Peds final review
The mother of a 14-year-old girl states to the nurse that her daughter is moody, shuts herself in her room, and fights with her younger sister. Which comment is most valuable to the mother? "This is normal for her age." "Set some rules for family etiquette." "Calmly talk to her about your concerns." "She may be hanging with a bad crowd."
"Calmly talk to her about your concerns." Rationale: Getting the mother and daughter talking and sharing information is the most valuable advice. Telling the mother that this is normal does nothing for the family situation. Setting rules will alienate the child. Suggesting an underlying problem can cause a rift between the mother and daughter.
The nurse is taking a health history of a child with suspected acute post-streptococcal glomerulonephritis. Which response by the client's parent will the nurse highlight for the primary health care provider as an indicator for this condition? "My child just got over a head cold with laryngitis." "My child's has recently reported urinary frequency." "My child's urine is pale yellow in color." "My child's eyes appear sunken to me."
"My child just got over a head cold with laryngitis." Rationale: Known risk factors include a recent episode of pharyngitis or other streptococcal infection, decreased urine output, rust or cola colored urine, and swelling around the eyes. Edema may occur in the abdomen, face, eyes, feet, ankles, hands, or generally.
During a health maintenance visit, a 15-year-old girl mentions that she is not happy with being overweight. Which approach is best for the nurse to take? "Tell me about your parents. Are they overweight?" "Don't worry; you are within the weight and height guidelines." "Good observation. Let's talk about diet and exercise." "What specifically have you been noticing?"
"What specifically have you been doing?" Rationale: It is best to find out what caused the teenager to make the comment so that you can work with her about the issue. This is an assessment and must be done first. Launching into a lecture on diet and exercise will be of no value if the teenager wants to talk about dealing with snide comments from her peers. Telling the teenager she is statistically in the normal range for weight and height may close the conversation prematurely. The focus is on the teenager, not her parents. Obtaining that information would be important, but not at this time.
The nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which statement describes a developmental milestone occurring in infancy? -By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. -Most infants triple their birthweight by 4 to 6 months of age and quadruple their birthweight by the time they are 1 year old. -The head circumference increases rapidly during the first 6 months: the average increase is about 1 inch per month. -The heart triples in size over the first year of life; the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.
-By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth.
Susan Ant is a 12 year old admitted the Pediatric unit with a 6 hour history of wheezing. The mother reports a history of cold-like symptoms for the past 48 hours. She has not eaten her usual amount the past few days since she has been sick. ALLERGIES: Penicillin (causes rash and hives) Vital Signs: Pulse: 100; Resp: 22; O2 sat: 95%; Temp: 101.8; BP: 110/64; weight: 83.6 lbs Medication Orders:1. Methylprednisolone 15mg IVP q 6 hrs2. Albuterol 0.6ml in 3ml NS per nebulizer every 15 minutes x 3, then q 4 hrs3. NS 20ml/kg IV bolus over 1 hour4. D51/2NS with 20mEq KCL at 81.7 ml/hr after NS bolus completed5. Acetaminophen 15mg/kg PO for temp > 101 prn q 4 hrs (do not exceed 5 doses in 24 hours); Available: 160mg/5ml6. Ibuprofen 10mg/kg PO q6h prn for continued temp >101 if not relieved with Acetaminophen Calculate how many mL of Methylprednisolone to give. Available: 20mg/mL
0.75 mL
Susan Ant is a 12 year old admitted the Pediatric unit with a 6 hour history of wheezing. The mother reports a history of cold-like symptoms for the past 48 hours. She has not eaten her usual amount the past few days since she has been sick. ALLERGIES: Penicillin (causes rash and hives) Vital Signs: Pulse: 100; Resp: 22; O2 sat: 95%; Temp: 101.8; BP: 110/64; weight: 83.6 lbs Medication Orders:1. Methylprednisolone 15mg IVP q 6 hrs2. Albuterol 0.6ml in 3ml NS per nebulizer every 15 minutes x 3, then q 4 hrs3. NS 20ml/kg IV bolus over 1 hour4. D51/2NS with 20mEq KCL at 81.7 ml/hr after NS bolus completed5. Acetaminophen 15mg/kg PO for temp > 101 prn q 4 hrs (do not exceed 5 doses in 24 hours); Available: 160mg/5ml6. Ibuprofen 10mg/kg PO q6h prn for continued temp >101 if not relieved with Acetaminophen Calculate how many mL of Acetaminophen to give. Available 160mg/5mL
17.8 mL
For the following question use case scenario below: Susan Ant is a 12 year old admitted the Pediatric unit with a 6 hour history of wheezing. The mother reports a history of cold-like symptoms for the past 48 hours. She has not eaten her usual amount the past few days since she has been sick. ALLERGIES: Penicillin (causes rash and hives) Vital Signs: Pulse: 100; Resp: 22; O2 sat: 95%; Temp: 101.8; BP: 110/64; weight: 83.6 lbs Medication Orders:1. Methylprednisolone 15mg IVP q 6 hrs2. Albuterol 0.6ml in 3ml NS per nebulizer every 15 minutes x 3, then q 4 hrs3. NS 20ml/kg IV bolus over 1 hour4. D51/2NS with 20mEq KCL at 81.7 ml/hr after NS bolus completed5. Acetaminophen 15mg/kg PO for temp > 101 prn q 4 hrs (do not exceed 5 doses in 24 hours); Available: 160mg/5ml6. Ibuprofen 10mg/kg PO q6h prn for continued temp >101 if not relieved with Acetaminophen Calculate how many mg of Ibuprofen to give and how many mL to administer. Available: 100mg/5mL
19 mL
Susan Ant is a 12 year old admitted the Pediatric unit with a 6 hour history of wheezing. The mother reports a history of cold-like symptoms for the past 48 hours. She has not eaten her usual amount the past few days since she has been sick. ALLERGIES: Penicillin (causes rash and hives) Vital Signs: Pulse: 100; Resp: 22; O2 sat: 95%; Temp: 101.8; BP: 110/64; weight: 83.6 lbs Medication Orders:1. Methylprednisolone 15mg IVP q 6 hrs2. Albuterol 0.6ml in 3ml NS per nebulizer every 15 minutes x 3, then q 4 hrs3. NS 20ml/kg IV bolus over 1 hour4. D51/2NS with 20mEq KCL at 81.7 ml/hr after NS bolus completed5. Acetaminophen 15mg/kg PO for temp > 101 prn q 4 hrs (do not exceed 5 doses in 24 hours); Available: 160mg/5ml6. Ibuprofen 10mg/kg PO q6h prn for continued temp >101 if not relieved with Acetaminophen Calculate the amount of NS bolus to infuse
760 mL
While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate? A girl's urethra is longer than a boy's urethra. Girls have smaller bladder size than boys do. Her kidneys are less well protected. A girl's urethra is closer to the rectal opening.
A girl's urethra is closer to the rectal opening. Rationale: In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination. Bladder size does not differ between boys and girls. The kidneys are less well protected in the abdomen, increasing the risk for injury but not UTIs.
The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? A less discriminating sense of taste A lack of fully developed hearing Visual acuity that has not fully developed A less discriminating sense of touch
A less discriminating sense of taste
The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which topic would be most appropriate? -Advising how to create a toddler-safe home -Warning about small objects left on the floor -Cautioning about putting the baby in a walker -Telling about safety procedures during baths
Advising how to create a toddler-safe home
After teaching the parents of a child with chickenpox (varicella zoster), the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time? Once the rash appears After the lesions have crusted over When the rash is completely gone After day #5 of the rash
After the lesions have crusted over Rationale:
The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the healthcare provider to order? Corticosteroids Retinoids Antifungals Antibiotics
Antifungals Rationale: Candidal diaper rash would require a fungicide like nystatin. The nurse would expect to administer topical antifungals as ordered. Corticosteroids are not typically recommended for young infants and are used for atopic dermatitis and certain types of contact dermatitis. Antibiotics would be ineffective against fungal infections. Retinoids are indicated for moderate to severe acne.
A nurse reports an incident of suspected child abuse. One of the parents of the child becomes upset and demands to know the reason for the nurse's action. Which of the following responses by the nurse is appropriate? As a nurse, I am required by law to report suspected child abuse. I am unable to discuss this, but I can contact my supervisor to speak with you. I reported the case because I don't like your tone. The doctor will be coming to explain the situation.
As a nurse, I am required by law to report suspected child abuse. Rationale: A nurse is required by law to report suspected child abuse. Therefore, this is a truthful, non-accusatory response.
A nurse is caring for a child who has red marks across his cheeks. Which of the following actions should the nurse take? Assess the rest of the child's body for a rash Question the parents about how the marks occurred on the child's cheeks. Obtain the child's temperature Refer the family to child protective services
Assess the rest of the child's body for a rash Rationale: Fifth disease presents with erythema on the face, which resembles slap marks. The nurse should further assess the child's body and extremities to determine if the child has Fifth disease.
Poppy, a 5-month-old female has been in the PICU x 2 days for respiratory distress. She is on room air, feeding well, but is increasingly fussy today. Her vital signs at last check were T99 F, HR 165, R 65, BP 80/48, SPO2 90% RA. Poppy has copious nasal mucus, intercostal retractions, head bobbing, and grunting. Re-evaluation shows vital signs of T 100 F, HR 60, RR 10 with see-saw pattern, BP 48/28, SPO2 82% RA. Select all of the actions the RN will perform after recognizing the cues of cardiopulmonary arrest. Begin CPR with 30 compressions to 2 breaths Provide SBAR report to code team upon arrival. Open airway and ventilate with bag-mask valve Begin chest compressions at a rate of 100/min using 2-thumbs encircling hands technique Call code and ask for crash cart
Begin CPR with 30 compressions to 2 breaths Provide SBAR report to code team upon arrival. Open airway and ventilate with bag-mask valve Call code and ask for crash cart
The adolescent continues to develop self-concept and self-esteem. What is most important to a teen's self-esteem? Spirituality Body image Strong authority figures Morals and values
Body image Rationale: Self-concept and self-esteem are tied to body image many times. Adolescents who perceive their body as being different than peers or as less than ideal may view themselves negatively. Sexual characteristics are important to the adolescent's self-concept and body image. Authority figures, spirituality, and morals and values play a role in development of self-esteem, but body image is most influential in the development of self-concept/self-esteem.
What is the most preventable injury in children and the 4th leading cause of death in children between 1-4 yrs of age? Burns Respiratory disease Drowning Non-accidental trauma
Burns
A nurse is caring for a child who has acute glomerulonephritis. Which of the following actions is the nurse's priority? Educate the parents about potential complications. Check the child's weight every day at the same time, on the same scale. Maintain a saline lock. To place the child on a no-salt added diet.
Check the child's weight every day at the same time, on the same scale. Rationale: The first action the nurse should take using the nursing process is to assess the child. Therefore, checking the child's weight daily is the priority.
The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which information would the nurse include in her teaching plan? Teachers are the most influential people in the development of the school-age child's social network. Continuous peer relationships provide the most important social interaction for school-age children. Parents should establish norms and standards that signify acceptance or rejection. A characteristic of school-age children is their formation of groups with no rules and values involved.
Continuous peer relationships provide the most important social interaction for school-age children.
When describing the various changes that occur in organ systems during adolescence, what would the nurse include? Decrease in activity of sebaceous glands Significant increase in brain size Decrease in heart rate Ossification completed later in girls
Decrease in heart rate Rationale: During adolescence, the heart rate decreases while the systolic blood pressure increases. Brain growth continues, but the size of the brain does not increase significantly. Ossification is more advanced in girls and occurs at an earlier age. Sebaceous gland activity increases during adolescence.
A nurse is preparing to begin chest compressions on an infant. The nurse should perform compressions using which of the following techniques? Deliver compressions just above the nipple line. Deliver compressions with the heel of one hand. Deliver compressions at ⅓ the depth of the chest. Deliver compressions at a depth of 5 cm (2 in).
Deliver compressions at ⅓ the depth of the chest. Rationale: The proper depth of chest compressions for an infant is ⅓ the depth of the chest, which is approximately 1 ½ inches.
The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned? Can copy a square on another piece of paper Can dress and undress herself without help Draws a person with three body parts Is beginning to tie her own shoelaces
Draws a person with three body parts Rationale: At this age they should be able to draw 5 body parts.
A nurse is assessing a child who has nephrotic syndrome. Which of the following findings should the nurse expect? Smokey brown urine Facial edema Hypertension Polyuria
Facial edema Rationale: The glomerular membrane is permeable to albumin, which is excreted and changes the colloidal osmotic pressure. Therefore, facial edema is a manifestation of nephrotic syndrome.
When assessing adolescents for health risks, the nurse must keep in mind the factors related to the prevalence of adolescent injuries. What accurately describes these factors? Select all that apply. Increased physical growth Peer pressure Lack of impulsivity Insufficient psychomotor coordination Inexperience Tiredness, lack of energy
Increased physical growth Peer pressure Insufficient psychomotor coordination Inexperience Rationale: Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes.
A nurse is assessing an infant following a motor vehicle crash. Which of the following findings should the nurse monitor to identify increased intracranial pressure? Increased sleeping Brisk pupillary reaction to light. Tachycardia Depressed fontanels
Increased sleeping Rationale: Following a head injury, an infant's level of consciousness can deteriorate, show signs of excessive sleeping, and eventually go into a coma. They can also have nausea and vomiting, pupils can be unequal and unreactive to light.
The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which task would the nurse expect the toddler to be able to perform? -Completing puzzles with four pieces -Winding up a mechanical toy -Playing make-believe with dolls -knowing which toys are hers/his
Knowing which are his or her toys
A nurse is teaching new parents the proper way to use an infant safety seat. Which of the following should indicate to the nurse a need for further teaching? We will need to go by the weight and height of the child when deciding to change to a booster seat My baby will be able to watch me drive while sitting in the back seat. I will dress my baby in a one piece outfit so I can use the harness to secure her in the car seat. I will place the infant safety seat in the middle of the back seat, away from the windows.
My baby will be able to watch me drive while sitting in the back seat. Rationale: The safest area for a car seat is in the back seat. Infants should travel in a rear-facing position for the best protection from airbags and neck and head injury. While in a rear-facing position, the back of the car seat supports the infant's weak neck muscles, soft fontanels, and spine in the event of a frontal motor vehicle crash.
A nurse is assessing a child and notes several bruises. Which of the following actions should the nurse take? Obtain a detailed history. Report the suspected abuse to the authorities. Separate the child from the parents. Ask a psychiatrist to talk with the parents.
Obtain a detailed history. Rationale: The nurse should obtain a detailed history in order to assess for other indicators of abuse.
A nurse is educating new parents about risk factors for sudden infant death syndrome (SIDS). Which of the following statements should indicate to the nurse the need for additional teaching? We will place my baby on her back when sleeping. Our baby will sleep in our bed because I am breastfeeding. We will give my baby a pacifier during naps and at bedtime. We will remove blankets and toys from the crib.
Our baby will sleep in our bed because I am breastfeeding. Rationale: Allowing an infant to sleep in the same bed as an adult can lead to suffocation and falls. The parent should place the infant back in her crib or bassinet after breastfeeding.
A child is diagnosed with scarlet fever. The nurse is reviewing the child's medical record, expecting which medication to be prescribed for this child? Ibuprofen Penicillin V Doxycycline Acyclovir
Penicillin V Rationale: Penicillin V is the antibiotic of choice for the treatment of scarlet fever. Ibuprofen is used to treat fever. Acyclovir is used to treat viral infections. Doxycycline, a tetracycline, is the drug of choice for treating Rocky Mountain spotted fever.
A nurse is weighing a 2-month-old infant in the clinic. To ensure safety, which action is most appropriate? Have the parent hold the child while standing on an adult scale. Place the baby in the scale and place one hand on top of the baby. Place the baby in the scale and hold one hand just over the baby. Prop the infant sitting up in the scale, then weigh the prop separately.
Place the baby in the scale and hold one hand just over the baby.
The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which nursing intervention should be questioned? Monitor fluid intake and output Administer antipyretics as ordered Keep the child's fingernails short Provide alcohol baths as needed
Provide alcohol baths as needed. Rationale: Treatments such as sponging the child with alcohol or cold water are not appropriate interventions for fever management. Rather, the nurse would use tepid sponge baths and cool compresses. Administering antipyretics, keeping the child's fingernails short, and monitoring intake and output are appropriate.
The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. What advice might be helpful for these parents? -School-age children are not ready to absorb information that deals with drugs and alcohol. -School-age children can think critically to interpret messages seen in advertising, media, and sports. -Parents must prevent their child from being exposed to messages that are in conflict with their values. -Discussions with children need to be based on facts and focused on the past and future.
School-age children can think critically to interpret messages seen in advertising, media, and sports.
The nurse is caring for a 2 month old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance? Promoting the digestibility of breast milk Telling how and when to introduce rice cereal Describing root reflex and latching on Advising how to choose a good formula
Telling how and when to introduce rice cereal
The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? -The child has trouble undressing himself. -The child is unable to push a toy lawnmower. -The child is unable to unscrew a jar lid. -The child falls when he bends over.
The child is unable to push a toy lawnmower.
The nurse is supervising lunch time for preschool children on a pediatric ward. Which observation is considered abnormal for this age group? The child has a full set of primary teeth. The child has no difficulty chewing and swallowing meat. The child uses his fingers and refuses to use a fork. The child is a picky eater.
The child uses his fingers and refuses to use a fork.
The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child? The newborn's eyes wander and occasionally are crossed. The newborn does not respond to a loud noise. The newborn's eyes focus on near objects. The newborn becomes more alert with stroking when drowsy.
The newborn does not respond to a loud noise.
The leading cause of death in children and adolescents is/are: Unintentional injuries Non-accidental trauma Lymphoma and other cancers Firearms
Unintentional injuries
The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of what happening? Viewing her baby sister's illness as her fault Harming the baby Experiencing clinical depression Creating an imaginary friend to cope with the situation
Viewing her baby sister's illness as her fault
A nurse is assessing the skin of a child with cellulitis. What would the nurse expect to find? Honey-colored exudate Papules progressing to vesicles Red, raised hair follicles Warmth at skin disruption site
Warmth at skin disruption site Rationale: Cellulitis is manifested by erythema, pain, edema, and warmth at the site of skin disruption. Red and raised hair follicles would indicate folliculitis. Honey colored exudate is indicative of impetigo. Papules that progress to vesicles are common in varicella.
A nurse is assisting with the admission of a child who has measles. Which of the following isolation precautions should the nurse initiate? Airborne Protective environment Contact Droplet
airborne Rationale: The nurse should initiate airborne precautions for a child who has measles, which is transmitted via droplet nuclei smaller than 5 microns. The nurse should place the child in a negative-pressure airflow room and wear a mask when providing client care.
The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). In educating the parents, the nurse would recommend that the child avoid: A liberal fluid intake Cotton underwear Cranberry juice Caffeine
caffeine Rationale: Caffeine is an irritant to the bladder and should be avoided. Liberal fluid intake and cranberry juice should be encouraged. The child should wear cotton underwear to avoid perineal irritation.
A nurse is caring for a 3-year-old child who has had 160 mL of urine output over the past 8 hr period. The child weighs 33 lb. Which of the following actions should the nurse take? Notify the provider Continue to monitor the client Perform a bladder scan at the bedside. Provide oral rehydration fluids
continue to monitor the client Rationale: This urine output is within the expected reference range for a toddler. The child's urine output should be greater than 1 mL/kg/hr. The client weighs 33 lb, which converts to 15 kg. 15 kg x 8 hr = 120 mL. This client's output indicates an adequate amount of urinary output during 8 hr. Other signs of adequate fluid volume are moist mucous membranes, capillary refill of 2 seconds or less, brisk skin turgor, balanced fluid intake and output, and electrolytes within expected range.
A 6-month-old girl weighs 14.7 pounds (6.7 kg) during a scheduled check-up. Her birth weight was 8 pounds (3.6 kg). What is the priority nursing intervention? Talking about solid food consumption Discouraging daily fruit juice intake Increasing the number of breast feedings Discussing the child's feeding patterns
discuss the child's feeding patterns
A 6-month-old girl weighs 14.7 pounds (6.7 kg) during a scheduled check-up. Her birth weight was 8 pounds (3.6 kg). What is the priority nursing intervention? Talking about solid food consumption Discouraging daily fruit juice intake Increasing the number of breast feedings Discussing the child's feeding patterns
discussing childs feeding patterns
The school nurse is performing a physical examination on a 13-year-old boy who is on the soccer team. What is a physical quality that develops during these early adolescent years? Coordination Endurance Accuracy Speed
endurance Rationale: It is usually during early adolescence that teenagers begin to develop endurance. Their concentration has increased so they can follow complicated instructions. Coordination can be a problem because of the uneven growth spurts. During middle adolescence, speed and accuracy increase while coordination also improves.
Based on Erikson's developmental theory, what is the major developmental task of the adolescent? Mastering motor skills Finding an identity Gaining independence Coordinating information
finding an identity Rationale: According to Erikson, it is during adolescence that teenagers achieve a sense of identity. The toddler developed a sense of trust in infancy and is ready to give up dependence and to assert his or her sense of control and autonomy. The psychosocial task of the preschool years is establishing a sense of initiative versus guilt by mastering skills. In the school-age years the child develops concrete operations and is able to assimilate and coordinate information about the world from different dimensions.
A nurse is caring for a school-age child who has acute glomerulonephritis with peripheral edema and is producing 35 mL of urine per hour. The nurse should place the client on which of the following diets? Low-carbohydrate, low-protein diet Low-sodium, fluid-restricted Low-protein, low-potassium diet Regular diet, no added salt
low-sodium, fluid restricted Rationale: A low-sodium, fluid-restricted diet will prevent complications.
The nurse is providing suggestions to a female adolescent about foods to help meet her nutritional requirements for iron. Which food would the nurse suggest as a good source of iron? Peanut butter Broccoli White beans Yogurt
peanut butter Rationale: Peanut butter is a good source of iron. Broccoli, yogurt, and white beans are good sources of calcium.
A nurse is assessing a toddler who has acute nephrotic syndrome. Which of the following findings should the nurse report to the provider? Poor appetite Yellow nasal drainage Irritability Facial edema
yellow nasal drainage Rationale: Yellow or green nasal discharge is an indication of an upper respiratory infection. Children who have nephrotic syndrome are at constant risk for infection. The nurse should report this manifestation to the provider so the child can receive appropriate and prompt treatment.
