Peds Exam #4

A child with myelomeningocele (meningomyelocele), corrected at birth, is now 5 years old. What is a priority nursing diagnosis for a child with corrected spina bifida at this age?

Impaired urinary elimination

You are taking care of an infant who has come back from having cleft lip and palate repair. The nurse would include all of the following in the plan of care except: A) Use of pacifier to prevent vigorous crying B) Holding, cuddling and rocking of infant C) Arm restraints or mummy restraint D) Placing infant in the supine position

Answer: A. It would be important to protect the palate operative site by avoiding putting items in the mouth that might disrupt the sutures such as suction catheters, spoons, straws, pacifiers, or plastic syringes. It would be important to keep the infant from rubbing the surgical sight. To prevent this the infant will be placed in the supine or side-lying position and arm restraints are often used. Holding, cuddling and rocking the infant can help soothe and comfort the infant after surgery.

A 3-year-old child is status postshunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? (Select all that apply.) A. Personality change B. Bulging anterior fontanel C. Vomiting D. Dizziness E. Fever

A. Personality change C. Vomiting E. Fever

The nurse is planning care for a school-age child with bacterial meningitis. The plan should include: A. keeping environmental stimuli at a minimum. B. avoiding giving pain medications that could dull sensorium. C. measuring head circumference to assess developing complications. D. having child move head side to side at least every 2 hours.

A. keeping environmental stimuli at a minimum.

A child with a mild traumatic brain injury is being sedated with a mild sedative so that pain and anxiety are minimized. The nurse should (Select all that apply): A. Place a continuous-pulse oximetry monitor on the child. B. Place the child in a room near the nurse's station. C. Allow for several visitors to remain at the child's bedside. D. Use soft restraints if the child becomes confused. E. Use sedation around the clock to decrease agitation.

AB

When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with observable distended scalp veins, the nurse recognizes these signs as indicative of a. Hydrocephalus b. Syndrome of inappropriate antidiuretic hormone (SIADH) c. Cerebral palsy d. Reye's syndrome

ANS: A The combination of signs is strongly suggestive of hydrocephalus.B SIADH would not manifest in this way. The child would have decreasedurination, hypertension, weight gain, fluid retention, hyponatremia, andincreased urine specific gravity.C The manifestations of cerebral palsy vary but may include persistence ofprimitive reflexes, delayed gross motor development, and lack of progressionthrough developmental milestones.D Reye's syndrome is associated with an antecedent viral infection with symptoms

The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest? a.Hamburger on a bun b.Spaghetti with meat sauce c.Corn on the cob with butter d.Peanut butter and crackers

ANS: C Treatment of celiac disease consists primarily of dietary management. Although a gluten-free diet is prescribed, it is difficult to remove every source of this protein. Some patients are able to tolerate restricted amounts of gluten. Because gluten occurs mainly in the grains of wheat and rye but also in smaller quantities in barley and oats, these foods are eliminated. Corn, rice, and millet are substitute grain foods. Corn on the cob with butter would be gluten free.

The nurse is assisting the pediatric provider with a newborn examination. The provider notes that the infant has hypospadias. The nurse understands that hypospadias refers to: 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.

A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions? a. WBC <1; specific gravity 1.008 b. WBC <2; specific gravity 1.025 c. WBC >2; specific gravity 1.016 d. WBC >2; specific gravity 1.030

ANS: D The white blood cell count (WBC) in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary tract inflammatory process. The urinalysis specific gravity for children with normal fluid intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient antidiuretic hormone secretion.

An infant is born with an esophageal atresia and tracheoesophageal fistula. Which preoperative nursing diagnosis is the priority for this infant? 1. Risk for Aspiration Related to Regurgitation 2. Acute Pain Related to Esophageal Defect 3. Ineffective Infant Feeding Pattern Related to Uncoordinated Suck and Swallow 4. Ineffective Tissue Perfusion: Gastrointestinal, Related to Decreased Circulation

Answer: 1 Rationale 1: With the most common type of esophageal atresia and tracheoesophageal fistula, the upper segment of the esophagus ends in a blind pouch and a fistula connects the lower segment to the trachea. Preoperatively, there is a risk of aspiration of gastric secretions from the stomach into the trachea because of the fistula that connects the lower segment of the esophagus to the trachea. Pain is not usually experienced preoperatively with this condition. The infant is always kept NPO (nothing by mouth) preoperatively, so ineffective feeding pattern would not apply. Tissue perfusion is not a problem with this condition.

The nurse is planning postoperative care for an infant after a cleft-lip repair. Which nursing intervention is most appropriate for this infant? 1. Prone positioning 2. Suctioning with a Yankauer device 3. Supine or side-lying positioning 4. Avoidance of soft elbow restraints

Answer: 3 Rationale 1: Integrity of the suture line is essential for postoperative care of cleft-lip repair. The infant should be placed in a supine or side-lying position to avoid rubbing the suture line on the bedding. The prone position should be avoided. A Yankauer suction device is made of hard plastic and, if used, could cause trauma to the suture line. Suctioning should be done with a small, soft suction catheter. Soft elbow restraints may be used to prevent the infant from touching the incisional area.

Which is the priority nursing diagnosis when planning care for a newborn who is born with esophageal atresia and tracheoesophageal fistula? 1. Ineffective Tissue Perfusion 2. Ineffective Infant Feeding Pattern 3. Acute Pain 4. Risk for Aspiration

Answer: 4 Explanation: 1. Tissue perfusion is not a primary problem with this condition. 2. The infant is always kept NPO (nothing by mouth) preoperatively, so ineffective feeding pattern would not apply. 3. Pain is not usually experienced preoperatively with this condition. 4. This is the most common type of esophageal atresia and tracheoesophageal fistula, where the upper segment of the esophagus ends in a blind pouch and a fistula connects the lower segment to the trachea. Preoperatively, there is a risk of aspiration of gastric secretions from the stomach into the trachea because of the fistula that connects the lower segment of the esophagus to the trachea.

Which of the following does the nurse understand places the child with myelomeningocele at high risk for infection? A) Neurogenic bladder B) Bowel incontinence C) Latex allergy D) Exposure of sac E) Corticosteroid use

Answer: A and D. Neurogenic bladder is the failure of the bladder to either store urine properly or empty itself of urine. Because of this urinary stasis occurs in the bladder placing the child at risk for infection. In myelomeningocele, the spinal cord is exposed, placing the child at high risk for infection. Immediate surgery is needed to help prevent infection from occurring. Bowel incontinence often occurs in children with myelomeningocele, but does not pose the same health risks as urinary incontinence. Latex allergy, although common, would not promote risk for infection alone. Corticosteroid use is not common in children with myelomeningocele.

When planning care for the infant diagnosed with cleft lip and palate, which action would the nurse take in relation to the priority nursing diagnosis for this child? A) Prevent the baby from vigorously crying B) Burp the baby well throughout feedings C) Temporarily refrain from having the baby breastfeed D) Encourage the mother to use false palate covering when feeding baby

Answer: D. A false palate covering will help prevent the baby from aspirating while breastfeeding by providing a covering for the cleft palate. Adaptive nipples can also be used for this purpose. Burping the baby would be important to include in the plan of care, but would not be for the priority nursing diagnosis of risk for aspiration. It would not be necessary to have the baby refrain from breastfeeding. Preventing the baby from vigorously crying would be important postoperatively to prevent sutures from ripping.

A nurse is teaching a parent of a child who has a urinary tract infection. Which of the following should the nurse include in the teaching? Select all that apply A. wear nylon underpants b. avoid bubble baths c. empty bladder completely with each void d. provide info about clinical manifestations e. wipe perineal area back to front

Avoid bubble baths empty bladder completely with each void provide information about clinical manifestations of infection

A child is being discharged after surgery for a myelomeningocele (meningomyelocele) repair. Before discharge, the nurse works with the parents to establish a catheterization schedule to prevent urinary tract infection. With what frequency should the nurse instruct the parents to catheterize the child? A. Every 1-2 hours. B. Every 3-4 hours. C. Every 6-8 hours. D. Every 10-12 hours.

B

A child with myelomeningocele (meningomyelocele), corrected at birth, is now 5 years old. What is a priority nursing diagnosis for a child with corrected spina bifida at this age? A. Dysfunctional Gastrointestinal Motility B. Ineffective Peripheral Tissue Perfusion C. Impaired Urinary Elimination. D. Impaired Comfort.

C

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is which of the following? a. Explain that analgesia is contraindicated with a head injury. b. Have parents describe the child's previous experiences with pain. c. Consult with practitioner about what analgesia can be safely administered. d. Teach parents that analgesia is unnecessary when child is not fully awake and alert.

C A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and to promote comfort and relieve anxiety. Analgesia can be safely used in individuals who have sustained head injuries. The child's previous experiences with pain should be obtained as part of the assessment, but because of the severity of injury, analgesia should be provided as soon as possible. Analgesia can decrease anxiety and resultant increased intracranial pressure.

The nurse is teaching the parents of a 3-year-old who has been diagnosed with tonic-clonic seizures. Which of the following statements by the parent would indicate a correct understanding of the teaching? a. "I should attempt to restrain my child during a seizure." b. "My child will need to avoid contact sports until adulthood." c. "I should place a pillow under my child's head during a seizure." d. "My child will need to be taken to the emergency department [ED] after each seizure."

C Parents should try to place a pillow or folded blanket under the child's head for protection. The parent should not try to restrain the child during the seizure. The child does not need to go to the ED with each seizures; the nurse can teach parents certain criteria for when their child would need to be seen. Discussing what will happen in adulthood is not appropriate at this time.

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. In the discussion the nurse should include that: A. parental protection is essential until the child reaches adulthood. B. cognitive impairment is to be expected with hydrocephalus. C. shunt malfunction or infection requires immediate treatment. D. most usual childhood activities must be restricted.

C. shunt malfunction or infection requires immediate treatment. Rationale: Except for contact sports, the child will have few restrictions. Cognitive impairment depends on the extent of damage before the shunt was placed. Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present. Limits should be appropriate to the developmental age of the child.

The nurse is teaching the parents of an​ 18-month-old female toddler with a urinary tract infection​ (UTI). Which should be included in the teaching to prevent the future risk of a​ UTI? Cleanse the perineal area front to back. Provide the child with a daily cup of​ low-sugar cranberry juice. Increase the​ child's fluid intake. Increase the​ child's intake of vitamin C.

Cleanse the perineal area front to back.

9) A child is diagnosed with a Wilms tumor. Which nursing action is most appropriate prior to surgery? 1. Careful bathing and handling 2. Monitoring of behavioral status 3. Maintenance of strict isolation 4. Administration of packed RBCs

1. Careful bathing and handling

A baby is born with bladder exstrophy. Immediate care for this infant will include which intervention? 1. Measuring intake and output 2. Inserting a Foley catheter 3. Covering the defect with sterile plastic wrap 4. Palpating the bladder mass to ensure urine is expelled

3: This reduces the contamination of the bladder, which should be sterile.

A four-year-old girl has been treated for three urinary tract infections (UTI) in the last two years. Which instructions can the nurse give to the mother to help reduce the child's risk of acquiring another UTI?(Select all that apply.) 1. Wear only nylon underwear for better air flow. 2. Teach the child to wipe from front to back. 3. Encourage the child to take long baths by allowing the child bubbles and toys in the tub. 4. Encourage the child to drink additional fluids throughout the day. 5. Plan potty breaks every two hours throughout the day.

2 4 5

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. The PRIORITY of nursing care is to: A. initiate isolation precautions as soon as the diagnosis is confirmed. B. initiate isolation precautions as soon as the causative agent is identified. C. administer antibiotic therapy as soon as it is ordered. D. administer sedatives/analgesics on a preventive schedule to manage pain.

C. administer antibiotic therapy as soon as it is ordered.Antibiotics are the priority function; pain should be managed if it occurs.

A preschooler has celiac disease. Her mother is preparing a gluten-free diet. By preparing which breakfast foods would you believe she understands the diet? a) Cheerios (oat cereal) and skim milk b) Wheat toast and grape jelly c) Eggs and orange juice d) Rye toast and peanut butter

Eggs and orange juice Children with celiac disease cannot digest the protein in common grains, such as wheat, rye, and oats.

The nurse is providing discharge instructions to the parents of a female child diagnosed with a UTI. Which information is most important for the nurse to include in the teaching to prevent future UTIs? Give the child a bubble bath every day. Ensure the child is voiding every 3-4 hours each day. Notify the provider if the child experiences discomfort during urination. Teach the child to wash the hands before and after using the bathroom.

Ensure the child is voiding every 3-4 hours each day.

A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? Select all that apply.

IV fluid administrationMonitor of intake and outputDaily weight assessment

Which statements are true about intussusception? Select all that apply. 1 More common in females than males 2 Passage of red, currant jelly-like stools 3 Associated with sudden acute abdominal pain 4 The cause of intussusception is usually inflammation 5 Olive-shaped mass in the epigastrium just right of the umbilicus

Intussusception is associated with passage of red, currant jelly-like stools and sudden acute abdominal pain. It is more common in males than females and generally the cause is unknown (not inflammation). An olive-shaped mass in the epigastrium just right of the umbilicus is a finding associated with hypertrophic pyloric stenosis.

A 4-year old child has a white pupillary reflex. Which medical term should the nurse use to describe this finding?

Leukocoria: The primary sign of retinoblastoma is leukocoria, a white pupillary reflex also called cat's eye reflex which is caused by the mass behind the lens.

Which nursing action is appropriate for the child that is receiving a blood transfusion and begins having dyspnea, hypertension, and precordial pain? Stop the transfusion. Give antihypertensive medication. Give epinephrine immediately. Insert catheter and monitor hourly outputs.

Stop the transfusion.

The nurse is caring for a client with pyelonephritis. Which clinical manifestation should the nurse assess in the​ client? (Select all that​ apply.) Vomiting Fever Dysuria Flank pain Enuresis

Vomiting Fever Flank pain Clinical manifestations that occur with pyelonephritis include​ fever, vomiting, and flank pain. Enuresis and dysuria occur with cystitis.

When viewing a urine specimen under a microscope, what would the nurse expect to see in a patient with a urinary tract infection? a. Bacteria b. Casts c. Crystals d. Protein

a

An infant is diagnosed with congenital hydrocephalus. Which of the following characteristics would the nurse expect to find? a. Enlarged ventricles b. Decreased cerebrospinal fluid (CSF) production c. Increased resorption of CSF d. Smaller than average head circumference

a. Enlarged ventricles Congenital hydrocephalus is characterized by enlargement of the cerebral ventricles.Increased, not decreased, CSF production would lead to hydrocephalus.Decreased resorption of CSF would lead to hydrocephalus, not increased CSF.An infant with congenital hydrocephalus would have increased head circumference.

The nurse is assessing a child who was just admitted to the hospital for observation after ahead injury. The most essential part of nursing assessment to detect early signs of a worsening condition is a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

d. Level of consciousness

When assessing a newborn with cleft lip, the nurse should be alert that which of the following will most likely be compromised?

sucking

The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.) a.Citrus b.Bananas c.Spicy foods d.Peppermint e.Whole wheat bread

ANS: A, C, D Avoidance of certain foods that exacerbate acid reflux (e.g., caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried foods) can improve mild GER symptoms. Bananas and whole wheat bread will not exacerbate acid reflux.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect?Select all that apply. a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E

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.

1) A child diagnosed with a Wilms tumor is prescribed chemotherapy. Which laboratory test will the nurse monitor prior to administering the chemotherapy to determine the child's infection- fighting capability? 1. Hemoglobin 2. RBC count 3. Absolute neutrophil count (ANC) 4. Platelets

Absolute neutrophil count (ANC)

An 18-month-old child is observed having a seizure. The nurse notes that the child's jaws are clamped. The priority nursing responsibility at this time would be: A. start oxygen via mask B. insert padded tongue blade C. restrain child to prevent injury to soft tissue D. protect the child from harm from the environment

D. protect the child from harm from the environment

A newborn infant is diagnosed with tracheoesophageal fistula (TEF). The nurse assesses the infant, knowing that a typical finding in this disorder is: A. Slowed reflexes B. Cyanosis, coughing, and choking C. Diaphragmatic breathing D. Passage of large amounts of frothy stool

B

A child is being evaluated in the emergency room for a possible diagnosis of meningitis. The nurse is assisting with the lumbar puncture and notes that the CSF is cloudy. The nurse is aware that cloudy CSF most likely means: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, as CSF is usually cloudy. 4. Sepsis.

2

An infant is born with a sac protruding through the spine. The sac contains CSF, a portion of the meninges, and nerve roots. The nurse knows that this is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifida occulta. 4. Anencephaly

2

An 18-month-old child is being discharged after surgical repair of hypospadias. Which postoperative nursing care measure should the nurse stress to the parents as they prepare to take this child home? 1.Leave diapers off to allow the site to heal. 2.Avoid tub baths until the stent has been removed. 3.Encourage toilet training to ensure that the flow of urine is normal. 4.Restrict the fluid intake to reduce urinary output for the first few days.

2.Avoid tub baths until the stent has been removed. After hypospadias repair, the parents are instructed to avoid giving the child a tub bath until the stent has been removed to prevent infection. Diapers are placed on the child to prevent the contamination of the surgical site. Toilet training should not be an issue during this stressful period. Fluids should be encouraged to maintain hydration.

A male child who had surgery to correct hypospadias is seen in a primary health care provider's office for a well-baby checkup. The nurse provides instructions to the mother, knowing that which long-term complication is associated with hypospadias? 1.Infertility 2.Renal anomalies 3.Erectile dysfunction 4.Decreased urinary output

2.Renal anomalies The nurse should ask the child's parents about the child's kidney function because hypospadias may be associated with renal anomalies. The incorrect options are not associated with a long-term effect of hypospadias.

A toddler is being admitted to the hospital with a diagnosis of bacterial meningitis. Select the best room assignment for the patient. 1. A semiprivate room with a roommate who also has bacterial meningitis. 2. A semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. A private room that is dark and quiet with minimal stimulation. 4. A private room that is bright and colorful and has developmentally appropriate activities available.

3

The child is admitted to the hospital after being diagnosed with retinoblastoma. Which assessment finding does the nurse anticipate for this child? 1. A red reflex 2. Yellow sclera 3. A white pupil 4. Blue-tinged sclera

3

The nurse is caring for a 6-month-old infant with a diagnosis of hydrocephalus. Which of the following signs best indicates increased ICP in this child? 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite

3

A child is admitted with gastroenteritis from suspected rotavirus. To prevent the spread of this disease, the nurse should: A. Observe enteric contact precautions. B. Administer antibiotics as soon as possible. C. Single-bag all linens. D. Use sterilizable eating utensils. E. Use an alcohol-based hand rub to prevent spread of pathogens.

A

A child with a known seizure disorder is hospitalized for an unrelated procedure. After walking the child back from the restroom, the nurse notes tonic-clonic movements. Which action should the nurse take first? A. Note the time B. Ease the child to the floor C. Clear the area of objects and pad the head D. Roll the child to side-lying position to protect the airway

A

An important nursing intervention when caring for a child who is experiencing a seizure would be which of the following? a. Describe and record the seizure activity observed. b. Suction the child during a seizure to prevent aspiration. c. Place a tongue blade between the teeth if they become clenched. d. Restrain the child when seizures occur to prevent bodily harm.

A When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child is not suctioned during the seizure. If possible, the child should be placed on the side, facilitating drainage to prevent aspiration.

A nurse is assessing a child who has a rotavirus infection. Which of the following are expected findings?(Select all that apply.) A. Fever B. Vomiting C. Watery stools D. Bloody stools E. Confusion

A B C A fever is a clinical manifestation of rotavirus infection.B. Vomiting for approximately 2 days is a clinical manifestation of rotavirus infection.C. Foul-smelling, watery stools is a clinical manifestation of rotavirus infection.

The nurse is caring for a child with a Wilms' tumor. What is the most important nursing intervention preoperatively? A. Avoid abdominal palpation. B. Closely monitor the arterial blood gases. C. Prepare the child and family for long-term dialysis. D. Prepare the child and family for renal transplantation.

A. Avoid abdominal palpation. Wilms' tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. A sign should be placed over the bed indicating that no abdominal palpation should be conducted.Monitoring of arterial blood gases is not indicated preoperatively for this abdominal surgery.Long-term dialysis is not indicated, unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative irradiation and/or chemotherapy is used to minimize the tumor size.Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.

A nurse is caring for an infant who is postoperative following cleft lip and palate repair. Which of the following actions should the nurse take? A. Remove the packing in the mouth B. Place the infant in an upright position C. Offer a pacifier with sucrose D. Assess the mouth with a tongue blade

B. Place the infant in an upright position

The parents of an infant who has just had a ventriculoperitoneal shunt inserted for hydrocephalus are concerned about the infant's prognosis and ongoing care. The nurse should explain that: A. the prognosis is excellent and the shunt is permanent B. the shunt will need to be revised as the child gets older. C. during the first year of life, any brain damage that has occurred is reversible. D. hydrocephalus is usually self-limiting by 2 years of age and the shunt will then be removed.

B. the shunt will need to be revised as the child gets older.

A child with hydrocephalus is increasingly irritable, lethargic, and having seizures, changes in vital signs, and feeding behavior. These signs may indicate: A. improving condition B. worsening condition C. expected outcomes D. concurrent respiratory distress

B. worsening condition

A child is diagnosed with intussusception. The nurse anticipates that which of the following would be attempted first to reduce this condition? a) Upper endoscopy b) Endoscopic retrograde cholangiopancreatography c) Surgery d) Barium enema

Barium enema A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.

A nurse is doing a postoperative assessment on an infant who has just had a ventriculoperitoneal shunt placed for hydrocephalus. Which assessment would indicate a malfunction in the shunt?

Bulging fontanel

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the child's younger brother had when he was an infant. The nurse should base her response on which of the following? a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.

D H. influenzae type B meningitis has been virtually eradicated in areas of the world where the vaccine is administered routinely. Bacterial meningitis remains a serious illness in children. It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases. The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms. Meningitis is an extension of a variety of bacterial infections. No genetic predisposition exists. Vaccinations are not available for all of the potential causative organisms.

A nurse is doing a postoperative assessment on an infant who has just had a ventriculoperitoneal shunt placed for hydrocephalus. Which assessment would indicate a malfunction in the shunt? A. Incisional pain. B. Movement of all extremities. C. Negative Brudzinski's sign. D. Bulging fontanel.

D. Bulging fontanel.

The nurse suspects a child is having an adverse reaction to a blood transfusion. What should the nurse's first action be? A. Notify the physician. B. Take vital signs and blood pressure and compare them with baseline values. C. Dilute infusing blood with equal amounts of normal saline. D. Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

D. Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

A 4-year-old child is being evaluated for hydrocephalus. An early indication of hydrocephalus in the child would be: A. bulging fontanels B. rapid enlargement of the head C. shrill, high-pitched cry D. early morning headache.

D. early morning headache. Rationale:head enlargement, bulging fontanels wouldn't be observed after 12-18 months due to closure of sutures. Shrill, high pitched cry is late-stage symptom.

A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. The nurse should recognize that this is: A. absence seizure. B. generalized seizure. C. status epilepticus. D. simple partial seizure.

C. status epilepticus.

The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The child will be managed medically. What actions would the nurse incorporate into the teaching plan?

- Keeping the child upright for 30 minutes after feeding - Giving the child small frequent feedings - Administering prokinetics to empty the stomach quickly

The nurse is teaching a parent preventive measures for decreasing the risk of urinary tract infections in their child. Which statement by the parent demonstrates an understanding of the preventive teaching? "I will have to redo the toilet training of my child after this to prevent another infection." "I will use soy milk instead of dairy milk to prevent future UTIs." "I will avoid giving my child citrus juices to drink." "I will use an antiseptic disposable wipe to cleanse my child after a bathroom visit to avoid future UTIs."

"I will avoid giving my child citrus juices to drink."

Which is the most common cause of diarrhea in children under 5? 1 Rotavirus 2 Salmonella 3 Escherichia coli 4 Clostridium difficile

1 The most common cause of diarrhea in children under 5 is rotavirus. There is a high incidence of Salmonella species and Escherichia coli in the summer months, but rotavirus is the most common cause of diarrhea in children under 5. Clostridium difficile is associated with alteration of normal intestinal flora by antibiotics.

While caring for a 9-year-old female in Buck's traction, which of the following actions by the nurse is correct? 1) The nurse encourages the child's 3 year-old sibling to sit on the bed and visit with the child. 2) The nurse helps the child learn how to raise and lower the head of her bed so she can complete her homework. 3) The nurse checks the capillary refill on the child's extremities every 4 hours. 4) The nurse teaches the child's mother to place the weights on the bedside table before the child uses the bedpan.

3)Extra visitors should not be invited on the bed- especially a toddler who may think the weights at the end of the bed are toys. The head of the bed should only be raised or lowered with physician's orders, and this should be done minimally. The weights should ALWAYS be hanging freely.

The nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which question to the mother should elicit information about the cause of this disease? 1."Has your child had any diarrhea?" 2."Have you noticed any rashes on your child?" 3."Did your child recently complain of a sore throat?" 4."Did your child sustain any injuries to the kidney area?"

3."Did your child recently complain of a sore throat?" Group A beta-hemolytic streptococcal infection is a cause of glomerulonephritis. Often the child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The questions to the mother in options 1, 2, and 4 are unrelated to a diagnosis of glomerulonephritis.

A nurse should expect which cerebral spinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis? Select all that apply. a. Elevated white blood count (WBC) b. Decreased protein c. Decreased glucose d. Cloudy in colore. Increase in red blood cells (RBC)

ANS: A, C, D FeedbackCorrect The CSF laboratory results for bacterial meningitis include elevated WBCcounts, cloudy or milky in color, and decreased glucose.Incorrect The protein is elevated and there should be no RBCs present. RBCs arepresent when the tap was traumatic.

A child with a mild traumatic brain injury is being sedated with a mild sedative so that pain and anxiety are minimized. The nurse should:

Place a continuous-pulse oximetry monitor on the child.Place the child in a room near the nurse's station.

What is the most important nursing consideration related to congenital hypothyroidism? A. Early identification of the disorder B. Facilitation of parent-infant attachment C. Initiation of referrals for mental retardation D. Help for parents in dealing with the child's future prospects

A. Early identification of the disorder. Early diagnosis of congenital hypothyroidism is imperative. Because brain growth is complete by 2 to 3 years of age, the thyroid hormone deficiency must be detected and replacement therapy begun as soon as possible to prevent long-term or life-threatening complications.The promotion of parent-infant attachment is important with all infants.With appropriate intervention, the child may not have any developmental deficit.With appropriate intervention, the child may not have any developmental deficit.

Which of the following should the nurse include in the teaching? (Select all that apply). A. Offer frequent feedings B. Thicken formula with rice cereal C. Use a bottle with a one-way valve D. Position baby upright after feedings E. Use a wide-based nipple for feedings

A. Offer frequent feedings B. Thicken formula with rice cereal D. Position baby upright after feedings

A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply) A. Vomiting B. Jaundice C. Swelling of the face D. Persistent diaper rash E. Failure to gain weight

ADE

What is the most appropriate nursing action when a child is in the tonic phase of a generalized tonic-clonic seizure? a. Guide the child to the floor if standing and go for help. b. Turn the child's body on the side. c. Place a padded tongue blade between the teeth. d. Quickly slip soft restraints on the child's wrists.

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

Prolonged seizure activity, in the form of either a single seizure lasting 30 minutes or recurrent seizures lasting more than 30 minutes, with no return to a normal level of consciousness is known as _________________.

ANS:status epilepticus The nurse caring for this patient should be aware that the causes of status epilepticus aremany. Acute CNS injury from head trauma, meningitis, or electrolyte imbalance frequentlyprecipitate status epilepticus.

The nurse is administering several medications to an infant with neurologic impairment and delay. Which medication is a proton pump inhibitor that is administered for gastroesophageal reflux? 1. Omeprazole 2. Ranitidine 3. Phenytoin 4. Glycopyrrolate

Answer: 1Rationale 1: Omeprazole is the proton pump inhibitor that blocks the action of acid-producing cells and is used to treat gastroesophageal reflux. Ranitidine causes the stomach to produce less acid and may be used to treat gastroesophageal reflux, but it is a histamine-2 receptor blocker. Phenytoin is an anticonvulsant used to treat seizures, and glycopyrrolate is an anticholinergic agent used to inhibit excessive salivation.

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures, and antimicrobial agents. The nurse knows that antibiotic therapy will begin: a. once the diagnosis is confirmed. b. when the medication is received from pharmacy. c. after the child's fluid and electrolyte balance is stabilized. d. as soon as the practitioner is notified of the culture results.

B Antimicrobial therapy is begun as soon as a presumptive diagnosis is made. The choice of drug is based on the most likely infective agent. Drug choice may be adjusted when the culture results are obtained. Waiting for culture results to begin therapy increases the risk of neurologic damage. Although fluid and electrolyte balance is important, there is no indication that this child is unstable. Antibiotic therapy would be a priority intervention.

An important nursing intervention when caring for an infant with a myelomeningocele (meningomyelocele) in the preoperative stage should be to: A. Place infant supine to decrease pressure on the sac. B. Apply a heat lamp to facilitate drying and toughening of the sac. C. Measure head circumference every shift to identify developing hydrocephalus. D. Apply a diaper to prevent contamination of the sac.

C

Which of the following is the initial clinical manifestation of generalized seizures? a. Confusion b. Feeling frightened c. Loss of consciousness d. Seeing flashing lights

C Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.

A child with gastroesophageal reflux disease (GERD) is prescribed omeprazole (Prilosec) to treat this condition. The pediatric nurse understands that the mechanism of action of omeprazole (Prilosec) is which of the following? A. This medication causes food to leave the stomach faster, decreasing the reflux of gastric contents into the esophagus. B. This medication inhibits histamine at the H2 receptors in the parietal cells of the gastric mucosa and leads to a reduction in secretion of gastric acid. C. This medication binds to the surface of the gastrointestinal tract, creating a physical barrier that protects the gastrointestinal tract from stomach acid. D. This medication binds to the proton pump, inhibiting acid secretion by the parietal cells of the stomach lining.

D

Which best describes acute glomerulonephritis? A. It requires a low protein diet as part of the treatment regimen B. It occurs after a lower urinary tract infection C. It is associated with anomalies of the GU tract D. It occurs after a streptococcal infection

D

Following surgery for the insertion of a shunt for hydrocephalus, the infant demonstrated irritability, high-pitched cry, elevated pulse rate, and temperature of 40 degrees C (104 degrees f). These symptoms are consistent with which of the following postoperative complications? A. shunt obstruction B. increased intracranial pressure C. decreased intracranial pressure D. infection

D. infection

The nurse is discussing the diagnosis of intussusception with a group of peers. Which of the following is an accurate statement regarding this disorder? a) The infant is pale, cries weakly, and has spasms of pain continuously. b) The disorder is seen most often in female infants under the age of 3 months. c) The stools of the infant are called currant jelly stools and consist of blood and mucous. d) There is a telescoping of the lower part of the bowel up over the upper part of the bowel.

The stools of the infant are called currant jelly stools and consist of blood and mucous. In the child with intussusception, the stools consist of blood and mucus, thereby earning the name currant jelly stools. There is a telescoping of the upper portion of the bowel slipping over the lower portion.The condition occurs more often in boys than in girls and the highest incidence occurs in infants between the ages of 4 and 10 months. The infant who previously appeared healthy and happy suddenly becomes pale, cries out sharply, and draws up the legs in a severe colicky spasm of pain. This spasm may last for several minutes, after which the infant relaxes and appears well until the next episode, which may occur 5, 10, or 20 minutes later.

Which of the following is a clinical manifestation of increased intracranial pressure (ICP) in infants? a. Irritability b. Photophobia c. Vomiting and diarrhea d. Pulsating anterior fontanel

a

The nurse has just started assessing a young child who is febrile and appears very ill. There is hyperextension of the child's head (opisthotonos), with pain on flexion. What is the priority action? a. Refer for immediate medical evaluation .b. Continue assessment to determine cause of neck pain. c. Ask parent when neck was injured. d. Record "head lag" on assessment record and continue assessment of child.

a. Refer for immediate medical evaluation

The Glasgow Coma Scale consists of an assessment of a. pupil reactivity and motor response. b. level of consciousness and verbal response. c. eye-opening and verbal and motor response. d. intracranial pressure and level of consciousness

c

The nurse is assessing a child with suspected necrotizing enterocolitis. Which of the following would the nurse expect to find? Select all that apply. a) Tachypnea b) Bilious vomiting c) Clay-colored stools d) Hyperirritabilitye) Abdominal distention

• Abdominal distention• Bilious vomiting Assessment findings associated with necrotizing enterocolitis include abdominal distention and tenderness, bloody stools, feeding intolerance characterized by bilious vomiting, sepsis, lethargy, apnea, and shock.

Following a hypospadias repair, the 10-month-old child returns from the operating room with a urethral stent. It is now four hours since the child's surgery. Which assessment finding should be reported to the surgeon? 1. The infant has bloody urine 2. The infant has voided one time since returning from surgery. 3. The infant seems to be having bladder spasms that respond favorably to anticholinergic medications. 4. Double diapering the infant has resulted in the stent being free from stool contamination.

2 A 10-month-old will void more often than one time in four hours. This could indicate the stent is occluded. The surgeon should be notified.

The nurse is caring for a patient diagnosed with a meningocele. The nurse should perform all of the following actions except: 1) Documenting the presence of a sac protruding from the lower spinal column. 2) Documenting the presence of clear fluid draining from the meningocele. 3) Encouraging fluids hourly. 4) Measuring head circumference every shift.

2)This may indicate a CSF leak and should be reported

The most common complication associated with myelomeningocele is: 1. Learning disability. 2. Urinary tract infection. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown.

2. Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection

The nurse is teaching parents of​ school-age children practices that should decrease the risk of urinary tract infections​ (UTIs). Which information should the nurse​ include?​" Encourage juices to increase the acidity of the​ child's urine." ​"Avoid large amounts of dairy in the​ child's diet."​ "Encourage the child to void five to six times a​ day."​ "Provide drinks with sugar substitutes when​ possible."

​"Encourage the child to void five to six times a​ day." The information the nurse can include in the teaching to prevent UTIs in children is to encourage them to void five to six times a day. Infrequent​ voiding, which is common in​ school-age children, results in incomplete emptying of the bladder and urinary​ stasis, both of which are factors in the development of UTIs. Dairy is associated with an increased risk of​ UTIs, but it is not the major contributing factor for UTIs in children. Juices and sugar substitutes in drinks are associated with UTIs.

The mother of an infant who just underwent cleft lip repair tells the nurse, "He seems restless. May I hold him?" What information influences the nurse's response? 1. Holding may meet needs and reduce tension on the suture line. 2. Sedation limits activity and decreases tension on the suture line. 3.Handling may increase irritability, causing tension on the suture line. 4. Arm movements cannot be controlled, placing tension on the suture line.

1 Touching and cuddling provide a sense of well-being and relieve strain on the suture line that results from restlessness and crying. It is inappropriate to sedate an infant for its calming effect or to decrease activity. Careful handling will not damage the suture line. Arm movement can be controlled by applying elbow restraints to prevent the infant's hands from touching the suture line.

A child has sustained a traumatic brain injury and is being monitored in the pediatric intensive-care unit. The nurse is using the Glasgow Coma Scale to assess the child. What will the nurse be assessing for this scale? Select all that apply. A. Eye opening. B. Verbal response. C. Motor response. D. Head circumference. E. Pulse oximetry.

ABC

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.

A nursing instructor is observing a nursing student caring for an infant with a diagnosis of bladder exstrophy. The nursing student provides appropriate care to the infant by performing which action? 1.Covering the bladder with a dry sterile dressing 2.Covering the bladder with a wet-to-dry dressing 3.Applying sterile water soaks to the bladder mucosa 4.Covering the bladder with a nonadhering plastic wrap

4.Covering the bladder with a nonadhering plastic wrap Care should be taken to protect the exposed bladder tissue from drying while allowing drainage of urine. This is best accomplished by covering the bladder with a nonadhering plastic wrap. The use of wet-to-dry dressings should be avoided because this type of dressing adheres to the mucosa and may damage the delicate tissue when removed. Sterile dressings and dressings soaked in solutions can also dry out and damage the mucosa when removed.

The nurse is planning care for a school-age child with bacterial meningitis. Which of the following should be included? a. Keep environmental stimuli to a minimum. b. Have child move head from side to side at least every 2 hours. c. Avoid giving pain medications that could dull sensorium. d. Measure head circumference to assess developing complications.

A The room is kept as quiet as possible and environmental stimuli are kept to a minimum. Most children with meningitis are sensitive to noise, bright lights, and other external stimuli. The nuchal rigidity associated with meningitis would make moving the head from side to side a painful intervention. If pain is present, the child should be treated appropriately. Failure to treat can cause increased intracranial pressure. In this age-group the head circumference does not change. Signs of increased intracranial pressure would need to be assessed.

An infant diagnosed with hydrocephalus is observed to demonstrate: a.Shrunken ventricles b.Bulging fontanels c.Retarded head growth d.Decreased production of cerebrospinal fluid

ANS: B During the early weeks of life, the head begins to grow at an abnormal rate. Significant dilation of the ventricles may occur before an abnormal increase in head growth develops. The fontanels enlarge and become full and bulging. Cerebrospinal fluid production does not decrease.

Which of the following problems is most often associated with myelomeningocele? A. Biliary atresia B. Hydrocephalus C. Craniosynostosis D. Tracheoesophageal fistula

Answer: b. Hydrocephalus is a frequently associated anomaly in 80% to 90% of children.

An important nursing intervention when caring for an infant with a myelomeningocele (meningomyelocele) in the preoperative stage should be to:

Measure head circumference every shift to identify developing hydrocephalus.