.

A. Unrelieved pain and the child's inability to extend his fingers are a sign of compartmental syndrome, which requires immediate attention. Placing ice on the extremity with the presenting symptoms is not an appropriate action. A child with compartmental syndrome should be seen immediately, waiting an hour could compromise the child's recovery.

Nursing care of the infant who has had a myelomeningocele repair should include a. Securely fastening the diaper b. Measurement of pupil size c. Measurement of head circumference d. Administration of seizure medications

C. Head circumference is essential because hydrocephalus can develop in these infants. A diaper should be placed under the infant but not fastened. Keeping the diaper open facilitates cleaning and decreases the risk of skin breakdown. Pupil size measurement is not necessary.

When a child injures the epiphyseal plate from a fracture, the damage may result in which of the following? A. Rheumatoid arthritis B. Permanent nerve damage C. Osteomyelitis D. Bone growth disruption

Correct Answer: D. Bone growth disruption The epiphyseal plate is a significant region of bone growth. Hence, any disruption may result in limb shortening. Sometimes, changes in the growth plate from the fracture can cause problems later. For example, the bone could end up a little crooked or a bit longer or shorter than expected.

What is a clinical finding that warrants further investigation with a child with poststreptococcal glomerulonephritis? A. Weight loss to within 1 lb of preillness weight B. Urine output of 1ml/kg/hour C. A normal blood pressure D. Inspiratory crackles

D. Children with excess fluid volume may have pulmonary edema. Fluid in the lungs can be a life threatening complication. Weight loss to within 1 lb of preillness weight indicates that the treatment is effective. A urine output of 1ml/kg/hour indicates that the child is responding to the treatment. A normal blood pressure also indicates the child is responding to treatment.

A mother reports that her child has episodes where he appears to be staring into space. This behavior is characteristic of which type of seizure? a. Absence b. Atonic c. Tonic-clonic d. Simple partial

A. Absence seizures are very brief episodes of altered awareness. The child has a blank expression. Atonic seizures cause an abrupt loss of postural tone, loss of consciousness, confusion, lethargy, and sleep. Tonic-clonic seizures involve sustained generalized muscle contractions followed by alternating contraction and relaxation of major muscle groups. There is no change in level of consciousness with simple partial seizures. Simple partial seizures consist of motor, autonomic, or sensory symptoms.

A child with spina bifida is being admitted to the hospital for a shunt revision. The nurse admitting the child anticipates what kind of precautions? A. Latex B. Bleeding C. Seizure D. Isolation

A. Children with spina bifida are at high risk for latex allergies because of continuous exposure to catherizations, shunt placements and other operations. The child with spina bifida is not at risk for bleeding, not all children with spina bifida are at risk for seizures and isolation would not be necessary for a shunt revision.

When would a child diagnosed with insulin dependent diabetes most likely have a decreased need for insulin? A. During the honeymoon phase B. During adolescence C. During a growth spurt D. During minor illness

A. During the honeymoon phase, which may last from a few weeks to a year or longer, the child will most likely have a decreased need for insulin. During adolescence, physical growth and hormonal changes contribute to an increased need for insulin. Stress from illness or environmental factors can cause hyperglycemia. Stress from minor illness can cause an increased need for insulin.

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine. The nurse's response is based on the knowledge that the presence of casts in the urine indicates a. Glomerular injury b. Glomerular healing c. Recent streptococcal infection d. Excessive amounts of protein in the urine

A. The presence of red blood cell casts in the urine indicates glomerular injury, not glomerular healing. A urinalysis positive for casts does not indicate a recent strep throat infection. Casts in the urine are unrelated to proteinuria.

The nurse is collecting data on a school-aged child with the following symptoms: Abrupt beginning to urinary symptoms Gross hematuria Vital signs: 99 (F), 37.2 (C), 92 bpm, 22 breaths/min, BP 142/92 Mild edema Which disease condition does the nurse anticipate? acute glomerulonephritis Wilms tumor urinary tract infection nephrotic syndrome

A. The symptoms are consistent with acute glomerulonephritis. Urinary tract infection includes fever, burning upon urination, and irritability. Nephrotic syndrome begins insidiously. Hematuria is rare but edema is extreme. Wilms tumor is a neoplasm of childhood.

What interventions should the nurse perform if the child is having a tonic clonic seizure? Select all that apply. a. Place a padded tongue blade in the childs mouth. b. Place the child in a supine position. c. Time the seizure. d. Restrain the child. e. Stay with the child. f. Loosen the childs clothing.

ANS: C, E, F As a seizure begins the nurse should look at his or her watch and time the seizure. The nurse should protect the child from injury by loosening clothing at the neck and turning the child gently onto the side, removing any obstacles in the childs environment. Do not restrain the child or insert any object into the childs mouth.

The parents of a child recovering from surgery to repair vesicoureteral reflux ask the nurse if they can do anything to help with the care of their child. What will the nurse encourage the parents to do at this time? Assist the child out of bed while keeping the drainage bags below the level of the catheter. Empty urinary collection bags by draining into the toilet. Help the child get into and out of the tub for a bath. Provide hard candy to help with mouth dryness because the child is on a fluid restriction

Assist the child out of bed while keeping the drainage bags below the level of the catheter. Explanation: The nurse will need to make sure that the child and parents understand the importance of not raising the collection system above the child's bladder level when getting out of bed. This action helps prevent potentially contaminated urine from flowing from the tubes back into the bladder or ureters. Tub baths are contraindicated until all surgical sites have healed. Nursing professionals will empty the drainage bags as they monitor the amount and characteristics of the output. The child will not be on a fluid restriction, so hard candy is not needed to help with mouth dryness

Which statement by a school aged girl indicates the need for further teaching about Urinary Tract Infections? A. I always wear cotton. underwear B. I really enjoy taking a bubble bath C. I go to the bathroom every 3-4 hours D.I drink 4-6 glasses of fluid every day

B. Bubble baths should be avoided because they tend to cause urethral irritation. It is desireable to wear cotton underwear as opposed to nylon. Nylon tends to hold in moisture and promote bacterial growth. Children should be encouraged to urinate four times a day. Drinking fluid prevents stasis of the urine and buildup of bacteria in the bladder.

What should the nurse suggest to the parents of a child with Insulin Dependent Diabetes Mellitus who is not eating as a result of a minor illness? A. Give the child half his regular dose of insulin B. Substitute calorie containing liquids for calorie heavy foods to maintain serum glucose levels C. Give the child plenty of unsweetened clear liquid drinks to maintain hydration D. Take the child to the emergency department

B. Calorie containing liquids will maintain normal serum glucose meals and prevent hypoglycemia. The child should have his regular dose of insulin even if he does not have an appetite. During periods of minor illness, patients with IDDM can be safely managed at home.

The nurse is assessing a child with post streptococcal glomerulonephritis should be alert for which finding? A. Increased urine output B. Tea colored urine C. Hypotension D. Weight gain

B. Glomerulonephritis is characterized by proteinuria, hematauria, renal insufficiency and edema. Tea colored urine may indicate blood in the urine. In acute poststreptococcal glomerulonephritis, urine output may decrease and blood pressure may rise. Edema may be noted around the eyelids and ankles, however edema is more associated with nephrotic syndrome

A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem. Which metabolic alteration should the nurse explain to the parent that is related to growth hormone deficiency? A. hypocalcemia B. Hypoglycemia C. Hyperglycemia D. Diabetes Insipidous

B. Growth hormone helps maintain blood sugar at normal levels. Symptoms of hypocalcemia are associated with hypoparathyroidism. Diabetes insipidous is a disorder of the posterior pituitary gland, growth hormones is made by the anterior pituitary gland. Hyperglycemia is a result of a lack of insulin made by the islets of langerhans in the pancreas.

When covering antecedent infections in acute glomerularnephritis, which of the following should the nurse cover? A. Scabies B. Impetigo C. Herpes Simplex D. Varicella

B. Impetigo, a bacterial infection of the skin, may be caused by streptococci and may precede acute glomerulonephritis. Although most streptococcal infections do not cause acute glomerulonephritis, when they do, a latent period of 10 to 14 days occurs between the infection, usually of the skin (impetigo) or upper respiratory tract, and the onset of clinical manifestations.

After a tonic-clonic seizure, it would not be unusual for a child to display a. Irritability and hunger b. Lethargy and confusion c. Nausea and vomiting d. Nervousness and excitability

B. In a tonic clonic seizure, the child may be confused and lethargic. Some children may sleep for a period of time. Neither irritability or hunger is typical of a period after a tonic clonic seizure. Nausea and vomiting are not expected in the postictal period.

What is the appropriate nursing action when a child is in the tonic phase of a generalized tonic- clonic seizure. A. Guide the child to the floor if he or she is standing and go get help. B. Turn the child's body on his side C. Place a padded tongue blade between the teeth D. Quickly slip soft restraints on the child's wrists

B. Positioning the child on his side will prevent aspiration. The child should be placed on a soft surface if he is not in bed, however, it would be inappropriate to leave the child during a seizure. Nothing should be inserted into the child's mouth during a seizure to prevent injury to the gums, teeth, or mouth. Restraints could cause injury. Sharp objects and furniture should be moved out of the way.

Which laboratory finding would indicate a child with IDDM is experiencing diabetic keto acidosis? A. No urinary ketones B. Low arterial pH C. Elevated serum carbon dioxide D. Elevated serum phosphorus

B. Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are normally present when a child is in DKA. Serum carbon dioxide levels are normally decreased during DKA and serum phosphorus is normally decreased during DKA.

A child has fractured his forearm and is unable to extend his fingers. The nurse knows : A. It is normal following this type of injury B. It may be a sign of compartmental syndrome C. may indicate fat embolism D. May indicate damage to the epiphyseal plate

B. Swelling causes pressure to rise within the immobilizing device, leading to compartmental syndrome. Signs include severe pain often unrelieved by analgesics, and neurovascular impairment.It is not normal that the child is unable to extend his fingers, this indicates neurovascular compromise of some kind. Paresthesia, numbness or loss of feelings can result in paralysis. Fat embolism causes respiratory distress with hypoxia and respiratory acidosis. Paresthesia is not related to the epiphyseal plate.

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? Kidneys, ureter, and bladder x-ray Creatinine clearance rate Urinalysis Computed tomography scan

B. 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

When assessing a child for an upper extremity fracture, a nurse should know these fractures most often result from: A. Automobile accidents B. Falls C. Physical abuse D. Sports injuries

B. The major cause of children's fractures is falls. Because of the protective reflexes, the extended arm most likely takes the full force of the fall.

The nurse teaches parents to alert the healthcare provider about which adverse effect when a child receives Valproic Acid to control generalized seizures? A. Weight loss B. Bruising C. Anorexia D. Drowsiness

B. Thrombocytopenia is an adverse effect of valproic acid. Parents should be alert for any unusual bruising or bleeding. Weight gain, not weight loss or anorexia is a side effect of valproic acid. Drowsiness is not a side effect of valproic acid, although is it a side effect of other anti convulsants.

Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge? a. "I rotate my insulin injection sites every time I give myself an injection." b. "I keep records of my glucose levels and insulin sites and amounts." c. "I'll be glad when I can take a pill for my diabetes like my uncle does." d. "I keep Lifesavers in my school bag in case I have a low-sugar reaction."

C. Children with IDDM have a need for lifelong insulin therapy. Rotating injection sites is appropriate for patients because insulin absorption varies at different sites. Keeping record of insulin injection sites and amounts is appropriate. Prompt treatment of hypoglycemia is necessary to avoid a serious reaction. Keeping hard candy on handy is an appropriate action.

Which statement made a 14 year old who is newly diagnosed with insulin dependent diabetes mellitus would indicate a need for further teaching? A. I should eat meals and snacks at the same time every day. B. Exercise will decrease my insulin requirements C. It is OK to drink chocolate milk with meals. D. It is ok to check my sugar before meals and at bedtime.

C. Chocolate milk is high in carbohydrates. Carbohydrates increase glucose levels. A beverage low in carbohydrates is a better choice. Meals and snacks should be eaten at regular times. Exercise decreases the need for insulin. Checking serum glucose before breakfast and dinner is appropriate.

What is the best nursing action for a child who is sweating, trembling, and pale? A. Offer the child a glass of water B. Give the child 5 units of insulin subcutaneously C. Give the child a glass of orange juice D. Administer glucagon subcutaneously

C. Four ounces of orange juice is an appropriate intervention for the child who is conscious who is exhibiting signs of hypoglycemia. A glass of water is not indicated in this situation. Insulin would lower the blood glucose and would be contraindicated with hypoglycemia. Glucagon is indicated for hypoglycemia when the child is unconscious.

When infants are seen for fractures, what nursing intervention is priority? A. No intervention is necessary. It is not uncommon for children to fracture their bones. B. Assess the family's safety practices. Fractures in infants are usually a result of falls. C. Assess for child abuse. Fractures in infants are often non accidental D. Assess for genetic factors.

C. Fractures in infants warrant investigation to rule out child abuse. Fractures in children less than one year are not common because of the cartilaginous quality of the bone; a large amount of force is necessary to fracture their bones. Infants should be cared for in a safe environment and should not be at risk for falls.

A newborn is diagnosed with hypospadias and the parents want him to be circumcised. Which response by the nurse would be most appropriate? "Circumcision now would increase the risk that your son will develop renal failure." "Your son will have to wait until he is about a year old before the circumcision can be done." "It's important to have your son seen by a urologist because the foreskin is needed for repair." "Circumcision in a child with your son's condition is not possible because the urethral opening is narrow."

C. If any degree of hypospadias is present, a circumcision should not be performed without a urologic evaluation because the prepuce is used for the reconstructive surgery. The surgery is typically performed between the ages of 6 and 12 months. The child's condition does not involve a narrowing of the opening. The meatus opens on the ventral surface of the penis. There is no association with circumcision, hypospadias and renal failure.

Which sign is a nurse most likely to assess in a child with hypoglycemia? A. Urine positive for ketones and a glucose higher than 300mg/dl B. Normal sensorium and glucose higher than 160 mg/dl C. Irritability and serum glucose less than 70 mg/dl D. Increased urination and serum glucose less than 120 mg/dl

C. Irritability and serum glucose less than 70mg/dl are manifestations of hypoglycemia. Urine positive for ketones and a glucose higher than 300mg/dl are signs of DKA. Normal sensorium and glucose higher than 160 mg/dl are signs of hyper glycemia. A serum glucose less than 120mg/dl is within normal limits.

A nurse needs to obtain a urine specimen from a child. Which of the following would be most helpful in encouraging the child to void? Tell the child that a catheter will be used if he does not urinate in the cup. Explain to the child in medical terms why he needs to urinate. Run water in the sink to trigger the sensation to void. Have the child sit in time-out until he can go to the bathroom.

C. Running water aids in helping children to void. Children do not understand many medical terms. The negative consequences such as a catheter or time-out are not the most therapeutic and do not usually work.

What is the best response to a father who tells the nurse that his child appears to be daydreaming at home and his teachers has observed this at school? A. "Your child must have an active imagination" B. Can you tell me how many times a day this occurs? C. Tell me about your sons activity when he daydreams D. He is probably tired and needs a rest.

C. The daydream episodes are suggestive of absence seizures and data about the daydream episodes should be obtained. Telling the father that the child has an active imagination does not address the father's concerns or the child's symptoms. The number of time the behavior occur is consistent with absence seizures and can occur one after the other several times a day. Determining an exact number of seizures is not as useful as learning about the behavior before the seizures and what activity may have precipitated the seizure. Blaming the seizures on rest ignores the child's symptoms and does not alleviate the father's concerns.

Which is an accurate statement of a child's musculoskeletal system and how it might be different than an adults? A. Growth occurs in children because of an increase in the number of muscle fibers B. Infants are at a greater risk for fractures because their epiphyseal plates are not fused. C. Because soft tissue in children are resilient, dislocations and sprains are less common than in adults D. Their bones have less blood flow.

C.Because soft tissue is more resilient, dislocations and sprains are less common in children than in adults. Growth occurs in children because of an increase in the size of muscle fibers, not the amount. Fractures in children under 1 are uncommon because a greater amount of force is needed to fracture their bones. Children have more blood flow in their bones, not less

In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following? A. Anterior pituitary gland hypofunction B. Posterior pituitary gland hyperfunction C. Parathyroid gland hyperfunction D. Thyroid gland hyperfunction

Correct Answer: A. Anterior pituitary gland hypofunction Short stature usually results from diminished or deficient growth hormone, which is released from the anterior pituitary gland. Growth hormone production from the anterior pituitary is regulated by the stimulatory and inhibitory control of the hypothalamus. Hypothalamus produces growth hormone-releasing hormone that stimulates the somatotrophs of the anterior pituitary to secrete growth hormone.

Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares to the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following? A. The child should be allowed to play because doing so can foster healthy self-esteem. B. The risk for fractures is increased because a GH deficiency results in fragile bones. C. Activity could aggravate insulin sensitivity, causing hyperglycemia. D. Activity would aggravate the child's joints, already over tasked by obesity

Correct Answer: A. The child should be allowed to play because doing so can foster healthy self-esteem. Engaging in peer-group activities can aid foster a sense of belonging and a positive self-concept. T-ball is a good sport to choose because physical stature is not an important consideration in the ability to participate, unlike some other sports, such as basketball and football. Physical examination may not reveal any significant findings as the presentation is usually subtle.

Niklaus was born with hypospadias; which of the following should be avoided when a child has such condition? A. Surgery B. Circumcision C. Intravenous pyelography (IVP) D. Catheterization

Correct Answer: B. Circumcision Hypospadias refers to a condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface (underside) of the penile shaft. The ventral foreskin is lacking, and the distal portion gives an appearance of a hood. Early recognition is important so that circumcision is avoided; the foreskin is used for surgical repair.

Katie is admitted to the intensive care unit of Nurseslabs Medical Center for diabetic ketoacidosis. Which of the following is of primary importance when caring for the child? A. Giving I.V. NPH insulin in high doses B. Evaluating the child for cardiac abnormalities C. Limiting fluids to prevent aggravating cerebral edema D. Monitoring and recording the child's vital signs for hypertension

Correct Answer: B. Evaluating the child for cardiac abnormalities. As the fluid volume deficit is improved, total body potassium deficiency may occur, leaving the child vulnerable to hypokalemia and, afterward, cardiac arrest. The nurse should monitor the cardiac cycle for prolonged QT interval, low T wave, and depressed ST segment, which indicate weakened heart muscle and potential irregular heartbeat.

The nurse is drawing blood from the diabetic patient for a glycosylated hemoglobin test. She explains to the woman that the test is used to determine: A. the highest glucose level in the past week. B. her insulin level. C. glucose levels over the past several months. D. her usual fasting glucose level.

Correct Answer: C. Glucose levels over the past several months. The glycosylated hemoglobin test measures glucose levels for the previous 3 to 4 months. The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person's level of glucose control. The test shows an average of the blood sugar level over the past 90 days and represents a percentage. The test can also be used to diagnose diabetes.

Spina bifida is one of the possible neural tube defects that can occur during early embryological development. Which of the following definitions most accurately describes meningocele? A. Complete exposure of spinal cord and meninges B. Herniation of the spinal cord and meninges into a sac C. Sac formation containing meninges and spinal fluid D. Spinal cord tumor containing nerve roots

Correct Answer: C. Sac formation containing meninges and spinal fluid. Meningocele is a sac formation containing meninges and cerebrospinal fluid (CSF). Meningocele is the simplest form of open neural tube defects characterized by cystic dilatation of meninges containing cerebrospinal fluid without any neural tissue. A complex meningocele is associated with other spinal anomalies.

Benjamin was rushed to the emergency department with possible increased intracranial pressure (ICP); which of the following is an early clinical manifestation of increased ICP in older children? A. Macewen's sign B. Setting sun sign C. Papilledema D. Diplopia

Correct Answer: D. Diplopia Diplopia is an early sign of increased ICP in an older child. Visual changes can range from blurred vision, double vision from cranial nerve defects, photophobia to optic disc edema and eventually optic atrophy. Clinical suspicion for intracranial hypertension should be raised if a patient presents with the following signs and symptoms: headaches, vomiting, and altered mental status varying from drowsiness to coma.

The adolescent patient has symptoms of meningitis: nuchal rigidity, fever, vomiting, and lethargy. The nurse knows to prepare for the following test: A. blood culture. B. throat and ear culture. C. CAT scan. D. lumbar puncture.

Correct Answer: D. Lumbar puncture. Meningitis is an infection of the meninges, the outer membrane of the brain. Since it is surrounded by cerebrospinal fluid, a lumbar puncture will help to identify the organism involved. The CSF findings expected in bacterial, viral, and fungal meningitis are listed in the chart: Expected CSF findings in bacterial versus viral versus fungal meningitis

A nurse is preparing to administer 10 units of regular insulin and 5 units of Lente insulin. Place in order the steps the nurse should follow to administer 15 units of insulin. Place the initial step first and end with the final step. A. Inject 5 units of air into the Lente vial B. Draw up the 5 units of Lente insulin C. Inject 10 units of air into the regular insulin vial. D. Cleanse the insulin vials with alcohol wipes. E. Draw up the 10 units of insulin.

D,A,C,E,B- Cleanse both vials with alcohol wipes. When drawing up two different insulins, inject the appropriate amount of air into both vials and then draw the clear insulin first.

Which is the nurse's best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child's continued participation in soccer? a. "Consider the swim team as an alternative to soccer." b. "Encourage intellectual activity rather than participation in sports." c. "It is okay to play sports such as soccer unless the weather is too hot." d. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."

D. Exercise lowers serum glucose levels. A snack with 15 to 30 grams of carbohydrates will prevent hypoglycemia. Soccer is an appropriate sport as long as the child eats a snack to prevent hypoglycemia. Participation in sports is not contraindicated for a child with IDDM. A child with IDDM may participate in sports regardless of the weather.

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? tachycardia hypertension hypothermia hypotension

B. Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

A child is scheduled to undergo a voiding cystourethrogram (VCUG). When teaching the parents about this procedure, which information would the nurse include? The test will identify if kidney stones are present. The test will help to rule out vesicoureteral reflux (VUR). The test will detect if the infection is gone. The test will prevent further complications of the urinary tract infection.

A VCUG will rule out reflux in the urinary tract, which may lead to frequent infections and scarring if not diagnosed and treated. The test is not performed if a urinary tract infection is present. It will not identify kidney stones.

A school-aged child diagnosed with glomerulonephritis is in the physician's office for a 6-month follow-up visit. Hematuria is found in the urine. The parents are concerned and want to know why the glomerulonephritis is not gone. Which response by the nurse would be most appropriate? "This is unusual and further testing will need to be done." "The child will need treatment with antibiotics for strep throat." "Hematuria can remain in the urine for up to 1 year." "This is probably related to a UTI and not glomerulonephritis."

A child with glomerulonephritis can have hematuria for up to a year after being diagnosed with it. Hematuria is a sign of a UTI, but given the history, this is probably unlikely. A urine culture would be a better indicator of a UTI. The child does not need to be treated for strep throat unless the throat culture is positive.

A nurse is assessing an infant with an UTI? Which assessment findings would the nurse expect? A. A change in urine odor/color B. Enuresis C. Fever or hypothermia D. Voiding urgency E. Poor weight gain

A, C, E. Signs of a UTI include fever or hypothermia, dysuria, irritability as evidenced by crying when urinating, changes in urine odor or color, poor weight gain and feeding difficulties. Voiding urgency and enuresis would be assessed in an older child.

Which statement is most accurate regarding childhood musculoskeletal injuries? A. After the injury is iced, the swelling decreases indicating that the injury is not severe. B. The presence of localized tenderness indicates a more serious injury. C. The more swelling there is, the less serious the injury D. The less willing the child is to bear weight, the more serious the injury.

An inability to bear weight on a injury, the more serious the injury is. With a fracture, general manifestations include pain or tenderness at the site, immobility or decreased range of motion, deformity of the extremity, edema, or inability to bear weight. A decrease in swelling after icing does not indicate the degree of injury.

A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts? A. Always keep insulin vials refrigerated B. Increase the amount of insulin before exercise C. Ketones in the urine signify a need for less insulin D. Systematically rotate injection sites

Correct Answer: D. Systematically rotate injection sites. It is necessary to rotate injection sites because injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop. Insulin delivery is by multiple daily injections (MDI) or an insulin pump to simulate endogenous insulin physiology. Multiple daily injections include basal insulin once or twice daily, and bolus insulin typically is given at meals three or more times daily and is based on carbohydrate content and current blood glucose.

A 7-year-old boy has experienced repeated urinary tract infections (UTIs). His older sister also experienced repeated UTIs and was diagnosed with vesicoureteral reflux, a condition that tends to appear in families. Therefore, the nurse suspects this same condition in this client. Which diagnostic tests would confirm this suspicion? Urine culture Cystoscopy Blood urea nitrogen test Urinalysis

Cystoscopy

The nurse is caring for a 7-year-old girl diagnosed with precocious puberty. The child is tearful when talking with the nurse about the signs and symptoms of the disorder. She states, "I don't look like my friends." When preparing the care plan for this child, which nursing diagnosis has the highest priority? Interrupted family process Deficient knowledge Disturbed body image Imbalanced nutrition

In precocious puberty, the child develops sexual characteristics before the usual age of pubertal onset. Disturbed body image would be the highest priority nursing diagnosis based on the child being tearful and the statement about not looking like her friends. Deficient knowledge about the disorder or treatment may apply, but is not the priority in this situation.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to prevent herniation of a spinal disk, which is painful." "It is important to prevent torticollis."

It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

A child is brought to the emergency department in a tonic clonic status epilepticus. What medication should the nurse expect to give in this situation? A. Traxene B. Cerebrex C. Phenytoin D. Lorazapam

Lorazapam or diazapam is given intravenously to control tonic clonic status epilepticus seizures and seizures that last longer than 5 minutes. Clorazapate Dipotassium (traxene) is indicated for cluster seizures. It can be given orally. Fosphenytoin (cerebrex) and phenobarbitol can be intravenously as a second round of medication if the seizures continue.

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 an age for this to begin. The nurse knows that these symptoms may be indicative of what disorder? adrenal hyperplasia pseudopuberty precocious puberty neurofibromatosis

Precocious puberty occurs when the child's sexual characteristics begin to develop before the normal age of puberty. Appropriate treatment can halt, and sometimes even reverse, sexual development and can stop the rapid growth that results in severe short adult stature caused by premature closure of the epiphysis. Treatment for precocious puberty allows the child to achieve the maximum growth potential possible. Mental development in children with precocious puberty is normal, and developmental milestones are not affected. The behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive. Pseudopuberty occurs when there is only partial development after testosterone is secreted. It occurs in males. Adrenal hyperplasia is an inherited disorder and it affects the production of androgen. Neurofibromatosis is a genetic disorder of the nervous system where tumors grow on the nerves.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Applying ice to the area will reduce the pain and swelling." "Apply ice to the injury for 60 minutes on and 60 minutes off." "Elevate the legs, and use bed rest for 24 hours." "Taking warm baths will help relax muscles and reduce pain."

Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling.

Parents ask the nurse, when should our child's hypospadia be corrected? The nurse responds with the knowledge that the child's hypospadia should be corrected by the time the child is: A. 1 month B. 6-8 months C. School Aged D. Sexually mature

The correction of the hypospadia should occur by the time the child is 6-8 months, and begins toilet training. Surgery should not take place before the child is 6 months old.It is preferable for the child to have the surgery to correct it before the child is school aged so that he has normal toileting behaviors in the presence of his peers. Corrective surgery is done long before the child reaches sexual maturity.

The nurse is collecting data on a child recently diagnosed with acute glomerulonephritis. Which clinical manifestation was likely noted in this child? increased nocturia bloody urine decreased specific gravity hypotension

The presenting symptom in the child with acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody.

A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? "Her body fights against the insulin." "I will just feed my child healthy foods and sign her up for more sports." "We will just have our child exercise and take medicine to cure this." "Her body doesn't have any insulin."

Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.

The nurse is caring for a 7-month-old female infant diagnosed with a urinary tract infection (UTI). The parents are upset as this is the infant's second UTI with a fever. Which instruction is most helpful? Select all that apply. Female urethras are shorter and straighter than males. Change diapers promptly, especially after bowel movements. After 3 days on antibiotics, the infection is clear. A fever is commonly noted with a UTI. UTI's are common in male infants at this age.

Urinary tract infections are common in females in the "diaper age" because the female urethras are shorter and straighter than in the males. This poses a potential for infection. Males have a higher rate of UTI's in the first 4 months. A fever is common with this diagnosis. Changing the diapers promptly eliminates the time that the infant is exposed to E-coli. The infant may feel better after 3 days of antibiotic use but it takes a full course of antibiotics to clear an infection.

What should the nurse include in a teaching for the parents of a child with vesicoureteral reflux? A. Screening for a UTI if febrile B. Suggestions for how to maintain fluid restrictions C. The use of bubble baths as an incentive to increase bathtime. D.The need for a child to hold the urine for 6-8 hours

A. A child with vesicoureteral reflux is screened for a UTI if febrile. Fluid restrictions should be not be implemented, in fact fluid intake should be encouraged. Bubble baths should be avoided and children should be taught to void frequently

What should the nurse teach parents about taking phenytoin for seizures? A. The child should use a soft toothbrush and floss after every meal. B. The child will require monitoring of his liver function while taking this medication C. Dilantin should be taken with food because it causes gastrointestinal distress, D. The medication should be stopped when the child has been seizure free for a month.

A. A side effect of dilantin is gingival hyperplasia. Good oral hygiene will minimize this effect. the child receiving depakene (valproic acid) should have liver function tests because this can cause liver dysfunction. Dilantin has not been found to cause gastrointestinal upset. Anticonvulsants should never be stopped suddenly without consulting a physician first. Such activity could result in seizure activity.

What is the primary concern for a child who is 7 years old who asks his mother not to tell anyone he has diabetes mellitus? A. Child's safety B. The privacy of the child C. Develop a sense of industry D. Acceptance by a peer group

A. The child's safety should be the primary concern. School personnel need to be made aware of the signs and symptoms of hyper and hypoglycemia. Privacy is not a life threatening concern. Peer group acceptance and body images are a concern for the early adolescent. This is not a primary concern over the child's safety.

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about? The child has had an MRI of their leg within the past 6 weeks. The child wears a medical alert bracelet for diabetes. The child is allergic to shellfish. The child is taking a vitamin supplement.

Allergies to shellfish should be reported because shellfish contains iodine; the dye used for a nuclear medicine scan is iodine based and could cause an anaphylactic reaction. The other information about the child would not need to be reported to the staff.

Which of the following organisms is the most common cause of Urinary Tract Infections in children? A. Klebsiella B. Staphylococcus C. Escherichia coli D. Pseudomonas

C. E. coli is the most common organism associated with the development of UTI. Escherichia coli is the most common organism in uncomplicated UTI by a large margin. Pathogenic bacteria ascend from the perineum, causing the UTI. Women have shorter urethras than men and therefore are far more susceptible to UTI. Very few uncomplicated UTIs are caused by blood-borne bacteria.

A 3-month-old infant is seen in the pediatric clinic. The infant's parent expresses concern that the child has developed cerebral palsy. The nurse assesses the infant. Which assessment finding indicates to the nurse that the parent's concern is valid? hypertonia in the upper extremities exhibits Gower sign unable to sit without support turns head toward sounds

Cerebral palsy manifests as hyper- or hypotonia, and cognitive and developmental delays. Gower sign is a manifestation of muscular dystrophy not cerebral palsy. A 3-month-old infant should be developmentally able to turn toward a voice or sound but is too young to sit without support.

When discussing congenital adrenal hyperplasia with a child's parents, the nurse would advise them that administration of which drug is anticipated? Hydrocortisone Vitamin D Growth hormone Calcium

Congenital adrenal hyperplasia is an autosomal inherited disease. The adrenal glands produce an insufficient supply of the enzymes required for the synthesis of cortisol and aldosterone. Hydrocortisone is a corticosteroid that is used to replace the supply of cortisol. It would be administered throughout the life of the child. The other drugs are not necessary to treat this disorder.

The nurse is evaluating a female child with acute post streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? A. Increased urine output B. Increased appetite C. Increased energy level D. Decreased diarrhea

Correct Answer: A. Increased urine output Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving. PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema, though it can also present with significant proteinuria

Which of the following should be included when developing a teaching plan to prevent urinary tract infection? Select all that apply. A. Maintaining adequate fluid intake B. Avoiding urination before and after intercourse C. Emptying bladder with urination D. Wearing underwear made of synthetic material such as nylon E. Keeping urine alkaline by avoiding acidic beverages F. Avoiding bubble baths and tight clothing

Correct Answer: A, C, & F Even with proper antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the quality of life is poor. About 25% of women experience such recurrences. Many cases of uncomplicated UTIs will resolve spontaneously, without treatment, but many patients seek therapy for symptom relief. Option A: Fluid intake helps dilute urine and minimize infection potential. Even without treatment, most UTIs will spontaneously resolve in about 20% of women; especially if increased hydration is used. The likelihood that a healthy female will develop acute pyelonephritis is very small. Option B: Void before and after intercourse (if sexually active). Sexual intercourse is a common cause of a UTI as it promotes the migration of bacteria into the bladder. Although there is no proof of prevention, women should urinate after sexual intercourse because bacteria in the bladder can increase by ten-fold after intercourse. Option C: Emptying the bladder fully with each urination prevents stasis. People who frequently void and empty the bladder tend to have a lower risk of a UTI. Option D: Children and teens should wear cotton underwear. The majority of organisms causing a UTI are enteric coliforms that typically inhabit the periurethral vaginal introitus. These organisms ascend the urethra into the bladder and cause UTI. Option E: Keep the urine acidic. Urine is an ideal medium for bacterial growth. Factors that make it less favorable for bacterial growth include a pH less than 5, the presence of organic acids, and high levels of urea. Normal urine pH is slightly acidic, with usual values of 6.0 to 7.5, but the normal range is 4.5 to 8.0. A urine pH of 8.5 or 9.0 is often indicative of a urea-splitting organism, such as Proteus, Klebsiella, or Ureaplasma urealyticum. Option F: Bubble baths and tight clothing may act as irritants. Vigorous urine flow is helpful to prevention. Baths should be avoided in favor of showers. A gentle, liquid soap should be used in bathing (such as Ivory or Dial) or a liquid baby soap such as Johnson's baby shampoo which is very acceptable for the vagina.

A child with secondary enuresis or dysuria or urgency should be evaluated for which syndrome? A. Hypocalciuria B. Nephrotic Syndrome C. Glomerulonephritis D. Urinary Tract Infection

D. Complaints of dysuria with urgency should be evaluated for a UTI. An excessive loss of calcium in the urine can be associated with pain in urination, urgency, frequency and wetting. Nephrotic syndrome is not usually associated with dysuria or frequency, acute glomerulonephritis is not likely to cause dysuria or frequency.