Peds final
The prevention of aspirational pneumonia
. A child with severe cerebral palsy is admitted to the hospital with aspiration pneumonia. What is the most beneficial educational information that the nurse can provide to the parents?
A lateral neck x-ray is a definitive test to diagnose epiglottitis. The child is at risk for complete airway obstruction and should always be accompanied by a nurse to the x-ray department
. Which is diagnostic for epiglottitis?
Keeping an extra month's supply of all medications, along with a prefilled syringe of hydrocortisone, will enable the family to treat an impending adrenal crisis before it gets severe.
A child with Addison disease takes oral cortisol supplements and receives monthly injections of desoxycorticosterone acetate injections. What teaching should be done at each visit for the injections?
Offer clear, cool liquids
A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled antiemetic. Which of the following should the nurse do when the child is nauseated?
"Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly."
A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation?
Fractures of the growth plate are serious, as they can disrupt the growth process.
A nurse is caring for a 5-year-old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that:
Give Demerol 25 mg intravenously every 4 hours as needed for pain. Restrict oral fluids
A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply.
Urine output
A nurse is caring for an infant who is very fussy and has a diagnosis of diabetes insipidus (DI). Which parameter should the nurse monitor while the infant is on fluid restrictions?
A 20-degree spinal curve that is nonprogressive will not disfigure or interfere with normal functioning, so it is not treated with bracing or surgery
A spinal curve of less than ________ degrees that is nonprogressive does not require treatment for scoliosis.
The dosages may need to be increased in times of stress.
A teen comes into the clinic with complaints of having been under a lot of stress recently. The teen is being treated for Addison disease and is taking cortisol and aldosterone orally. Today, the teen shows symptoms of muscle weakness, fatigue, salt craving, and dehydration. What should the nurse discuss with the teen regarding the medications?
General post-operative nursing interventions include assessing for pain. Specific to scoliosis surgery, logrolling is the means of changing positions. It is essential to check neurological status in a patient who just had scoliosis surgery. General post-operative nursing interventions include assessing vital signs.
A 13-year-old just returned from surgery for scoliosis. Which nursing intervention(s) is/are appropriate in the first 24 hours? Select all that apply
A normal respiratory rate for a child from 3 to 6 years is 20 to 30 breaths per minute.
A 3-year-old admitted to the hospital with croup has the following vital signs: heart rate 90, respiratory rate 44, blood pressure 100/52, and temperature 98.8°F (37.1°C). The parents ask the nurse if these vital signs are normal. The nurse's best response is:
Bone marrow aspirate
A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over varies area of the body. The physician suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following?
The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.
A 5-year-old is brought to the ER with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for?
Edema, numbness or tingling, and pain are early signs of compartment syndrome. Edema, numbness or tingling, and pain are early signs of compartment syndrome. A weak pulse is a late sign of compartment syndrome.
A 6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. Which is/are an early sign(s) of compartment syndrome in this child? Select all that apply.
In DI, fluid restriction does not cause urine concentration.
A 7-year-old is tested for diabetes insipidus (DI). Twenty-four hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale, with a low specific gravity. Which is the most likely reason for this?
Calcium gluconate via slow intravenous push
A child diagnosed with acute renal failure (ARF) complains of "not feeling well," having "butterflies in the chest," and arms and legs "feeling like Jell-O." The cardiac monitor shows that the QRS complex is wider than before and that an occasional premature ventricular contraction (PVC) is seen. Which would the nurse expect to administer?
Vasopressin.
A child has been diagnosed with a midline brain tumor. In addition to showing signs of increased intracranial pressure (ICP), she has been voiding large amounts of very dilute urine. Which medication does the nurse expect to administer?
Destroys abnormal lymphocytes.
Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan?
High protein and calcium and low potassium and phosphorus.
The diet for a child with chronic renal failure (CRF) should be high in calories and include:
Diabetes insipidus is different from diabetes mellitus.
The family of a young child has been told the child has diabetes insipidus (DI). What information should the nurse emphasize to the family?
Initial WBC on diagnosis
The mother of a child who is newly diagnosed with ALL asks the nurse "What is the prognosis?" Which of the following is correct regarding prognostic factors for determining survival for such a child?
DI is treated with vasopressin on a lifelong basis.
The nurse caring for a 14-year-old girl with diabetes insipidus (DI) understands which of the following about this disorder?
High-calorie liquids are sometimes received better when the child has a poor appetite. Offering favorite foods can sometimes tempt the child to eat, even with a poor appetite. Small, frequent meals might increase daily caloric intake.
The nurse caring for a child with osteomyelitis assesses poor appetite. Which intervention(s) is/are most appropriate for this child? Select all that apply
"My child will have to use the bathroom more often than other children."
The nurse has completed discharge teaching for the family of a 10-year-old diagnosed with diabetes insipidus (DI). Which statement best demonstrates the family's correct understanding of DI?
Cheese, banana slices, rice cakes, and whole milk.
The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals?
30 minutes before the feeding.
The nurse is caring for a 4-month-old with gastroesophageal reflux (GER). The infant is due to receive Zantac (rantadine). Based on the medication's mechanism of action, when should this medication be administered?
Eliminates excess iron
The nurse is caring for a child diagnosed with thalassemia major who is receiving the first chelation therapy. What information should the nurse teach the parent regarding the therapy
Only the affected kidney will be removed.
The nurse is caring for a child due for surgery on a Wilms tumor. The child's procedure will consist of which of the following?
Anemia Infection
The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply.
Adm o2
The nurse is caring for a child with sickle cell anemia who has a vaso-occlusive crisis. Which of the following interventions should improve tissue perfusion?
The procedure is done to prevent further sickling during a vaso-occlusive crisis.
The nurse is caring for a child with sickle cell anemia who is scheduled to have an exchange transfusion. What information should the nurse teach the family?
"The baby is always hungry after vomiting so I refeed."
The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis?
"Pyloric stenosis can run in families. It is more common among males."
The nurse is caring for an infant with pyloric stenosis. The parent asks if any future children will likely have pyloric stenosis. Select the nurse's best response.
Aplastic crisis, splenic sequestration, Vaso occlusive crisis
The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply
In a recent fracture, the nurse should assess pain and provide treatment. Pain, pallor, and weak or absent pulses are all signs of compartment syndrome. Weak or absent pulse is a sign of compartment syndrome, so monitoring capillary refill is important in assessment. Pain, pallor, and weak or absent pulses are signs of compartment syndrome. Pain should be treated
Nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes which of the following? Select all that apply
Providing a high-protein, high-calorie diet. Encouraging exercise. Minimizing pulmonary complication. Encouraging medication compliance.
What does the therapeutic management of cystic fibrosis (CF) patients include? Select all that apply
The use of the flexible nasal tube. Nasal congestion causes this route to be ineffective. The medication should be administered every 8 to 12 hours. Overmedication results in signs of SIADH
What should the parent of a child with diabetes insipidus (DI) be taught about administering desmopressin acetate nasal spray? Select all that apply
Take the child outside into the more humid night air for 15 minutes.
What would the nurse advise the parent of a child with a barky cough that gets worse at night?
Blood cultures will be obtained. Pus will be aspirated from the subperiosteum. Antibiotics will be given via an intravenous line.
When a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? Select all that apply
Depletion of phosphorus and calcium stores from the bones.
Which best describes the electrolyte imbalance that occurs in chronic renal failure (CRF)?
The teen who has been vomiting for several days and is unable to tolerate oral fluids and medication should be admitted for intravenous hydration
Which child diagnosed with pneumonia would benefit most from hospitalization?
6-year-old who has high fever, no spontaneous cough, and frog-like croaking
Which child is in the greatest need of emergency medical treatment?
Mild proteinuria, hematuria, decreased urinary output, and lethargy.
Which combination of signs is commonly associated with glomerulonephritis?
Because bacteria from an open wound can lead to osteomyelitis, thorough cleaning with soap and water is the best prevention.
Which is most important when teaching a parent about preventing osteomyelitis?
Epiglottitis is bacterial in nature and requires intravenous antibiotics. A 7- to 10-day course of oral antibiotics is usually ordered following the intravenous course of antibiotics.
Which is the nurse's best response to the parent of a child diagnosed with epiglottitis who asks what the treatment will be?
It can occur at any age but is seen most often between the ages of 2 and 5 years. It can occur on its own or can be associated with many congenital anomalies.
Which is true of a Wilms tumor? Select all that apply.
Leg pain Fever. Bruising Enlarged lymph nodes
Which of the following can be manifestations of leukemia in a child? Select all that apply.
Assess the central nervous system for infiltration. Give intrathecal chemotherapy
Which of the following is a (are) reason(s) to do a spinal tap on a child with a diagnosis of leukemia? Select all that apply
Intrathecal chemotherapy
Which of the following should be done to protect the central nervous system from the invasion of malignant cells in a child newly diagnosed with leukemia?
Lying on the left side may provide the patient with the most comfort. Lying on the left splints the chest and reduces the pleural rubbing.
Which position would be most comfortable for a child with left-sided pneumonia?
Albuterol.
Which should the nurse administer to provide quick relief to a child with asthma who is coughing, wheezing, and having difficulty catching her breath?
The capsules may be opened and sprinkled over acidic food.
Which should the nurse include in teaching parents about administrating pancreatic enzymes to their child?
Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. Suggest that the parents burp the infant after every 1-2 ounces consumed.
Which should the nurse include in the plan of care to decrease symptoms of gastroesophageal reflux (GER) in a 2-month-old? Select all that apply
Children with bacterial pneumonia are usually sicker than children with viral pneumonia. Children with bacterial pneumonia can be treated effectively, but they require a course of antibiotics.
Which statement about pneumonia is accurate?
"I should administer two quick puffs of the albuterol inhaler using a spacer."
Which statement by the parent of a child using an albuterol inhaler leads the nurse to believe that further education is needed on how to administer the medication?
Pain in an extremity leads to resistance to movement. Pain is frequently severe in osteomyelitis. Fever is present in the acute phase of the illness. Redness and swelling occur because of the infection.
Which would the nurse assess in a child diagnosed with osteomyelitis? Select all that apply.
Obtain stool sample and prepare child for jejunal biopsy
Which would the nurse expect to be included in the diagnostic workup of a child with suspected celiac disease?
Increased blood pressure, normal temperature, and a firm mass located on one side of the midline of the abdomen.
Which would the nurse expect to find on assessment in a child with Wilms tumor?
Prepare the child for an IV infusion.
A 12-year-old with type 2 diabetes mellitus presents with a fever and a 2-day history of vomiting. The nurse observes that the child's breath has a fruity odor and breathing is deep and rapid. Which should the nurse do first?
If a patient does not respond to an appropriate antibiotic within 48 hours, surgery may be indicated.
A 10-year-old with osteomyelitis has been on intravenous antibiotics for 48 hours. The child is allergic to amoxicillin. Vital signs are T 101.8°F (38.8°C), BP 100/60, P 96, R 24. Which is the primary reason for surgical treatment?
Children this age are very conscious of their appearance and fitting in with their peers, so they might be very resistant to wearing a brace.
A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long?
Physiological needs take priority over other needs; therefore, hypotension is the priority need.
An adolescent is received in the pediatric intensive care unit after scoliosis surgery. Using Maslow's Hierarchy of Needs as a guide, which problem takes priority?
Retention of sodium and water.
Chronic hypertension in the child who has chronic renal failure (CRF) is due to which of the following?
"Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."
The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" Which is the nurse's best response?
"The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems."
The parent of a child being evaluated for celiac disease asks the nurse why it is important to make dietary changes. Select the nurse's best response
Infection through the bloodstream is the most likely cause of osteomyelitis in a child.
The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. Which is the nurse's best response?
Younger children have less developed immune systems and usually exhibit worse symptoms than older children
The parent of a child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asks the nurse why this child is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response?
ARF is often reversible, whereas CRF results in permanent deterioration of kidney function.
The parents of a 7-year-old tell the nurse they do not understand the difference be- tween chronic renal failure (CRF) and acute renal failure (ARF). Which is the nurse's best response?
