Peds Exam 3

3. Intussusception Acute abdominal pain followed by episodes of comfort accompanied with the passage of red jelly-like stools is the clinical manifestation of intussusception. An omphalocele is a birth defect in which the infant's intestine or other abdominal organs protrude through the abdominal wall. Gastroschisis is a birth defect in which an infant's intestines protrude from the body through a defect on one side of the umbilical cord. Anorectal malformations are birth defects in which the anus and rectum do not develop properly.

A 3-month-old child presents with sudden acute abdominal pain. The child is having episodes of screaming and drawing knees to her chest followed by periods of comfort. The parent tells the nurse the child's stool looked like red jelly. What do these clinical manifestations suggest? 1. Omphalocele 2. Gastroschisis 3. Intussusception 4. Anorectal malformations

c. Permanent record of heart size and configuration ANS: CA chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It willprovide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs.Electrocardiography (ECG) measures the electrical potential generated from heart muscle.Echocardiography will produce a computerized image of the heart vessels and tissues by using soundwaves.DIF: Cognitive Level: Understand REF: p. 738TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A chest radiograph film's ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" What knowledgeabout the x-ray should the nurse include in the response to the parents? a. Bones of chest but not the heart. b. Measurement of electrical potential generated from heart muscle. c. Permanent record of heart size & configuration .d. Computerized image of heart vessels & tissues.

4. Tracheoesophageal fistula

A nurse caring for a neonate immediately after birth notices an excessive amount of frothy mucus coming from the child's nose and mouth. What condition does the nurse suspect? 1. Cleft lip 2. Cleft palate 3. Biliary atresia 4. Tracheoesophageal fistula

2. Affected extremity feels cool when touched Rationale: If the affected extremity feels cool when touched, arterial obstruction may be present. The health care provider would be notified immediately. A weak pulse distal to site for the first few hours after cath is not a cause for concern. However, the pulse would gradually increase in strength. The child's usual diet can be resumed as soon as tolerated, beginning with sips of clear liquids and advancing as the condition allows. The child would take in enough fluids to ensure adequate hydration. Blood loos, NPO and diuretic actions of dyes used during procedure increase the risk for hypovolemia and dehydration. The child would be kept in bed, with the affected extremity maintained straight for several hours, to promote healing of the cannulated vessel.

After cardiac cath of a child, which assessment finding is a cause of concern to the nurse? 1. The pulse distal to the cath site is weak 2. The affected extremity feels cool when touched 3. The child has resumed oral intake with clear liquids 4. the child is in bed with affected extremity straight

2. Biliary atresia Biliary atresia is associated with worsening of jaundice, especially in the sclerae; dark-yellow urine; difficulty gaining weight; and irritability in babies who were once thriving. Peptic ulcer disease, liver disease, and acute hepatitis have other presentations.

An 8-week-old infant is brought to the clinic. The infant's parents tell the nurse that the baby was thriving and doing well with only a mild amount of jaundice at birth but report that over the past several days the baby has become increasingly irritable and has started passing dark yellow urine and is having difficulty gaining weight. The nurse notices jaundice in the baby's sclerae. With what condition are these clinical manifestations associated? 1. Liver disease 2. Biliary atresia 3. Acute hepatitis 4. Peptic ulcer disease

3. Hirschsprung disease Clinical signs of constipation, foul-smelling ribbon like stools, abdominal distention, visible peristalsis, an easily palpable fecal mass, and a malnourished, anemic appearance are all associated with Hirschsprung disease. These signs do not suggest dehydration, constipation, or inflammatory bowel disease.

An 8-year-old child comes to the clinic with a history of constipation and malnourishment. Her parents say that her stools look like ribbons and smell strong. The nurse notes visible peristalsis and abdominal distension. With what condition are these clinical manifestations associated? 1. Dehydration 2. Constipation 3. Hirschsprung disease 4. Inflammatory bowel disease

3. Rationale: The condition of ambiguous genitalia is marked by hypospadias, micropenis, and no palpable gonads. Cushing syndrome is an endocrine disorder that involves excessive circulating free cortisol. Atrophy and adrenal insufficiency are not associated with hypospadias, micropenis, or gonads that are not palpable.

An infant presents with hypospadias, micropenis, and no palpable gonads. How would the nurse document these findings? 1. atrophy 2. Cushing syndrome 3. Ambiguous genitalia 4. Adrenal insufficiency

2. Hyponatremia Rationale: A teenager who consumes low-sodium diet for a prolonged period is at risk for hyponatremia, a low-sodium level. Water excess occurs when intake exceeds output. Hypernatremia can be caused by a high-sodium, rather than low-sodium, diet. Water depletion occurs when the body fails to absorb or resorb water or there is a prolonged reduction in the intake of water.

For which complication is an adolescent who has been consuming a low-sodium diet for a long period is at risk? 1. Water excess 2. Hyponatremia 3. Hypernatremia 4. Water depletion

4. An excessive amount of frothy saliva in the mouth Excessive salivation and drooling are indicative of tracheoesophageal fistulas. The child with a fistula has difficulty managing the secretions, which may cause choking, coughing, and cyanosis. Jaundice and bile-stained vomitus are not usually associated with tracheoesophageal fistula. The infant is able to suck with a tracheoesophageal fistula but is not able to manage the secretions.

The nurse assesses a neonate immediately after birth. What is one clinical sign/symptom of tracheoesophageal fistula? 1. Jaundice 2. Absence of sucking 3. Bile-stained vomitus 4. An excessive amount of frothy saliva in the mouth

a. Cardiac arrhythmia ANS: A Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization. DIF: Cognitive Level: Apply REF: p. 739TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for? a. Cardiac arrhythmia. b. Hypostatic pneumonia. c. Heart failure. d. Rapidly increasing blood pressure.

2 inflammation results in stiffening of the bowel wall. Inflammation can occur anywhere in the GI from mouth to anus but effects the terminal ileum. UC inflammation is limited to the distal colon and rectum.

The nurse is caring for a child with Crohn disease (CD). What is a distinctive characteristic of CD? 1. Inflammation is limited to the distal colon and rectum. 2. Inflammation results in stiffening of the bowel wall. 3. The most dangerous form is toxic megacolon. 4. Rectal bleeding is common in these patients.

2. Inhibits hydrogen ion pump in parietal cells Proton pump inhibitors (PPIs), such as omeprazole, inhibit the hydrogen ion pump in the parietal cells, thus blocking the production of gastric acid. Sucralfate is an aluminum-containing agent that forms a protective barrier over the ulcerated mucosa to protect against acid and pepsin. Antacids are beneficial preparations that neutralize gastric acid. Bismuth compounds are sometimes prescribed for the relief of ulcers, but they are used less frequently than PPIs. These compounds inhibit the growth of microorganisms.

The nurse is caring for a child with a peptic ulcer, who has been prescribed omeprazole. What is the effect of this drug on the child? 1. Protects the ulcerated mucosal layer 2. Inhibits hydrogen ion pump in parietal cells 3. Neutralizes gastric acid 4. Inhibits the growth of microorganisms

d. Apply direct pressure above the catheterization site. ANS: D If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.

The nurse is caring for a school-age child whose had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage & bed soaked with blood. What's the priority nursing action? a. Notify physician. b. Apply new bandage with more pressure. c. Place the child in Trendelenburg position. d. Apply direct pressure above catheterization site.

A polyarthritis. swollen hot, red, painful joints, is a major clinical manifestation of rheumatic fever, is a major clinical manifestation of rheumatic fever.

The nurse is conducting a staff in-service on childhood-acquired heart diseases. Which is a major clinical manifestation of rheumatic fever? a. Polyarthritis. b. Osler nodes. c. Janeway spots. d. Splinter hemorrhages of distal third of nails.

1 Rationale: Because of the unstable nature of the child's fluid and electrolyte balance, encouraging the child to wear a medical alert bracelet or carrying a medical id card is an extremely important intervention. With DI, the child should have unrestricted access to fluids because the child will characteristically have pulyuria as a result of hyposecretion of ADH. No urine test is needed. This disorder is both life-long and life-threatening. Medication must be taken and the effects monitored closely.

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). Which nursing intervention would be planned? 1. Encouraging the child to wear medical identification 2. Discussing with the child and family ways to limit fluid intake 3. Teaching the child and family how to do required urine testing 4. Reassuring the child and family that DI is usually not a chronic or life-threatening illness.

3. "I should provide a bowl of rice in my child's lunch and dinner." Rationale: Rice dose not contain gluten, but wheat, rye, oats and barley do contain gluten.

The nurse is teaching a 2-year-old's parent about necessary dietary restrictions needed to manage celiac disease. Which statement made by the parent indicates effective learning? 1. "I should include oats in my child's breakfast daily." 2. "I should provide rye bread in my child's daily diet." 3. "I should provide a bowl of rice in my child's lunch and dinner." 4. "I should include two slices of wheat bread in my child's daily diet."

4. Hypertrophic pyloric stenosis Clinical manifestations of hypertrophic pyloric stenosis (HPS) include projectile vomiting 30 to 60 minutes after feeding with vomitus that resembles stale milk. An olivelike mass can be palpated when the stomach is empty. Gastroschisis is protrusion of intraabdominal contents. Hiatal hernia presents with dysphagia, growth failure, vomiting, neck contortions, frequent respiratory problems, and bleeding. Umbilical hernia is noted on inspection and palpation of the abdomen.

The parents of a 1-month-old infant bring the child to the clinic because the infant has been projectile vomiting 30 minutes after feeding. The parent describes the vomit as stale milk. On assessment the nurse palpates an olivelike mass. What condition do these clinical manifestations characterize? 1. Gastroschisis 2. Hiatal hernia 3. Umbilical hernia 4. Hypertrophic pyloric stenosis

4 Rationale: Type 1 DM is a carbohydrate-metabolism disorder characterized by polyuria, polydipsia, overeating, weight loss, fatigue, and irritability. The patient with type 1 DM may have hyperglycemia because of an inability of the pancreas to secrete insulin. Therefore the nurse should monitor the capillary blood glucose levels before meals and at bedtime. It is important to assess the feet of patients with diabetes for open sores, but this is a long-term complication of uncontrolled DM. Dipstick for bacteria will help diagnose UTI and is not related to DM. Steriods will increase blood glucose and should not be administered.

The parents report that their child has excessive urination, thirst, hunger, irritability, fatigue, flushed skin, HA, blurred vision, and dry skin. The child is diagnosed with type 1 DM. Based on this diagnosis, which would the nurse include in the plan of care? 1. Assess the feet for open sores. 2. Obtain a urine dipstick for bacteria 3. Administer corticosteroids to decrease inflammation 4. Monitor capillary blood glucose levels before meals and at bedtime.

d. Prevent the return of oxygenated blood to the lungs ANS: D The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood(from the aorta) will return to the lungs through the pulmonary artery. The aorta carries oxygenated blood to the systemic circulation. Because of the higher pressure in the aorta, blood is shunted into the pulmonary artery and the pulmonary circulation. Edema in the legs and feet is usually a sign of heart failure. This repair would not directly affect the edema. Increasing the oxygenation of blood would not interfere with the return of oxygenated blood to the lungs.

What does the surgical closure of the ductus arteriosus do? a. Stop the loss of unoxygenated blood to the systemic circulation b. Decrease the edema in legs & feet. c. Increase the oxygenation of blood .d. Prevent the return of oxygenated blood to the lungs.

1.

What is an appropriate breakfast for the hospitalized child who has celiac disease? 1. Eggs, turkey bacon, fruit 2. Cheerios, low-fat milk, fruit 3. Pancakes, eggs, turkey bacon 4. Eggs, turkey bacon, toast, low-sugar orange juice

4. Vitamin supplements

What should dietary management of a child with inflammatory bowel disease include? 1. High-fiber foods 2. Low-calorie foods 3. Low-protein foods 4. Vitamin supplements

3. Liver transplantation may be needed

What should the nurse consider when providing support to a family whose infant has just been found to have biliary atresia?1. Death usually occurs by 6 months of age .2. The prognosis for full recovery is excellent. 3. Liver transplantation may be needed eventually. 4. Children with surgical correction live normal lives.

4. Provide cheek support when feeding

What should the nurse teach the parents of an infant with cleft lip (CL) about feeding? 1. Avoid breastfeeding; provide bottle feeds .2. Use bottles with a narrow base nipple .3. Feed the infant in the supine position .4. Provide cheek support when feeding.

b. Counsel parents of high-risk children about prophylactic antibiotics. ANS: B The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. Children should be observed

What's the primary nursing intervention to prevent bacterial endocarditis? a. Institute measures to prevent dental procedures. b. Counsel parents of high-risk children about prophylactic antibiotics. c. Observe children for complications, such as embolism & heart failure. d. Encourage restricted mobility in susceptible children.

2. Rationale: Clinical manifestations of juvenile hypothyroidism include dry skin, sparse hair, decelerated growth, constipation, puffiness around the eyes, sleepiness, and mental decline. Diarrhea and enlarged thyroid are not associated with juvenile hypothyroidism

Which are the clinical manifestations of juvenile hypothyroidism? 1. Sleepiness, dry skin, diarrhea 2. Dry skin, sparse hair, slowed growth 3. Diarrhea, dry skin, decelerated growth 4. Constipation, dry skin, enlarged thyroid

4. cool lower extremities Rationale: An infant with coarctation of that aorta, an obstructive defect of the heart, has cooler lower extremities because of localized narrowing near the insertion of the ductus arteriosus. This leads to decreased pressure in the lower extremities and weak or absent femoral pulses. The narrowing also causes increased pressure in the head and upper extremities and bounding pulses in arms.

Which clinical manifestation would the nurse expect to find during the assessment of an infant with coarctation of the aorta? 1. bounding femoral pulses 2. Low pressure in the arms 3. weak pulses in arms 4. cooler lower extremities

1 Burns, 3 Tachypnea, 4 DKA Rationale: Conditions that place an infant at risk for Increased fluid requirements include burns, tachypnea, and DKA. After surgery, infants have a decreased fluid-replacement requirement. CHF reduces an infant's fluid replacement requirement.

Which condition places an infant at risk for INCREASED fluid requirements? Select all that apply. 1. Burns 2. Surgery 3. Tachypnea 4. DKA 5. CHF

c. Atrial septal defect ANS: C Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. Pulmonic stenosis is an obstruction to blood flowing from the ventricles. Tricuspid atresia results in decreased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis. b. Tricuspid atresia. c. Atrial septal defect. d. Transposition of the great arteries.

fluid losses are classified as insensible, urinary, or fecal. Insensible losses occur through the skin and the respiratory tract and are not measurable in Intake and output. Heat and humidity, body temp, and resp. rate influence insensible fluid loss. The infants relatively great body surface area allows larger quantities of fluid to be lost to insensible perspirations through the skin. Hyperventilation and an increased metabolic rate contribute to fluid loss through the respiratory tract. Health conditions that affect the gastrointestinal system may influence fluid loss through stool and urine formation.

Which factor would the nurse attribute to insensible fluid loss in an infant? select all that apply 1. Heat and humidity 2. body temp 3. stool formation 4. urine formation 5. Respiratory rate

1. Irrigate the would with saline 3. Listen for bowel sounds 4. Encourage intake of ice chips Rationale: wound care includes irrigation of the wound with antibacterial solution or saline to prevent infection at the surgical site. The nurse monitors bowel function, including bowel sounds and passage of flatus to evaluate bowel status and function postoperatively. the child would be encouraged to take small amounts of ice chips and then progress to fluids as prescribed. A wound binder or montgomery straps may be used when the wound is left open postoperatively. this facilitates dressing changes and prevents frequent placement and removal of the tape on sensitive skin. The child would be encouraged to ambulate early to prevent accumalation of flatus and abdominal distention and promote early return of proper bowel function.

Which intervention would the nurse perform for the child after an uncomplicated appendectomy? select all that apply. 1. Irrigate the would with saline 2. Cover the wound with tape 3. Listen for bowel sounds 4. Encourage intake of ice chips 5. Ensure complete bed rest

d. Cardiac valve damage ANS: D Cardiac valve damage is the most significant complication of rheumatic fever. Seizures, cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic fever. DIF: Cognitive Level: Understand REF: p. 767TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Which is a common, serious complication of rheumatic fever? a. Seizures. b. Cardiac arrhythmias .c. Pulmonary hypertension. d. Cardiac valve damage.

3, No distended neck veins Rationale: A lack of distended neck veins is an appropriate patient outcome for a child with congestive heart failure. The child would have a heart rate that is acceptable for the child's age rather than rapid. The skin would be warm to the touch rather than cool. the child would sleep with the head of bed elevated rather than with head down and feet elevated.

Which is a priority patient outcome for a child with congestive heart failure? 1. Rapid heart rate 2. Skin that is cool to the touch 3. Not have distended neck veins 4. Sleep with the head down and feet elevated.

2. 70bpm Rationale: the most appropriate nursing action when digoxin is being administered is checked the apical heart rate and holding the medication if the pulse is below 70 bpm. Never give an extra dose if one is missed, and never mix digoxin with foods or other fluids. Holding the drug if the apical pulse is below 90-110 bpm is appropriate for an infant.

Which is the MOST appropriate action when the nurse is administering digoxin to a 2-year-old child? 1. Give an extra dose if one is missed 2. Mix the dose with juice to disguise the taste 3. Check the apical heart rate and holding the medication if the pulse is below 70 bpm 4. Check the apical heart rate and holding the medication if the pulse is below 90 to 110 bpm

3. pulses distal to cath site Rationale: Monitoring pulses distal to the cath site helps reduce the chance of perfusion problems after cardiac cath. Resuming a reg. diet, using acetaminophen or ibuprofen for pain, and monitoring the site are appropriate nursing interventions but will not reduce the chance of perfusion problems after cardiac cath.

Which is the PRIORITY nursing intervention for reducing the chance of perfusion problems after cardiac catheterization? 1. Resuming the regular diet without restrictions 2. Using acetaminophen or ibuprofen to relieve pain 3. Checking the pulses distal to the cath site 4. monitoring the site for redness, swelling, drainage, bleeding, temperature, and color.

3 Orally administered rehydration solutions. Rationale: Orally administer rehydration solution is the first treatment for accurate clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Absorbents are not recommended. Antidiarrheal are not recommended because they do not get rid of pathogens.

Which is the first line of TX for a 5 year old child who has acute diarrhea? 1. Clear liquids 2. Absorbents such as kaolin and pectin 3. Orally administered rehydration solutions 4. Antidiarrheal medications such as paregoric

1. Rationale: Low levels of circulating TH and raised levels of TSH at birth are characteristic of primary congenital hypothyroidism.

Which levels of thyroid hormone (TH) and thyroid-stimulating hormone (TSH) characterize primary congenital hypothyroidism? 1. low level of circulating TH, raised level of TSH at birth 2. Low level of circulating TH, low level of TSH at birth 3. Low level of circulating TH, normal level of TSH at birth 4. High level of circulating TH, increased level of TSH at birth

4 Rationale: The child with type 1 DM needs education as to how to manage the disease. The child should refrain from eating concentrated sweets. Meals can cause the glucose levels in the blood to fluctuate; therefore the patient should check the blood glucose level before meals and at bedtime. Taking an injection at the same site results in tissue trauma; therefore the patient should rotate the injection sites. Increased blood glucose and ketones during illness can cause harmful effects; therefore patients should check their blood glucose and ketones every 3 hours when they are sick.

Which statement made by the child indicates the need for further education about how to manage newly diagnosed type 1 diabetes mellitus (DM)? 1. "I should check my blood glucose levels before meals and at bedtime." 2. "It is important to rotate the injection sites to prevent tissue damage." 3. "I should check my blood glucose and ketones every 3 hours when i am sick." 4. "I can eat cake and candy as long as I give myself extra insulin to compensate."