Peds Exam #3
A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show: a. bacteriuria and hematuria. b. hematuria and proteinuria. c. bacteriuria and increased specific gravity. d. proteinuria and decreased specific gravity.
ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.
The nurse is assessing a 5-year-old patient with a several-day history of vomiting and diarrhea. Which of the following signs would indicate that this patient is severely dehydrated? (Select all that apply.) a. cool, mottled extremities b. brisk capillary refill c. normal heart rate d. deeply sunken orbits e. elastic skin turgor
Cool, mottled extremities Deeply sunken orbits Rationale: Assessment findings with severe dehydration include deeply sunken orbits, dry oral mucosa, tenting skin, increased heart rate progressing to bradycardia, and cool, mottled, or dusky skin color with significantly delayed capillary refill.
The nurse is obtaining a health history for a patient showing signs of dehydration. Which of the following are considered risk factors for dehydration? (select all that apply) a. diabetic ketoacidosis b. constipation c. hypothermia d. vomiting e. excessive burns
Excessive Burns Diabetic Ketoacidosis Vomiting Rationale: Risk factors for dehydration include the following: diarrhea (not constipation), vomiting, decreased oral intake, sustained high fever (not hypothermia), diabetic ketoacidosis, and excessive burns.
Changes in heart rate are one of the initial indicators of dehydration in children. Which of the following heart rate values indicate that Eva is progressing into moderate dehydration? a. 105 b. 65 c. 85 d. 125
125 bpm - heart rate increases due to decrease in cardiac output
The nurse closely monitors the temperature of a child diagnosed with nephrosis. The purpose of this is to detect an early sign of what undesirable outcome? a. Infection b. Hypertension c. Encephalopathy d. Edema
ANS: A Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection, but it is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.
What is the earliest clinical manifestation of biliary atresia? a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling
ANS: A Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera and may be present at birth, but is usually not apparent until ages 2 to 3 weeks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.
Eva's signs and symptoms suggest an acute viral gastroenteritis. A characterization of a potential bacterial etiology would be which of the following? a. fever b. abdominal cramping c. bloody stools d. vomiting
bloody stools vomiting, fever, abdominal cramping, and diarrhea may be associated with viral or parasitic gastroenteritis
Which of the following examination findings in a preschool-aged patient with vomiting and diarrhea support the decision for oral rehydration therapy instead of IV fluids a. capillary refill less than 2 seconds b. anuria c. dry and cracking lips d. deeply sunken eyes
capillary refill less than 2 seconds
In the patient history, Eva's mother reports she considered giving Eva Bismuth salicylate (pepto-bismol) for her symptoms. What patient education is needed based on this statement? a. antacids may contribute to the development of steven-johnson syndrome b. bismuth salicylate should be given 30 mins after vomiting c. lomotil is a better alternative for her symptoms d. salicylates may trigger Reye syndrome
salicylates may trigger Reye syndrome
The nurse is caring for a 5-year-old patient admitted with suspected dehydration. What is the daily oral fluid maintenance requirement in milliliters for the patient weighing 45 lb?
1510 mL Rationale: Calculate daily maintenance fluid requirement using the 100-50-20 formula. Convert pounds to kilograms: 45 ÷ 2.2 = 20.5 kg. Multiply 100 by the first 10 kg: 100 × 10 = 1,000. Multiply 50 by the second 10 kg: 50 × 10 = 500. Multiply 20 by the remaining 0.5 kg: 20 x 0.5 = 10. Add the sum of the calculations together to get the daily fluid maintenance: 1,000 + 500 + 10 = 1,510.
Eva has completed her oral rehydration as ordered by the provider. She has progressed to a clear liquid diet. How long should she be on the clear liquid diet? a. 24 hours b. 8 hours c. 12 hours d. 36 hours
24 hours - clear liquid diet is recommended to not exceed 24 hours, as it can result in "starvation stools"
What are the primary clinical manifestations of acute glomerulonephritis? (Select all that apply.) a. Oliguria b. Hematuria c. Proteinuria d. Hypertension e. Bacteriuria
ANS: A, B, C, D The principal feature of acute glomerulonephritis include oliguria, edema, hypertension and circulatory congestion, hematuria, and proteinuria. Bacteriuria is not a principal feature of acute glomerulonephritis.
What is a common cause of acute diarrhea? a. Hirschsprung's disease b. Antibiotic therapy c. Hypothyroidism d. Meconium ileus
ANS: B Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy. Hirschsprung's disease, hypothyroidism, and meconium ileus are usually manifested with constipation rather than diarrhea.
Which factor predisposes a child to urinary tract infections? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder
ANS: B The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake and frequent bladder emptying offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.
When does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. During preadolescent growth spurt d. Adolescence
ANS: C Idiopathic scoliosis is most noticeable during the preadolescent growth spurt and is seldom apparent before age 10 years.
An infant diagnosed with pyloric stenosis experiences excessive vomiting that can result in which condition? a. Hyperchloremia b. Hypernatremia c. Metabolic acidosis d. Metabolic alkalosis
Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Chloride ions and sodium are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.
Eva came to the clinic with a 2-day history of loose, watery, green-brown stools five to six times daily. She is vomiting three to four times daily. What is the priority nursing diagnosis based on these findings? a. Risk for impaired skin integrity related to frequent loose stools b. Risk for deficient fluid volume related to vomiting and diarrhea c. dysfunctional GI motility related to frequent loose stools d. imbalanced nutrition: less than body requirements related to inability to absorb nutrients
Risk for deficient fluid volume related to vomiting and diarrhea
A mother shares with the clinic nurse that she has been giving her 4 year old the antidiarrheal drug loperamide. What conclusion should the nurse arrive at based on knowledge of this classification of drugs? a. Not indicated b. Indicated because it slows intestinal motility c. Indicated because it decreases diarrhea d. Indicated because it decreases fluid and electrolyte losses
ANS: A Antimotility medications are not recommended for the treatment of acute infectious diarrhea. These medications have adverse effects and toxicity, such as worsening of the diarrhea because of slowing of motility and ileus, or a decrease in diarrhea with continuing fluid losses and dehydration. Antidiarrheal medications are not recommended in infants and small children.
What effect does immobilization have on the cardiovascular system? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes
ANS: A Because of decreased muscle contraction, the physiologic effects of immobilization include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found, with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes, with an inability to adapt readily to the upright position and pooling of blood in the extremities in the upright position.
What intervention is a component of the therapeutic management of nephrosis? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis
ANS: A Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.
What should the nurse recommend to prevent urinary tract infections in young girls? a. Wearing cotton underpants b. Limiting bathing as much as possible c. Increasing fluids; decreasing salt intake d. Cleansing the perineum with water after voiding
ANS: A Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids, decreasing salt intake, or cleansing the perineum with water decreases urinary tract infections in young girls.
Nurses must be alert for increased fluid requirements when a child presents with which possible concern? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure (ICP)
ANS: A Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. ICP does not lead to increased fluid requirements in children.
A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child will begin with which intervention? a. Intravenous fluids b. Oral rehydration solution (ORS) c. Clear liquids, 1 to 2 ounces at a time d. Administration of antidiarrheal medication
ANS: A Intravenous fluids are initiated in children with severe dehydration. ORS is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.
What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours
ANS: A Prophylactic antibiotics are used to prevent urinary tract infections (UTIs) in a child with vesicoureteral reflux, although this treatment plan has become controversial. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. Bubble baths should be avoided to prevent urethral irritation and possible UTI. To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.
Four year old, placed in Buck's extension traction for Legg-Calvé-Perthes disease, is crying with pain as the nurse assesses that the skin of the right foot is pale with an absence of pulse. What should the nurse do first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify the physician. d. Chart the observations and check the extremity again in 15 minutes.
ANS: A The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. Pain medication and repositioning should be addressed after the practitioner is notified. This is an emergency condition; immediate reporting is indicated. The findings should be documented with ongoing assessment.
When a child diagnosed with chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as what? a. Uremia b. Oliguria c. Proteinuria d. Pyelonephritis
ANS: A Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urine output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.
The nurse is caring for an infant with developmental dysplasia of the hips (DDH). Which clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani sign b. Unequal gluteal folds c. Negative Babinski's sign d. Trendelenburg's sign e. Telescoping of the affected limb f. Lordosis
ANS: A, B A positive Ortolani sign and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hips (DDH) seen from birth to 2 to 3 months. Trendelenburg's sign is noted in a child capable of standing alone. Negative Babinski's sign, telescoping of the affected limb, and lordosis are not clinical manifestations of developmental dysplasia of the hips (DDH).
The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations would be observed? (Select all that apply.) a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash
ANS: A, C, F Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a urinary tract infection. Jaundice, swelling of the face, and back pain would not be observed in an infant with a urinary tract infection.
A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.) a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries
ANS: A, D, E Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium and sodium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.
A 10 year old sustained a fracture in the epiphyseal plate of the right fibula when falling from a tree. When discussing this injury with the child's parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.
ANS: B Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma.
A 4-month-old infant diagnosed with gastroesophageal reflux disease (GERD) is thriving without other complications. What should the nurse suggest to minimize reflux? a. Place in Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.
ANS: B Giving small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. Placing the child in Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. Smaller, more frequent feedings are recommended in reflux.
The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor for? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones
ANS: B Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake, leads to hypercalcemia, and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.
The narrowing of preputial opening of foreskin is referred to as what? a. Chordee b. Phimosis c. Epispadias d. Hypospadias
ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.
The diet of a child with nephrosis usually includes requirement? a. High protein b. Salt restriction c. Low fat d. High carbohydrate
ANS: B Salt is usually restricted (but not eliminated) during the edema phase. The child has very little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.
An objective of care for the child with nephrosis is what desired outcome? a. Reduced blood pressure b. Reduced excretion of urinary protein c. Increased excretion of urinary protein d. Increased ability of tissues to retain fluid
ANS: B The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimizing of complications associated with therapy. Blood pressure is usually not elevated in nephrosis. Increased excretion of urinary protein and increased ability of tissues to retain fluid are part of the disease process and must be reversed.
An infant is brought to the emergency department with poor skin turgor, sunken fontanel, lethargy, and tachycardia. This is suggestive of which condition? a. Overhydration b. Dehydration c. Sodium excess d. Calcium excess
ANS: B These clinical manifestations indicate dehydration. Symptoms of overhydration are edema and weight gain. Regardless of extracellular sodium levels, total body sodium is usually depleted in dehydration. Symptoms of hypocalcemia are a result of neuromuscular irritability and manifest as jitteriness, tetany, tremors, and muscle twitching.
What is an appropriate nursing intervention when caring for a child in traction? a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity 3 times a day. d. Keep child in one position to maintain good alignment.
ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released/replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.
The nurse, caring for an infant whose cleft lip was repaired, should include which interventions into the infant's postoperative plan of care? (Select all that apply.) a. Postural drainage b. Petroleum jelly to the suture line c. Elbow restraints d. Supine and side-lying positions e. Mouth irrigations
ANS: B, C Apply petroleum jelly to the operative site for several days after surgery. Elbows are restrained to prevent the child from accessing the operative site for up to 7 to 10 days. The child should be positioned on back or side or in an infant seat. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. Mouth irrigations would not be indicated.
A school-age child has been admitted to the hospital diagnosed with minimal-change nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that apply.) a. Weight loss b. Generalized edema c. Proteinuria > 2+ d. Fatigue e. Irritability
ANS: B, C, D, E The disease is suspected on the basis of clinical manifestations that include generalized edema, steadily gaining weight; appearing edematous; and then becoming anorexic, irritable, and less active. The hallmark of this syndrome is proteinuria (higher than 2+ on urine dipstick).
A mother who intended to breastfeed has given birth to an infant with a cleft palate. Which nursing interventions should be included in the plan of care? (Select all that apply.) a. Giving medication to suppress lactation. b. Encouraging and helping mother to breastfeed. c. Teaching mother to feed breast milk by gavage. d. Recommending use of a breast pump to maintain lactation until infant can suck.
ANS: B, D The mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues. The nipple must be positioned and stabilized well back in the infant's oral cavity so that the tongue action facilitates milk expression. The suction required to stimulate milk, absent initially, may be useful before nursing to stimulate the let-down reflex. Because breastfeeding is an option, if the mother wishes to breastfeed, medications should not be given to suppress lactation. Because breastfeeding can usually be accomplished, gavage feedings are not indicated.
The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing? (Select all that apply.) a. Nothing by mouth for 24 hours b. Administration of analgesics for pain c. Ice bag to the incisional area d. Intravenous (IV) fluids continued until tolerating fluids by mouth e. Clear liquids as the first feeding
ANS: B, D, E Feedings are usually instituted soon after a pyloromyotomy surgery, beginning with clear liquids and advancing to formula or breast milk as tolerated. IV fluids are administered until the infant is taking and retaining adequate amounts by mouth. Appropriate analgesics should be given round the clock because pain is continuous. Ice should not be applied to the incisional area as it vasoconstricts and would reduce circulation to the incisional area and impair healing.
What major complication is noted in a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen
ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.
The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. "You will need to decrease the number of calories in your child's diet." b. "Your child's diet will need an increased amount of protein." c. "You will need to avoid adding salt to your child's food." d. "Your child's diet will consist of low-fat, low-carbohydrate foods."
ANS: C For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.
When infants are seen for fractures, which nursing intervention is a priority? a. No intervention is necessary. It is not uncommon for infants to fracture bones. b. Assess the family's safety practices. Fractures in infants usually result from falls. c. Assess for child abuse. Fractures in infants are often nonaccidental. d. Assess for genetic factors.
ANS: C Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. Infants should be cared for in a safe environment and should not be falling. Fractures in infancy are usually nonaccidental rather than related to a genetic factor.
What is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a. Risk for Injury related to malignant process and treatment. b. Deficient Fluid Volume related to excessive losses. c. Excess Fluid Volume related to decreased plasma filtration. d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces.
ANS: C Glomerulonephritis has a decreased filtration of plasma. The decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration, not fluid accumulation.
Therapeutic management of the child with acute diarrhea and dehydration usually begins with what intervention? a. Clear liquids b. Adsorbents such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric
ANS: C ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended and neither are antidiarrheal because they do not get rid of pathogens.
What is the term used to identify when the meatal opening is located on the dorsal surface of the penis? a. Chordee b. Phimosis c. Epispadias d. Hypospadias
ANS: C Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.
The viral pathogen that frequently causes acute diarrhea in young children is: a. Giardia organisms. b. Shigella organisms. c. Rotavirus. d. Salmonella organisms.
ANS: C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. Giardia and Salmonella are bacterial pathogens that cause diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States.
Which type of traction uses skin traction on the lower leg and a padded sling under the knee? a. Dunlop b. Bryant's c. Russell d. Buck's extension
ANS: C Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant's traction is skin traction with the legs flexed at a 90-degree angle at the hip. Buck's extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, before surgery with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should base the explanation on what fact? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.
ANS: C Serial casting, the preferred treatment, is begun shortly after birth before discharge from the nursery. Successive casts allows for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.
The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hips (DDH). What information should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove the harness several times a day to prevent contractures. c. Hip stabilization usually occurs within 12 weeks. d. Place a diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.
ANS: C The harness is worn continuously until the hip is proved stable on both clinical and ultrasound examination, usually within 6 to 12 weeks. Lotions and powders should not be used with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness.
What is the primary purpose of prescribing a histamine receptor antagonist for an infant diagnosed with gastroesophageal reflux? a. Prevent reflux b. Prevent hematemesis. c. Reduce gastric acid production. d. Increase gastric acid production.
ANS: C The mechanism of action of histamine receptor antagonists is to reduce the amount of acid present in gastric contents and may prevent esophagitis. None of the remaining options are modes of action of histamine receptor antagonists but rather desired effects of medication therapy.
The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a. Abdominal rigidity and pain on palpation b. Rounded abdomen and hypoactive bowel sounds c. Visible peristalsis and weight loss d. Distention of lower abdomen and constipation
ANS: C Visible gastric peristaltic waves that move from left to right across the epigastrium are observed in pyloric stenosis, as is weight loss. Abdominal rigidity and pain on palpation, and rounded abdomen and hypoactive bowel sounds, are usually not present. The upper abdomen is distended, not the lower abdomen
Which description of a stool is characteristic of intussusception? a. Ribbon-like stools b. Hard stools positive for guaiac c. "Currant jelly" stools d. Loose, foul-smelling stools
ANS: C With intussusception, passage of bloody mucus-coated stools occurs. Pressure on the bowel from obstruction leads to passage of "currant jelly" stools. Ribbon-like stools are characteristic of Hirschsprung's disease. Stools will not be hard. Loose, foul-smelling stools may indicate infectious gastroenteritis.
A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be to identify which occurrence? a. Blood pressure will stabilize. b. Child will have more energy. c. Urine will be free of protein. d. Urinary output will increase.
ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.
Which clinical manifestation would be seen in a child with chronic renal failure? a. Hypotension b. Massive hematuria c. Hypokalemia d. Unpleasant "uremic" breath odor
ANS: D Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urine output occurs. Hyperkalemia is a concern in chronic renal failure.
Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room
ANS: D Cryptorchidism is the failure of one or both testes to descend normally through inguinal canal. For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infant's testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.
Careful hand washing before and after contact can prevent the spread of which condition in day care and school settings? a. Irritable bowel syndrome b. Ulcerative colitis c. Hepatic cirrhosis d. Hepatitis A
ANS: D Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good hand washing is critical in preventing its spread. The virus can survive on contaminated objects for weeks. Irritable bowel syndrome is the result of increased intestinal motility and is not contagious. Ulcerative colitis and cirrhosis are not infectious.
The nurse understands that hypospadias refers to what urinary anomaly? a. Absence of a urethral opening. b. Penis shorter than usual for age. c. Urethral opening along dorsal surface of penis. d. Urethral opening along ventral surface of penis.
ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias does not refer to the size of the penis. When the urethral opening is along the dorsal surface of the penis, it is known as epispadias.
What would cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia b. Cold toes c. Increased respirations d. "Hot spots" felt on cast surface
ANS: D If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so a window can be made in the cast to observe the site. The "five Ps" of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and the child should be evaluated
Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyperalbuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria
ANS: D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.
A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which condition? a. Protein intolerance b. Parasitic infection c. Fat malabsorption d. Bacterial gastroenteritis
ANS: D Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. Protein intolerance is suspected in the pre sence of eosinophils. Parasitic infection is indicated by eosinophils. Fat malabsorption is indicated by foul-smelling, greasy, bulky stools.
What is a common side effect of corticosteroid therapy? a. Fever b. Hypertension c. Weight loss d. Increased appetite
ANS: D Side effects of corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.
What is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration
ANS: D The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure in children. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.
A child with secondary enuresis who reports of dysuria or urgency should be evaluated for what condition? (Select all that apply.) a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. Urinary tract infection (UTI) e. Diabetes mellitus
ANS: D, E Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.
The physical examination of a preschool-aged patient with a gastrointestinal complaint should include assessments of which of the following? (Select all that apply.) a. clubbing of fingertips b. mental status c. abdominal size and shape d. skin color and temperature e. deep tendon reflexes
Abdominal size and shape Mental status Skin color and temperature Rationale: In the initial phase of examination of the preschool-aged patient with a gastrointestinal concern, the child's skin color (red and flushed versus pale versus cyanotic) and temperature, abdominal size and shape, and mental status comprise the inspection and observation assessment. Deep tendon reflexes would be assessed in a child with a neurological disorder. Clubbing of the fingertips would be assessed in a child with a respiratory disorder.
Atraumatic care for the preschool-aged patient and patient's family includes which of the following? (Select all that apply.) a. encourage parents to leave child's favorite blanket and toys at home b. Provide verbal and written instructions during discharge teaching c. insist parents wait in another room during a procedure d. Use a toy to entertain the patient while the nurse palpates the abdomen e. Allow the patient to hold and look at the stethoscope before the nurse listens for bowel sounds
Allow the patient to hold and look at the stethoscope before the nurse listens for bowel sounds Use a toy to entertain the patient while the nurse palpates the abdomen Provide verbal and written instructions during discharge teaching Rationale: Atraumatic care is an intentional effort to decrease or eliminate stress and distress for the patient and family. Separation of family and child should be minimized. Be considerate of a parent's preference to be in the room or not be in the room during an invasive procedure. Prevent or minimize physical stressors by using strategies such as distraction techniques. Stress is decreased when the patient and family have some sense of control. Promote control by providing education to meet the needs of the patient and family. Anxiety for the preschool child can be decreased by allowing exploration of equipment, such as the stethoscope, prior to use on the child.
The charge nurse is making patient assignments for the next shift. The nurse should assign Eva to the same cohort or group of patients as which of the following? a. a child recovering from an appendectomy b. a child with fever and neutropenia c. an infant with meningitis d. another child with gastroenteritis
Another child with gastroenteritis Rationale: Gastroenteritis may be viral or bacterial and can be infectious. It is best to assign children who require contact precautions, as does Eva, to a cohort or group with patients who have the same or a similar infection. Good handwashing is essential to prevent the spread. An infant with meningitis, a child with fever and neutropenia, and a child recovering from an appendectomy should not be in contact with a child who has an infectious process.
The nurse is admitting Eva, a 5-year-old with severe gastroenteritis and dehydration, to the hospital. Which of the following nursing interventions has highest priority? a. Orienting Eva's family to the unit b. Assessing Eva's heart rate, skin turgor, and last urine output c. Making sure that Eva has changed into a hospital gown d. Obtaining a detailed family medical history from Eva's mother
Assessing Eva's heart rate, skin turgor, and last urine output Rationale: Checking heart rate, skin turgor, and last urine output is the best way for the nurse to assess dehydration, which is a primary concern. The other choices are not a high priority.
A 5-year-old patient admitted with dehydration secondary to diarrhea and vomiting is placed on isolation precautions until the source of gastrointestinal distress is determined. Which of the following types of isolation precautions would be most appropriate for this patient? a. droplet b. contact c. airborne d. reverse isolation
Contact precautions Rationale: Contact isolation precautions would be most appropriate to implement when caring for a patient admitted with diarrhea and vomiting. Gowns and gloves will prevent the health care provider from coming into contact with bodily fluids until the source of gastrointestinal distress is determined. Droplet precautions are used to prevent the spread of germs from the patient by coughing or sneezing. Airborne precautions are appropriate to use when the infectious agent is spread through the air. Reverse isolation precautions are used with patients who are immunocompromised or unable to fight infection; the patient must wear a mask when leaving the room.
A preschool-aged patient comes to the clinic with a history of vomiting and diarrhea. As the nurse completes the health history, questions related to which of the following should be included? (Select all that apply.) a. frequency of stooling b. complaints of back pain c. difficulty with mobility d. characteristics of emesis e. contact with others who are sick
Contact with others who are sick Frequency of stooling Characteristics of emesis Rationale: Frequency of stooling, recent contact with those who are sick, and characteristics of emesis for a patient presenting with vomiting and diarrhea are a few of the components of a thorough gastrointestinal health history. Complaints of back pain are more often associated with injury or an underlying renal issue. Difficulty with mobility is not associated with a gastrointestinal complaint.
A 5-year-old patient has had loose to watery stools three to four times daily for the past 5 days. During the last 24 hours the patient has had two loose stools. On examination, the child is alert with moist, pink oral mucosa, brisk capillary refill, warm extremities, and good urine output. Vital signs include the following: heart rate of 100 beats per minute, respiratory rate of 24 breaths per minute, blood pressure 95/53 mm Hg, and oral temperature of 37.2°C (98.9°F). The patient is presently on a regular diet. Which of the following recommendations should the nurse make to the parent concerning nutrition? a. offer small amounts of oral rehydration solution b. encourage consumption of dairy products to thicken stools c. continue regular diet d. provide a clear liquid diet for the next 48 hours
Continue regular diet. Rationale: The child is not showing signs of dehydration and the diarrhea is improving, so a regular diet should continue for optimal nutrition. Milk products should be discouraged during the acute phase of diarrhea due to a temporary intolerance as a result of villus injury. A clear liquid diet is not recommended for more than 24 hours. Extending the duration of clear liquids will induce "starvation stools," resulting in continuation of liquid stools. Oral rehydration solution is not indicated because the patient is not showing signs of dehydration.
The nurse is caring for a preschool-aged patient admitted with dehydration. Which of the following measurements is the best indicator of fluid status in this patient? a. skin turgor b. oral intake c. daily weight d. urine output
Daily weight Rationale: In children, daily weights are the best indicator of changes in fluid status. Oral intake and urine output measurements are important nursing interventions for monitoring fluid status; however, daily weights are the best indicator. Skin turgor is a measure of hydration, but it is not the single best indicator of fluid status.
A preschool-aged child comes to the clinic with signs of mild dehydration as a result of vomiting and diarrhea. The nurse is teaching the parents about promoting fluid intake to treat mild dehydration. Which of the following is the most appropriate fluid source to correct mild dehydration and replace lost electrolytes? a. Electrolyte replacement solution with sodium chloride and glucose b. chicken broth c. tap water d. white grape juice
Electrolyte replacement solution with sodium chloride and glucose Rationale: Undiluted fruit juice, chicken broth, and tap water are not appropriate sources for oral rehydration therapy. Fruit juice is high in simple carbohydrates, which may contribute to worsening of diarrhea. Chicken broth contains excessive sodium. Tap water does not contain the adequate carbohydrates and electrolytes needed to maintain balance. An adequate solution contains 75 mmol/L sodium chloride and 13.5 g/L glucose.
Which of the following findings from Eva's history alert the nurse to a priority need for further parent education? a. Eva is in contact with ill children at home b. Eva has been on a diet of chicken noodle soup and apple juice since she became ill c. Eva was brought to the clinic after 2 days of vomiting and diarrhea d. Eva has received no medications to treat vomiting and diarrhea
Eva has been on a diet of chicken noodle soup and apple juice since she became ill - chicken broth contains excessive sodium
The nurse is providing Eva's mother with discharge instructions regarding diet progression. Which of the following responses by Eva's mother indicates that teaching has been effective? a. Milk is a good choice for rehydration and will help to reduce the acid in Eva's stomach b. I should encourage Eva to drink large amounts of whatever she wants to drink c. Eva should drink an oral rehydration solution in small amounts until she is ready to progress to a regular diet. d. When Eva is ready to eat, I should offer her her favorite foods like chicken nuggets and fries
Eva should drink an oral rehydration solution in small amounts until she is ready to progress to a regular diet. Rationale: For the first 24 hours, the patient should drink the oral rehydration solution prescribed by the health care provider in small, frequent amounts as the patient is able to handle it. This will help replace the fluids, salts, and sugars in the body. When the patient is able to eat, a normal, healthy diet should be offered. Milk is not appropriate for oral rehydration. Fatty foods, fried foods, and foods that are high in sugar should be avoided. Certain drinks should be avoided, such as soda, water, ginger ale, tea, fruit juice, caffeinated drinks, or sports drinks. These do not contain the right mix of sugar and salts. They can also irritate the patient's stomach, make vomiting and diarrhea worse, and increase the severity of dehydration.
A nurse caring for a 5-year-old patient admitted with dehydration has an order to collect a stool specimen to test for ova and parasites. The patient is ambulatory and has a recent history of diarrhea and vomiting. What is the best method to use to collect the stool specimen from this patient? a. have the patient lie in bed and collect the specimen with a bedpan b. place a urine bag to the anal area to collect the specimen and place a diaper on the patient to hold the bag in place c. diaper the patient and use a tongue blade to scrape the specimen into the container d. have the patient urinate first and then place a clean container under the seat at the back of the toilet to collect the specimen
Have the patient urinate first and then place a clean container under the seat at the back of the toilet to collect the specimen. Rationale: For ambulatory patients, the patient must first urinate in the toilet, and then the stool specimen may be retrieved from the new or clean collection container that fits under the seat at the back of the toilet. It is important to keep urine from contaminating the stool specimen. For the bedridden patient, the stool specimen should be collected using a clean bedpan, but this patient is ambulatory. If the patient is in diapers, the stool specimen may be collected by scraping the specimen into a container with a tongue blade. If the patient is diapered and has runny stools, the specimen can be collected utilizing a piece of plastic wrap in the diaper to catch the stool or by application of a urine bag to the anal area to collect the specimen.
A nurse is explaining contact isolation precautions to the caregiver of a child admitted with gastroenteritis and dehydration. Which of the following statements by the caregiver indicates that teaching has been effective? a. I need to wear gloves and a gown when I am in my child's room and discard them in the trash when leaving the room. b. My child has to be put in a special room and I have to wear a fitted mask when in the room c. I only need to use hand sanitize when I enter and leave the room d. I must put on a mask and wear a gown and gloves when I am in my child's room
I need to wear gloves and a gown when I am in my child's room and discard them in the trash when leaving the room. Rationale: Contact precautions are used to prevent the spread of microorganisms that are spread by direct or indirect contact with the patient or the patient's environment. Effective contact precautions require a single room, if possible, and the use of gloves and gowns by anyone having contact with the patient, the patient's support equipment, or items that have come in contact with the patient or the patient's environment. Proper hand hygiene and handling and disposal of articles that have come in contact with the patient and environment are essential.
Eva has started oral rehydration and is tolerating the treatment well. Nurse is going over patient education. Which of the following statements by Eva's mother indicates that patient education has been successful? a. I will call the provider if Eva's urine output increases b. I will continue to watch her at home if her vomiting and diarrhea are not improved in the next 6 hours c. I will bring Eva back to the office or the emergency room if she has high fever or blood in her stool d. I will continue home monitoring if she is listless and not wanting to drink
I will bring Eva back to the office or the emergency room if she has high fever or blood in her stool
Which of the following statements characterizes a developmentally appropriate response from a 5-year old experiencing illness? a. I can do it myself b. I want to be left alone c. I'm sick because I kicked my brother d. I will be good and drink my medicine because I want to make my mommy happy
I'm sick because I kicked my brother - a 5 year old's psychosocial development task is initiative vs guilt
The nurse is reviewing a teaching handout with Eva's mother on home care of a child with dehydration, which includes information about when it is necessary to return to see the health care provider. Which of the following responses by Eva's mother indicates that teaching has been effective? a. The provider needs to see Eva if she gets tired after running and playing at the park b. If Eva has diarrhea or vomiting and doesn't pee, or feels worse, the provider needs to see her. c. I need to call the provider if Eva hasn't peed in more than 48 hours d. I need to take Eva to the emergency room if she has a temperature of 99.5 F
If Eva has diarrhea or vomiting and doesn't pee, or feels worse, the provider needs to see her. Rationale: Eva needs to return for further assessment by the health care provider if any of the following occur: she demonstrates signs of infection such as a fever of 100.4°F or higher, has dark, concentrated urine, has not urinated in more than 6 hours and is vomiting, is very sleepy or has less energy for light activities, or if the health problem does not improve or worsens. Eva's mother should not wait 48 hours since the last time Eva urinated to call the provider; she should call the provider after just 6 hours, since delaying would cause the dehydration to become more severe. Fatigue would be expected after vigorous exercise, such as actively playing at the park; the parent should be more concerned if Eva is fatigued following more passive activities such as reading or watching television.
The nurse is caring for a 5-year-old patient with dehydration and hypovolemic shock. The patient received a 400-mL bolus of normal saline over 15 minutes. On reassessment, which of the following findings would indicate that the patient's condition is improving? a. increased heart rate b. decreased blood pressure c. increased urine output d. increased capillary refill time
Increased urine output Rationale: Following administration of an isotonic crystalloid bolus (normal saline or lactated Ringer's), the nurse would expect to see an improvement in systemic perfusion as indicated by a decrease in heart rate and capillary refill time and an increase in blood pressure, oxygen saturations, urine output, and strength of peripheral pulses.
A 5-year-old patient admitted with dehydration has an order for a urinalysis. What is the best and most appropriate way for the nurse to collect the urine specimen? a. place cotton balls in diaper b. sterile intermittent catheterization c. midstream clean catch d. urine bag
Midstream clean catch Rationale: Specimen collection for a urinalysis should be obtained using aseptic technique. A midstream clean catch is the least invasive and most appropriate method to use to obtain the urine specimen from this patient. A urine bag works but is most appropriate for infants and small children who are not yet toilet trained. Sterile intermittent catheterization is invasive and not necessary in this situation.
Dehydration can be categorized as mild, moderate, or severe. Which of the following characteristics would be associated with moderate dehydration? a. pink and moist oral mucosa b. tenting skin turgor c. mildly sunken orbits d. capillary refill less than 2 seconds
Mildly sunken orbits Rationale: In moderate dehydration, patients have mildly sunken orbits. Tenting skin turgor is associated with severe dehydration. Pink and moist oral mucosa and capillary refill less than 2 seconds are normal and may be found in mild dehydration.
A 5-year-old patient comes to the emergency room with a 3-day history of vomiting and diarrhea. The patient weighed 21.8 kg 1 month ago at a well-child checkup and now weighs 20.5 kg. The nurse knows that the patient would be classified as having which of the following levels of dehydration? a. mild dehydration b. no dehydration c. severe dehydration d. moderate dehydration
Moderate dehydration Rationale: The patient weighed 21.8 kg prior to the illness and presented to the emergency room weighing 20.5 kg. A difference of 3% to 4% weight loss indicates mild dehydration, 6% to 8% indicates moderate dehydration, and 10% or greater indicates severe dehydration. The patient lost 1.3 kg of weight. To determine what percentage of weight the patient has lost, divide the amount lost by the starting weight: 1.3 ÷ 21.8 = .059633 kg. Move the decimal two places to the right to convert the number to a percentage and round to the nearest whole number: 6%. Thus, the change in the patient's weight equals a 6% weight loss, so the patient is moderately dehydrated.
Therapeutic management of most children with Hirschsprung's disease is primarily: a. daily enemas. b. low-fiber diet. c. permanent colostomy. d. surgical removal of affected section of bowel
Most children with Hirschsprung's disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet until the child is physically ready for surgery. The colostomy that is created in Hirschsprung's disease is usually temporary
What is the most appropriate nursing action when a child with a probable intussusception has a normal, brown stool? a. Notify the practitioner b. Measure abdominal girth c. Auscultate for bowel sounds d. Take vital signs, including blood pressure
Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic/therapeutic plan of care.
A 5-year-old patient comes to the clinic with acute gastroenteritis. The nurse is providing instruction for the family regarding signs of dehydration and nutrition. The parent asks how to prevent the spread of the illness to other family members. What is the best recommendation by the nurse? a. practice thorough handwashing b. begin prophylactic probiotic therapy c. expect that infection of the other family members is inevitable d. isolate the child from the other family members
Practice thorough hand washing Rationale: The best recommendation for preventing the spread of infectious types of diarrhea is proper hand washing. Isolation is not developmentally appropriate or necessary for this child. Although probiotic therapy may be beneficial for treatment of gastroenteritis to decrease the length and extent of diarrhea, it is not indicated for prevention of vomiting and diarrhea. Infection of the other family members is not inevitable; education should be focused on how the illness is transmitted and how proper hand washing techniques can reduce the risk of spreading the infection.
A preschool-aged patient presents with acute gastroenteritis. The nurse recognizes that a child may become dehydrated more quickly than an adult for which of the following reasons? a. Preschool-aged patients have increased ratios of body surface area to mass b. pre-school aged patients have decreased extracellular fluid percentage c. pre-school aged patients have decreased basal metabolic rate d. pre-school aged patients have increased renal function
Preschool-aged patients have increased ratios of body surface area to mass Rationale: Infants and young children progress to dehydration more quickly than adults due to increased extracellular fluid, increased basal metabolic rate, increased body surface area relative to body mass, and immature renal function.
The nurse would expect which of the following laboratory results to be elevated in a preschool-aged patient with moderate dehydration? (Select all that apply.) a. Serum sodium b. Creatinine c. Serum Potassium d. Urine specific gravity e. Blood urea nitrogen (BUN)
Serum sodium Creatinine Urine specific gravity Blood urea nitrogen (BUN) Rationale: Blood urea nitrogen (BUN), creatinine, serum sodium level, and urine specific gravity may be elevated with a fluid volume deficit and dehydration. Serum potassium level will be decreased with loss of body fluids through vomiting and diarrhea.
The nurse is caring for 5-year-old Eva admitted with dehydration for intravenous rehydration. Eva's mother must leave the bedside to care for another child at home and asks whether the nurse can find something for the patient to play with while unsupervised. Which of the following toys would be most appropriate for the nurse to provide Eva with? a. simple jigsaw puzzle b. board book c. unbreakable mirror d. bucket and a shovel
Simple jigsaw puzzle Rationale: A simple jigsaw puzzle with large pieces would be most appropriate for a preschool-aged child. An unbreakable mirror and a board book would be appropriate for an infant. A bucket and plastic shovel would be more appropriate for a toddler to use in a sandbox, not for a preschool-aged child in the hospital.
The nurse is teaching Eva how to wash her hands properly to prevent the spread of infection. Which of the following is the most developmentally appropriate language to include in the nurse's teaching? a. Wash your hands for at least 15 seconds b. Hand sanitizer is better at killing germs than soap and water c. Sing "Happy Birthday" to make sure you wash your hands for the right amount of time. d. Germs like viruses and bacteria can spread from person to person when you are sick
Sing "Happy Birthday" to make sure you wash your hands for the right amount of time. Rationale: Having the child sing a familiar song like "Twinkle, Twinkle Little Star," "Happy Birthday," or the "ABC" song can ensure that hands have been washed for an adequate cleaning time. Hands should be washed for a minimum of 15 seconds; however, a 5-year-old may not understand the concept of time, so associating a song with the 15-second timeframe is more developmentally appropriate. The terms "viruses" and "bacteria" are too technical. It is important to explain procedures to a child in simple terms that are nonthreatening.
Eva's mother asks why the health care provider ordered a stool sample. Which of the following responses by the nurse identifies the most likely rationale for the stool sample, given Eva's condition? a. The lab will check the stool for parasites to see if that is why Eva is having diarrhea. b. The sample is needed to help determine if there is blood in Eva's stool c. The specimen will help the lab determine if Eva has rotavirus or other viruses d. The lab will assess for the presence of bacteria in Eva's stool
The lab will check the stool for parasites to see if that is why Eva is having diarrhea. Rationale: Eva's health care provider ordered a stool sample for ova and parasites to help determine the cause of Eva's diarrhea. Other diagnostic tests for stool testing, which were not ordered by the health care provider, include testing the stool for occult blood, performing a stool culture to check for the presence of bacteria, and completing a stool viral panel to assess for rotavirus and other viruses.
The nurse is preparing a 5-year-old patient for a clean-catch urine specimen collection. Which of the following demonstrates that the nurse understands developmentally appropriate communication? a. I will put a hat in the toilet. When you go to the bathroom, it will catch your urine in the hat. b. Let your mom know when you have to void again so she can help you obtain a specimen. c. I need you to urinate in a specimen cup next time you go to the bathroom. d. Your mommy will use a special wipe to clean your bottom and then will catch your pee-pee in a cup when you go potty.
Your mommy will use a special wipe to clean your bottom and then will catch your pee-pee in a cup when you go potty. Rationale: It is important to explain procedures to a child in simple terms that are nonthreatening, such as "clean," "bottom," "pee-pee," "cup," and "potty." Avoid terms that are too technical or confusing, which may cause the child to misunderstand what is going to occur. The terms "urine," "urinate," "specimen," and "void" in the answers above are likely too technical for a 5-year-old to understand. Also, the term "hat" may cause the child to expect a literal hat to be in the toilet.
The nurse is caring for a 5 year old patient admitted with gastroenteritis. Prioritize the following nursing interventions beginning with the most important initial action. ***Correct sequence shown*** Wash hands Ask questions pertinent to rule out dehydration Auscultate bowel, heart, and lung sounds Palpate abdomen Report findings to healthcare provider Provide patient education on signs of dehydration
correct sequence in question
