Peds Exam 2
The nurse is evaluating a child who is being treated for nephrotic syndrome. Which observation indicated successful treatment of nephrosis?
Diuresis and weight loss
The nurse has developed a plan of care of a 12 month old hospitalized with severe dehydration as a result of rotavirus. Which intervention would the nurse include in the plan of care?
Maintaining the IV fluid rate as ordered.
A 13 year old was found to have a noticeable rib hump during the scoliosis screening by the school nurse. What would be the most accurate information for the parents in answering their questions about scoliosis?
"It is important to follow through on getting the child checked by an orthopedic doctor"
A two year old with cerebral palsy is on continuous tube feedings. Which intervention should the nurse expect to see ordered to ensure proper hydration and *********?
. Administer water through the PEG tube every 4 hours to prevent hypotonic dehydration
Cefazolin 2GM IVPG q6h has been prepared in 100 ml of 0.9% NS. It is ordered to be infused over 1 hour. The drip factor for the IV tubing is 10gtts/ml. The nurse should regulate the IV rate at _________ gtts/min
100ml/60 min X 10 gtts/1 ML X 60 min/ 1hr= 60,000 16-17 gtts/min
A child weighing 17kg is receiving and IV at the rate of 30ml/hr. how many more mls will this child need to take in orally to meet his total daily fluid requirements?
10kg X 100 ml = 1000 7 kg X 50 ml = 350 30 X 24= 720 1350-720= 630 ml more needed
A two year old has had one bout of nephrosis (nephrotic syndrome) His mother suspected a recurrence when she observed swelling around his eyes. The nurse helps to confirrm the condition by recognizing what additional sympton?
Marked proteinuria
A toddler is admitted to the hospital with a possible diagnosis of ******. the health care provider prescribed loazapam IV 0.05mg/kg/dose every 6 hours PRN as a muscle relaxant. The child weighs 32lbs. How many miligrams of ativan should the nurse administer per dose?
32lbs/1 X 1 kg/2.2 lbs=14.54 0.05mg X 14.54=0.727 mg per dose
A nurse is caring for a child who is scheduled for an appendectomy. The nurse reviews the physcian's preoperative orders. Which order should be questioned?
Activity as tolerated, up ad lid
. The nurse is caring for a 5 year old with botulism in the pediatric intensive care unit. Which health care provider prescription should the nurse clarify with the health care provider before implementing?
Administer diphenoxylate (lomotil) by mouth every 4 hours prn for diarrhea
A newborn has just been delievered via C-Section with a myelomeningocele which was detected pre-natally via amniocentecic. The child is scheduled to have surgery within the first 48 hours. Which of the following nursing actions is appropriate?
Assess head circumference and fontenals for signs of ICP.
The nurse is assessing an 11 year old girl with scoliosis. Which of the following would the nurse expect to find? SATA
Asymmetric shoulder elevation when standing Pronounced one-sided hump when bending over
.When developing a teaching plan for the parents of a 12 month old infant with hypospadias with chordee repair, which of the following should the nurse expect to include as most important?
Avoiding tub baths after the catheter is removed to decrease the risk of infection
A six week old infant is brought to the pediatricians office for a well-baby visit. During examinations the physcian displaces the femoral head and reduces it back into place by manipulation of the thighs and hips. The nurse recognizes that the physcian is assessing:
Barlow and ortalani tests for developmental dysplasia of the hip
A one-week olf infant is being assessed for hydrocephalus when brought into the emergency room by his parents. which clinical manifestations are consistent with this diagnosis? SATA
Bulging fontanel high pitched cry; opisthotonic positioning dilated scalp veins
An infant is diagnosed with communicating hydrocephalus. Which statement best explains what is happening in the body with this defect?
CSF flows through all of the brain's ventricles. how ever CSF is not reabsorbed adequately
An 18th month old has been admitted to the hospital with rotavirus. Which precautions should be implemented in the care plan?
Caregivers should wear a gown and gloves in the room
The parents of a child diagnosed with oligoarthritis type of juvenile idiopathic arthritis asks the nurse if their child will ever get better. The nurse's response should be based on which of the following statements?
Children with all types of juvenile idiopathic arthritis will have permanent deformities of joins and soft tissue
The nurse is conducting discharge teaching to parents of a preschool child with myelomeningocele repaired at birth, being discharged from the hospital after a urinary tract infection. Which should the nurse include in the discharge related to management of the child's Genitourinary function? SATA
Continue to perform the clean intermittent catheterization at home Administer the oxybutynin chloride (ditropan) as prescribed monitor for signs of a recurrent UTI
A 2 year old is being treated for congenital hypothyroidism. The parents are seeking medical attention today due to the child's change in behavior. They have noticed a decrease in appetite and difficulty sleeping over the past several weeks. The nurse expects the physician to check the thyroid levels and then:
Decrease the amount of thyroid hormone as these are signs of too much replacement therapy.
A six-year old who has been diagnosed with muscular dystrophy is being seen in the outpatient clinic. The child is noted to have Gower's sign when observed. Which of the following describes this finding.
Difficulty standing from a lying position
A child is 12 hours post op following an open appendectomy performed for a perforated appendix. The patient has a naso-gastric tube connected to low intermittent suction. Which of the following assessment findings is the highest priority to be reported to the physician?
Distended abdomen with pain.
A 12 year old has been diagnoses with slipped capital femoral epiphysis. In addition to pain, what other assessment would the nurse expect to find?
External rotation of the hip
A 3 year old has just returned to the unit following a ventriculoperitoneal shunt for placement for hydrocephalus. How Should the child be positioned?
Flat in bed supine or on the non shunt side.
A child is brought to the emergency room due to nausea, vomiting, and diarrhea. Primary observations of dehydration are present. The electrolyte profile reveals Sodium level of 129, Potassium of 3.1 and serum C02 of 16. Based on this result, what physician order should the nurse anticipate to receive.
Give a bolus of 0.9% NS and admit to the pediatric unit for rehydration
A child is admitted with acute glomerularnephritis. The nurse would expect the UA during this acute phase to show which of the following?
Hematuria, proteinuria
A 3 month old is admitted to the hospital with gastroenteritis and moderate dehydration. His electrolyte panel is as follows: NA 124 and K 3.4. Based on this lab work, which type of dehydration does the infant have?
Hypotonic
A young child is brought to the emergency room with suspected meningitis. Blood work with cultures, a urine specimen with a culture and sensitivity, and the spinal tap were completed in the ER and he is being admitted to the pedatric unit for continued care. Which of the following is a major priority of nursing care?
Inititate isolation procedire immediatly and administer ordered antibiotics
A 4 year old is diagnosed with Duchenes Muscular Dystrophy. His parents are worried about their daughter age 2, and they wonder if she will show signs of this disease in the future. Which information would be the most accurate for these parents?
It is unlikely that the daughter has Duschense Muscular Dystrophy , however she could be a carrier of the disease.
A 10 year old is admitted with possible appendicitis. The doctor's history and physical indicates a WBC count of 17,000, increased segmented neutrophils, decreased lymphocytes, and 6% bands. The patient complains of abdominal pain, localized at Mcberney's point. Which statement most accurately describes the data?
Lab work revels a left shift and pain localized in the right lower quadrant
A child with autism spectrum disorder (ASD) is admitted to the hospital with pneuomonia. The nurse should plan which priority intervention when caring for this child?
Maintain a structured routine and keep stimulation to a minimim
An adolescent with a fractured femur is in Russell's traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action?
Maintaining continuous traction and checking position of traction frequently
A child is admitted with a dx of Hirshbringers disease. Which of the following would be the appropriate explanation of this diagnosis to the parents?
Missing nerves in the colon have stopped peristalsis and caused enlargement of a bowel segment.
An 11 month old is admitted to the pediatric unit with a diagnosis of gastroenteritis and dehydration. Admission weight is 30 pounds. The parents state that this is a 3 pound weight loss since she checked his weight a week ago. Using weight as a guide, the nurse determines the child has which degree of dehydration? (round to nearest whole number)
Moderate
A child has been diagnosed with juvenile idiopathic arthritis and has been prescribed medications for treatment. Which statements indicate that the parent understands the overall treatment regimens for this condition? SATA
My child will need to take NSAIDS as prescribed to decrease pain and inflammation My child may have to take corticosteroids for short intervals in the event of a serious exacerbation
A patient is brought to the emergency room with suspected botulism secondary to eating home canned vegetables. which assessment will be the most appropriate for the nurse to perform to check for the initial symptoms of botulism?
Neurological assessment including hand grasp and pedal push/pull
The nurse reads in the physician's progress notes that aganglionic megacolon is suspected in a newborn. Which of the following observations are consistent with this diagnosis. SATA
No meconium stool in first 48 hours poor feeding pattern, difficult to nurse vomiting - bile emesis. abdominal distention
A nurse is caring for a boy with probable intusseception. He had diarrhea before admission but while waiting for administration of air pressure to reduce the intusseception he produced a normal brown stool. Which nursing action is the most appropriete.
Notify practitioner
At birth an infant girl is noted to have a myelomeningocele below the 2nd lumbar vertebrae. Which additional assessment, if abnormal, is consistent with the diagnosis?
Observe the infant for lower extremity response to sensory stimulation
A 4 year old has a fractured femur and is not immobilized in a hip spica cast. The child is crying with pain and the nurse assesses that the foot is pale, cool and no pedal pulse can be palpated. Based on the data, the nurse should:
Recognized these as signs of compartment syndrome, which will need physician intervention quickly.
An autistic 4 year old is admitted to the pediatric unit. Which of the following would be the best strategy for the nurse to assess vital signs?
Request the mother stay with the child to assist as needed.
an infant with congenital hypothyroidism has been receiving thyroxine for the past 3 months. which diagnostic test does the nurse expect to be ordered to monitor the effectiveness of this drug?
Serum T3, T4, TSH
The mother of a 3 year old questions the nurse about diagnostic test for juvenile idiopathic arthritis. Which answer is most appropriate?
Several blood tests plus your childs symptoms will help the physician make a diagnosis
A teen has been diagnosed with Legg Calve Perthe disease. What comment indicates that the teen understand the treatment regime?
Since i must stay on bedrest for awhile, I'll probably need a tutor for school
The nurse is assisting the physician in the examination of an 8 year old with suspected bacterial meningitis. How should the child be positioned initially in preparation for the assessment of Kernig's sign?
Supine with legs extended
A 4 Year old child is newly diagnosed with Legg-Calve Perth disease. Nursing consideration should include which action?
Teaching the family the importance of rest and non weight bearing regimen
A mother was called by the health department 2 weeks after giving birth to a full-term newborn. They reported that the baby's lab tests came back abnormal, suggesting congenital hypothyroidism. The mother states that she will let her family doctor know about this when she takes the baby in for his 3 month check up. How should the health department nurse respond?
The baby will need to be seen by a physician immediately so that further lab tests may be done to confirm the diagnosis and then start treatment asap.
A newborn male infant has been found to have unilateral talpies equinovarus ( club foot) deformation. Which would be the most important information to give the parent?
The baby will probably need to start serial casing as soon as possible.
Upon examination of a newborn, the right foot was found to be turned inward. The physician was able to manipulate the foot into alignment. Which explanation to the parents is accurate?
The baby's abnormal foot positioning is probably a mild positional club foot, not a true defect, but should still be monitored.
A child is being admitted to rule out acute glomerular nephritis. Parents report that the child had a sore through two weeks ago. Upon admission an Antistreptolysin O (ASO) titer test was done and revealed a result of 12 units. The upper limits of the normal ASO titer is 250 units. The titer level indicated that
The child has recovered from a streptococcal infection in the recent past
The doctor has ordered a Pavlik Harness for a 3 month old patient. What information should the nurse include?
The child must wear this as much as possible to be effective
When interviewing the parents of a 6 month old with atopic dermatitis (infantile eczema) they describe the following care measures. Which one would lead the nurse to think
The parent applies alcohol to the lesions to decrease risk of infection
The parent of a 5 year old child with Duchenes Muscular Dystrophy is bringing her child to the clinic for a follow up. She reports that she has noticed that her son's calves seems to be enlarged since the last visit. Which explanation by the nurse is appropriate?
This is due to pseudohypertrophy in which fat replaces muscle in the calves
An infant is scheduled to repair a myelomeningocele. Which statement by the parents indicates effective pre-op teaching?
This surgery will decrease the risk of an infection developing in the cerebral spinal fluid
An abdominal flat plate xray ordered for a child admitted with suspected intussusception reveals no free air beneath the diaphragm. What order should the nurse anticipate next from the physician?
Transport child to radiology and prepare him for a barium enema
The mother of a 1 month old infant tells the nurse she worries that her baby will get meningitits like her oldest son did when he was an infant. The nurse should base her response on which statement?
Vaccination to prevent Haemophilus influenzae type B meningitits has decreased the frequency of this disease in children.
The nurse is caring for a 4-year old child immobilized by a fractured leg. Which complication should the nurse monitor related to the child's immobilization status?
Venous stasis leading to thrombi or emboli formation.
A child has been admitted to the pedatric unit with suspected meningitis. The CSF aanalysis reveals the following: Apperance: Clear, WBC: within normal limits, Protein: within normal limits, Glucose: within normal limits, Culture: negative. Based on the results, the nurse suspects that the child has:
Viral meningitis
A new born has a hypospadias with chordee. A mother is upset about her sons appearance and asks if he will ever be normal. What would be the best response to the mother?
When the baby gets older, surgery will probably be done to correct the problem.
A nurse is caring for an infant who is suspected of having Wilm's tumor. Upon arriving in the room the mother is seen massaging her child's abdomen stating that this often helps her child to expel gas. Which response would be the most appropriate for the nurse to give?
While the doctor is running tests to rule out a kidney problem It would be best not to massage your child's abdomen as this could cause some complications
A primary care provider has ordered a clear liquid diet for a child who is postoperative surgical removal of a Wilm's tumor. Which of the following assessment findings requires that the nurse clarify this order?
absence of bowel sounds on second postoperative day
The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery in 2 hours. The client began to complain of increased abdominal pain and begins to vomit. On assessment the nurse notes that the abdomen is distended and bowel sounds are diminished. Which of the following is the most appropriate nursing intervention?
assess vital signs and notify the physician
An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt to the left lateral ventricle. Post operative nursing care should include which of the following:
monitor temperature and assess surgical site for inflammation and drainage
the nurse is talking to a parent with a child with spina bifida who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching
my child should not eat bananas or kiwis.
A two year old has a body surface area of .51. The physician has ordered maxipime 900mg IV twice a day. The recommended adult dose is maxipime 2GM IV every 12 hours. According to body surface area, compare what the child is getting to the recommended dose and indicate whether or not the child is receiving a safe dose of the drug.
not safe .51/1.7 X 2000 = 600mg Q2hr
Before assessing an infant for cryptorchidism the nurse should:
provide a warm environment
A child is suspected of having Trisomy 21. What assessments are likely to be found? SATA
short broad neck protruding tongue transverse palmar crease
An adolescent who has chronic SCFE (slipped capital femoral epiphysis) sustains a fall during gym class and-is transported to the hospital with severe pain. Which is the most appropriate explanation for what happened.
the child has developmental dysplasia of the hip
A mother of a full-term newborn asks the nurse if her child's cryptochidism will need to have surgical intervention. What is the best response from the nurse?
this will probably need to be corrected as soon as possible to prevent reproductive problems later in life.
The parents of a 4-year old child are given pre-op instructions to follow prior to surgery to correct Hirschsprung's disease in their child. Which statement requires further instruction by the nurse?
we will feed out child foods high in fiber and calories prior to surgery
