Random Questions

Priority Nurse Action: Poisoning Treatment Order of interventions

1. Assess the child (vitals and ABC) 2. terminate exposure to poison 3. ID poison 4. take measure to prevent absorption of poison 5. Document

A pediatric client experiences status epilepticus. In what sequence should the nurse perform the following actions? -Insert two large gauge IV catheters -Check blood glucose levels -Turn client into recovery position -Provide respiratory support -Give lorazepam (Ativan) IV as ordered

1. Provide respiratory support 2. Insert two large gauge IV catheters 3. Give lorazepam (Ativan) IV as ordered 4. Check blood glucose level 5. Turn client into recovery position

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? A. watery diarrhea B. ribbon-like stools C. profuse projectile vomiting D. bright red blood and mucus in stool

4: Bright red blood and mucus in stool Bright red blood and mucus are passed through the rectum, and commonly are described as currant jelly-like stools. The child will have severe abdominal pain that is crampy and intermittent. Intussusception can reduce itself on its own and not require surgical intervention.

Lead levels and their interventions

<5: normal! 20-44: coordinate care, treatment 45-69: care and clinical management within 48 hours >70: treatment asap

What should the initial bolus of crystalloid fluid replacement for a pediatric patient in shock? A. 20 ml/kg B. 10 ml/kg C. 30 ml/kg D. 15 ml/kg

A. 20 ml/kg Fluid volume replacement must be calculated to the child's weight to avoid overhydration. Initial fluid bolus is administered at 20 ml/kg, followed by another 20 ml/kg bolus if there is no improvement in fluid status. Shock is a life-threatening manifestation of circulatory failure. Circulatory shock leads to cellular and tissue hypoxia resulting in cellular death and dysfunction of vital organs.

The nurse is instructing the parents of a child diagnosed with CF on how to perform chest physiotherapy. What should the nurse include in these instructions? A. ask the child to cough before changing to a different position B. administer the prescribed bronchodilator after the therapy C. start with the lower lobes and progress to the upper lobes D. use a cupped hand when performing the physiotherapy over the sternum

A. ask the child to cough before changing to a different position Cup the hand and steadily clap a specific area on the chest wall for 3-5 minutes. Next, the child should be instructed to cough forcefully to get the mobilized mucus out of the lungs. The child should be placed in different positions every few minutes so that mucus from different areas of the lungs can be removed. Chest physiotherapy should be done BEFORE meals or 2-3 hours AFTER eating to prevent n/v. Bronchodilators, if ordered, should be done BEFORE therapy to promote mucus clearance. Therapy should start in the upper lobes to make space for mucus in lower lobes to pass through.

thalassemia

An inherited defect in ability to produce hemoglobin, leading to hypochromia (pink colored RBCs).

Which clinical finding would the nurse expect when assessing an infant with pyloric stenosis? A. board like abdomen B. visible peristaltic waves C. decreased bowel sounds D. cramping movements in lower abdomen E. olive shaped mass in RUQ

B and E

The child with HIV has immunosuppression. Which vaccines can be given safely at this time? A. varicella B. Hep A C. Polio (IPV) D. MMR E. DTaP

B, C, E Varicella and MMR should not be given because they are LIVE vaccines. Hep A, Polio and DTaP are not live vaccines

Baby Melody is a neonate who has a very-low-birth-weight. Nurse Josie carefully monitors inspiratory pressure and oxygen (O2) concentration to prevent which of the following? A. meconium aspiration syndrome B. bronchopulmonary dysplasia C. respiratory syncytial virus D. respiratory distress syndrome

B. bronchopulmonary dysplasia

Which of the following would be inappropriate when administering chemotherapy to a child? A. monitoring the child for both general and specific adverse effects B. observing the child for 10 minutes to note for signs of anaphylaxis C. administering the med througha free-flowing IV line D. assessing for signs of infiltration, infusion and irritation

B. observing the child for 10 minutes to note for signs of anaphylaxis When administering chemotherapy, the nurse should observe for an anaphylactic reaction for 20 minutes and stop the medication if one is suspected. Anaphylaxis is a severe allergic reaction, which can cause shock, low blood pressure, and occasionally death. Food allergies, including allergy to peanuts and tree nuts, are said to account for the majority of fatal or near-fatal anaphylactic reactions in the U.S.A. Care is taken especially when chemotherapy medications are known to be common allergic reaction producers, to premedicate to prevent or lessen the reaction.

The nurse is instructing about cow's milk allergy to the parents of a 5 month old infant. What statements should the nurse include? SATA A. exclusively breastfeeding will solve the problem if he develops the allergy B. soy-based formula is a good alternative for infants <6 months with the allergy C. lactase supplements help infants digest milk product better D. most babies will outgrow the allergy in a few years E. cow's milk should be avoided until the infant is 1 year old

D, E Cow's milk allergy is typically transient, and by age 5 majority of children has regained tolerance to cow's milk protein. Never give cow's milk to a child less than 1 because it can put them at risk for iron deficiency anemia.

Characteristics of diabetic ketoacidosis

-Hyperglycemia that progresses to metabolic acidosis -Blood glucose is greater than 300 mg/dL -Manifestations: Kussmaul respirations, fruity (acetone) odor of breath, increasing lethargy and decreasing LOC

Important post-op interventions for imperforate anus

-Side-lying prone position with hips elevated OR supine position with legs at a 90 degree angle to the trunk to reduce edema and pressure on the surgical site -Colostomy care

Clinical manifestations of thalassemia

1. Frontal bossing 2. Maxillary prominence 3. Wide set eyes and flattened nose 4. Green/yellow skin 5. Hepatosplenomegaly 6. Severe anemia 7. Microcytic, hypochromic RBC

Three main effects of leukemia on the body

1. anemia (depressed bone marrow, decreased erythrocytes) 2. neutropenia 3. thrombocytopenia (decreased platelet)

Priority Nursing Actions: Hypoglycemia in a Hospitalized Child with Diabetes Mellitus What are the steps?

1. check blood glucose level 2. give the child 1/2 cup of fruit juice or other acceptable item 3. take the child's vital signs 4. retest the blood glucose (in 15 minutes) 5. give the child a small snack of a carbohydrate AND protein 6. document

4 steps of chestphysiotherapy

1. postural drainage: have child lie or sit in multiple positions with the head below the lungs to allow gravity to help drain the secretions from the alveoli and bronchioles into the bronchi 2. percussion: forceful tapping techniques for 3-5 minutes on the child's chest wall with cupped hands 3. vibration: use flat hands to create a fine shaking motion. this should be done while the child breathes deeply at least 3 times. 4. Coughing: cough deeply and expectorate any loosened secretions

von Willebrand's disease, what is it characterized by?

A hereditary bleeding disorder characterized by defect in protein called von Willebrand factor. Causes bleeding from mucous membranes. (epistaxis, gum bleeding, easy bruising, excessive menstrual bleeding)

The nurse is instructing a newly graduate nurse on the care of a child diagnosed with sickle cell anemia and is admitted for a vaso-occlusive crisis. What should be included in the teaching? A. never palpate the child's abdomen during a crisis B. promoting tissue oxygenation is the main nursing objective C. long term oxygen supply is needed to reduce sickling of the RBC D. prophylactic antibiotics are indicated until the child turns 5 E. applying cool compresses can reduce joint pain

A, B, D Palpating the abdomen could cause rupture of the spleen due to sequestration of RBC in this organ. Hypoxia leads to metabolic acidosis and sickling of the RBC so promoting tissue oxygenation is super important. Penicillin prophylaxis is indicated in all children younger than 5 to prevent pneumococcal infection. Long-term supply oxygen would suppress normal RBC production, so short-term is better.

The nurse provides health teaching on Albuterol (Proventil) metered-dose inhaler to an adolescent child. What should be included in these instructions? A. take 2 puffs every 4-6 hours prn B. palpitations and shakiness are common side effects of this med C. keep the medication in the glove box of a car when not in use D. wash and dry mouthpiece at least once a week E. if your symptoms are severe and do not improve within 15 minutes, take another dose of the med

A, B, D, E A: 2 puffs every 4-6 hours as needed is the recommended dose for adolescents and adults. Maxiumum therapeutic effect occurs after 60-90 minutes. B: palpitations and shakiness are common side effects of Proventil. D: It should be cleaned at least once a week. E: During an acute asthma attack, the client should be instructed to take 2-4 inhalations every 15-20 minutes for 3 doses at home. If the dyspnea improves, dosing can be spaced out to every 3-4 hours. Medication should be stored away from heat and direct sunlight.

The nurse is teaching the parents of an infant girl with a rash in the diaper area for the past ten days. What instructions should the nurse include? A. use a topical antifungal as prescribed B. clean the perineal area with a wipe ASAP after passing stool C. lay the infant on a towel without a diaper several times each day D. apply baby powder after each diaper change E. watch for white patches in your baby's mouth that won't rub off

A, C, E Common causes of diaper rash include irritant or allergic contact dermatitis, candida (yeast), seborrheic dermatitis or bacterial superinfection of a pre-existing rash. Treatment consists of topical anti-fungals twice daily for 2-3 weeks or until 1 week after the rash has cleared. Laying the child on a towel will allow area to air dry and speed up healing/ The infant has an increased risk for developing oral candidiasis or thrush. Do not use wipes they can be irritating. Baby powder can be irritating and can be inhaled and cause respiratory problems.

12-year-old Caroline has recurring nephrotic syndrome. Which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care? A. body image B. sexual maturation C. muscle coordination D. intellectual development

A. body image Because of edema associated with nephrotic syndrome, potential self-concept, and body image disturbances related to changes in appearance and social isolation should be considered. Nephrotic syndrome is a condition that causes the kidneys to leak large amounts of protein into the urine. This can lead to a range of problems, including swelling of body tissues and a greater chance of catching infections.

When visiting a family with a newborn the nurse notes the activity of another child who is 4 years old. The nurse suggests that the parents have the child evaluated for muscular dystrophy. What did the nurse observe? A. child performed Gowers' manuever B. child has genu valgum C. child pushed a table chair with both arms D. child bended over when fixing socks and tying shoes

A. child performed Gower's manuever This is a manifestation of Duchenne muscular dystrophy. The child uses the arms to move into a position to get up off the floor. Genu valgum (knocking knees) is normal in 3-5 years old

What is the most common cause of ophthalmia neonatorum in infants born to adolescent mothers? A. chlamydia B. gonorrhea C. human papilloma virus D. herpes simplex virus

A. chlamydia

Nurse Elena is handling a 7-year-old child who has cystitis. Which of the following would Nurse Elena expect when assessing the child? A. dysuria B. costovertebral tenderness C. flank pain D. high fever

A. dysuria Dysuria is a symptom of a lower urinary tract infection (UTI) such as cystitis. Common symptoms include frequency, dysuria, urgency, suprapubic pain, cloudy urine, hematuria, nausea, vomiting, and fever. A history is the most important tool for the diagnosis of acute uncomplicated cystitis, and it should be supported by a focused examination and urinalysis.

The nurse is teaching a high school student about scoliosis treatment options. On which priority information would the nurse focus? A. effect on body image B. least invasive treatment C. continuation with schooling D. maintenance of contact with peers

A. effect on body image Establishing an identiy is related to the affirmation of self-image. To achieve this task, there is a need to conform to group norms, one of which is appearance.

The emergency room nurse is evaluating a 5-year-old child with a mild fever and series of rapid coughs followed by a whooping sound on inspiration. After confirming the suspected diagnosis by PCR test, what action should the nurse take? A. file a report with the National Notifiable Diseases Surevillance System B. abstain from using tongue depressor or culture swab C. Ask about Hib vaccination status D. order nothing by mouth to prevent aspiration

A. file a report A series of rapid coughs followed by a high-pitched whooping sound on inspiration is characteristic of pertussis, or whooping couhg. This disease is highly communicable and should be reported. Vaccination against pertusseis is called DTaP.

The nurse in the pediatric clinic is reviewing the health history of a 6 year old child with celiac disease who has been on the dietary regimen for 6 months. Which evaluation criterion would the nurse use to assess the child's adherence to the diet? A. formed bowel movements B. ability to handle stressful situations C. understanding of the disease process D. knowledge of foods allowed on the diet

A. formed bowel movements Steatorrhea disappears, replaced by formed bowel movements when the child adheres to the diet. Even when the child understands the disease process, adherence to the diet may be relaxed, and as a result, s/s may recur.

The nurse analyzes lab values of a child who has leukemia and is receiving chemo. The nurse notes the platelet count is 19,500 mm. What intervention should be included in the plan of care? A. initiate bleeding precautions B. monitor for signs of infection C. monitor temperature every 4 hours D. initiate protective isolation precautions

A. initiate bleeding precautions. A platelet count of less than 20,000 mm indicates the child is severely thrombocytopenic and needs bleeding precautions because of increased risk for hemorrhage and increased risk of bleeding.

Which of the following is most likely associated with a cerebrovascular accident (CVA) resulting from congenital heart disease? A. polycythemia B. cardiomyopathy C. endoraditis D. low BP

A. polycythemia The child with congenital heart disease develops polycythemia resulting from an inadequate mechanism to compensate for decreased oxygen saturation. Secondary erythrocytosis of cyanotic congenital heart disease (CCHD) is pathologically different from primary erythrocytosis of polycythemia vera (PV). An association between elevated hematocrit and thrombosis has been established in PV patients, and treatment guidelines recommend maintaining hematocrit <45%.

The school nurse is planning disease prevention strategies for the upcoming school year. Which strategy should be included for female students between the ages of 10 and 13? A. Screen for scoliosis B. instructions on menstruation C. benefits of PAP smear D. important of obtaining vaccination with IPV (inactivated poliovirus)

A. screen for scoliosis Scoliosis occurs most often in girls during the growth spurt between ages 10 and 13. Menstruation is a normal milestone, and there are no diseases that can be talked about. PAP smears don't happen until 21.

The mother of a toddler tells the nurse that she is concerned the child will not want to come home from the hosptial because the child doesn't cry when the mother leaves each day. What explanation should the nurse provide for the child's behavior? A. the child is likely being distracted by staff when the mother leaves to make it easier for her and the child B. most children become accustomed to being in the hospital C. many children prefer the controlled evr of the hospital than at home D. the child knows the mother will return so there's no reason to show emotion

A. the child is likely being distracted by staff when the mother leaves to make it easier for her and the child Toddlers will cry when being separated from their parents. The toddler developmentally will not know that the mother will return.

The nurse is reassessing an infant with plagiocephaly. Which observation indicates that this disorder is improving? A. the infant's head is less flat B. the infant's head is less twisted C. the infant's neurological symptoms are improving D. the infant's upper lip is healed

A. the infant's head is less flat Plagiocephaly is asymmetrical flattening of the occiput due to sleeping on the back. Sleeping on the back is recommended to prevent SIDS. Tummy time and helmets can prevent permanent flattening.

Which outcome indicated ROM exercises have been effective for a child with JIA? A. the knees are more mobile B. the pedal pulses are stronger C. subcutaneous nodules at the joints recede D. the child states that the pain is diminished

A. the knees are more mobile The exercises are done to preserve function by mobilizing restricted joints. Circulation is not affected by the arthritic process. Exercise does not affect the nodules. The exercises are done to restore joint function, they do not necessarily relieve pain.

The nurse is counseling the parents of a newborn with bilateral cryptorchidism on the need for orchiopexy surgery. Which statement regarding the condition is correct? A. it's recommended to wait 4-6 months to see if condition resolves spontaneously B. the surgery will reverse the risk of reduced fertility completely C. the baby needs surgery asap to prevent testicular cancer later in life D. the baby will need hormonal replacement therapy until the surgery

A. wait 4-6 months to see if it resolves Cryptochism: failure of testes to descent fully into scrotum. In 80% of infants with this, the testes will descent in the first 6 months of life. Time for surgery is around 6 months and no later than 1 year. Even after orchiopexy, the patient is at risk for testicular cancer and at risk for reduced fertility.

A 3-year-old client with a diagnosis of Duchenne Muscular Dystrophy is seen in clinic. When taking the client's history, which symptoms should the nurse expect the parent to describe? SATA A. decreased muscle tone B. clumsiness with frequent falls C. enlarged calf or thigh muscles D. walking on toes or balls of feet E. muscle weakness in face and shoulders

B, C, D Clumsiness with frequent falls, enlarged calf or thigh muscles and walking on toes or balls of feet. Onset of symptoms occur around age 2/3. Symptoms include muscle weakness (core muscles, then distal limb muscles), difficulty walking, running and jumping, enlargement of calves or thighs, a waddling gait, late walking, falling down frequently. This can lead to impaired pulmonary function and acute respiratory failure and death.

A school nurse is reviewing a medication routine with a student with asthma. Which statement suggests the asthma is poorly controlled? A. I use my Flovent (flucticasone) inhaler twice per day B. I use my ProAir (albuterol) inhaler before bed each night C. I use my resuce inhaler before running track in gym class D. I need to use a spacer when I use my inhalers or they don't seem to work as well

B. I use my ProAir (albuterol) inhaler before bed each night Most commonly in asthma, short acting bronchodilators like albuterol are used to quickly and temporarily relieve constriction of the bronchioles and improve breathing. With more persistent or severe symptoms, daily usage of inhaled corticosteroids (like fluticasone) prevents the lungs from being as easily triggered. Using albuterol at night indicates the child is having nighttime symptoms like coughing, which is a sign of poorly controlled asthma. Flovent (fluticasone) is an inhaled corticosteroid that is used for long term management of asthma and should be used twice daily regardless of symptoms. ALL inhalers are recommended to be used with spacers/chambers.

A 2 year old toddler has hearing loss caused by recurrent otitis media. Which treatment would the nurse anticipate that the practitioner will recommend? A. eardrops B. myringotomy C. Mastoidectomy D. steroid therapy

B. Myrinogotomy Myringotomy is a surgical opening into the eardum to permit drainage of accumulated fluid associated with otitis media.

Niklaus was born with hypospadias; which of the following should be avoided when a child has such condition? A. surgery B. circumcision C. intravenous pyelography (IVP) D. catheterization

B. circumcision Hypospadias refers to a condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface (underside) of the penile shaft. The ventral foreskin is lacking, and the distal portion gives an appearance of a hood. Early recognition is important so that circumcision is avoided; the foreskin is used for surgical repair.

A six year old is recovering from a cardiac catheterization and will be returning home in a few hours. What should the nurse instruct the parents about the client's care? A. restrict oral fluids for 5 days B. encourage quiet play for 24 hours C. expect bleeding at the site for 3 days D. keep on bed rest for 48 hours at home

B. encourage quiet play for 24 hours Quiet play prevents the clot to break and free, causing bleeding. Oral fluids should be encouraged. Bleeding at the site should be reported immediately. Bedrest should occur for the first 4-6 hours after surgery.

A child undergoes surgical removal of a brain tumor. During the post-op period, the nurse notes that the child is restless, the pulse rate is elevated, and the BP has decreased significantly. The nurse suspects the child is in shock. What is the most appropriate nursing action? A. place child in supine B. notify the HCP C. place the child in Trendelenburg D. increase flow of IV fluids

B. notify the HCP In the event of shock, the NCP is notified ASAP before the nurse changes the child's position or increases fluids. After craniotomy, the child is never placed in supine or Trendelenburg because it increases ICP. IV fluids can't be increased without an order.

A mother is concerned that her 3 year old child is not developing appropriately for the child's age. Which of the following assessment findings indicate appropriate gross motor ability for a 3 year old? A. learning to dress self B. walks up and down the stairs C. scribbles on paper D. uses push and pull toys

B. walks up and down the stairs A and C are fine motor skills. Using pushing and pull toys is a gross motor skill for 1-2 year olds. Gross motor skills applicable for a 3 year old include ability to jump, kick a ball, and walk up and down stairs.

The mother of a toddler being treated for head lice tells the nurse that the child continues to scratch the head after receiving the medicated shampoo. Which of the following should the nurse respond to this mother? A. did you rinse the shampoo in a minute as prescribed? B. did you apply the shampoo to dry hair as indicated? C. wait a few days since it takes up to a week for the shampoo to be effective D. scalp itching is a side effect of the shampoo

B: Did you apply the shampoo to dry hair? Applying to wet hair can dilute the product and reduce effectiveness. Waiting a few days will cause the child's condition to get worse.

The nurse should implement which interventions for a child older than 2 years old with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL? Select all that apply! A. administer regular insulin B. encourage the child to ambulate C. Give the child a teaspoon of honey D. provide electrolyte replacement therapy IV E. wait 30 mintues and confirm the blood glucose reading F. prepare to administer glucagon subcutaneously if unconsciousness occurs

C and F Give the child a teaspoon of honey Prepare to administer glucagon subq if unconsciousness occurs

The nurse is caring for a 3 year old with repeated episodes of rash around his mouth and nose. What instruction should the nurse provide to the child's parents? A. apply an antifungal cream to the lesions twice a day B. apply warm compresses and gently scrape off the crusted lesions C. both parents will need to have a nasal swab sent for a culture D. the child may continue attending day care while using the prescribed treatment for the rash

C. both parents will need to have a nasal swab sent for a culture. Impetigo is a common skin infection seen in kids aged 2-5 due to staph aureus. If the rash is recurring despite treatment, it is likely someone in frequent contact is a carreir of the bacteria.

The nurse suspects that a 4 year old child might be suffering from growth hormone deficiency. Which finding is most consistent with this diagnosis? A. child's weight and height dropped below the 5th percentile B. radiographic examination shows retarded bone maturation C. child has short stature and developmental delays D. child's heigh dropped 3 percentile points

C. child's height dropped 3 percentile points A drop of 2 percetnage point or more on the growth scale in a child over 3 years of age indicates a growth anomaly. Growth hormone deficiency manifests after the 2nd year of life. Below 5th percentile means failure to thrive. Children with growth hormone deficiency are usually well fed and weight is in normal range.

During a routine health visit the nurse suspects a 2 month old is experiencing hypothyroidism. What did the nurse assess in the infant? A. constant crying B. rapid heart rate C. cool extremities D. rapid arm and leg movement

C. cool extremities

The nurse is caring for a child returning from a cardiac catheterization through the femoral artery for management of a congential heart defect. What action should the nurse include in this child's plan of care? A. replace pressure dressing with an adhesive bandage B. provide a regular diet after the procedure C. maintain bedrest for at least 4 hours with the bed flat D. prepare to discharge child home once vital signs are stable

C. maintain bedrest for at least 4 hours with the bed flat After a cardiac catheterization, the child should be kept on bed rest for at least 4 hours with the leg straight to allows the artery/vein to heal and minimize bleeding. The pressure dressing should remain in place during post-op, and the nurse ewill assess the puncture site every 30 minutes and the size of bleeding should be marked. The pressure dressing can be removed 24 hours after the procedure and replaced with an adhesive bandage for the following 3 days. Clear liquids should be provided before a full diet to avoid n/v.

The nurse is caring for a patient with a patent ductus arteriosus (PDA). Which statement regarding this condition is incorrect? A. this is an acyanotic congenital heart condition B. thie infant's caloric needs are higher C. Prostaglandin E1 therapy is indicated D. a machine like murmur can be heard over the heart

C. prostaglandin E1 therapy is indicated Prostaglandin E1 is used to maintain an open ductus arteriosus in ductus dependent congenital heart disease. In infants with PDA, blood is shunted back into the pulmonary circulation which interferes with peripheral blood flow and predisposing the child to pulmonary HTN and edema. The goal is close the ductus and treatment with prostaglandin would keep it open. The heart condition is acyanotic since the blood that's shunted through the ductus has passed pulmonary circulation and is rich in oxygen.

The nurse is assessing a child diagnosed with dyskinetic CP. Which finding is the nurse most likely to assess in this client? A. exaggerated deep tendon reflexes B. increased muscle tone C. uncontrollable writhing or jerking movements D. wide-base unsteady gait

C. uncontrollable writing or jerking movements Exaggerated deep tendon reflexes and increased muscle tone are characteristic of spastic CP. A wide-base unsteady gait is ataxic CP. Dyskinetic CP presents with twisting, uncontrolled, abrupt muscle movements.

The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder? A. bile-stained fecal emesis B. the passage of currant jelly-like stools C. failure to pass meconium stool in the first 24 hours after birth D. sausage shaped mass palpated in the upper right abdominal quadrant

C: failure to pass meconium stool in the first 24 hours after birth The defect should be seen easily. Other assessment findings include absence or stenosis of the anal rectal canal, presence of an anal membrane, and an external fistula to the perineum

A school age child is prescribed phenytoin (Dilanton) to control seizures. What should the nurse instruct the parents regarding this medication? A. avoid sunlight B. monitor vision because of night blindness C. take the child for frequent dental checkups D. restrict food products with calcium and vitamin D

C: take the child for frequent dental check ups Dilantin can cause gingival hyperplasia. An adequate intake of vitamin D and calcium is needed while taking this medication.

Jones Criteria Major

Carditis Polyarthritis Chorea Erythema marginatum Subcutaneous nodules

What are the three C's that would lead to a diagnosis of esophageal atresia and tracheoesophageal fistula?

Coughing and Choking during feeds. unexplained Cyanosis

The nurse receives an order to prepare a solution for administering a cleansing enema for an adolescent client. Which is the volume of solution that would be prepared? A. 150-250 mL B. 250-350 mL C. 300-500 mL D. 500-750 mL

D. 500-750 mL The nurse would prepare 150-250 mL of warmed solution for infants. The nurse would prepare 250-350 mL of warmed solution for administering a cleansing enema in a toddler. In school-age children, the volume is 300-500 mL.

A 6 year old child is diagnosed with the 5th disease. Which statement made by the mother indicates teaching has been effective? A. the infection is the aftermath of a recent vaccination and will resolve spontaneously B. I can't bring my child to daycare until this resolves C. my child needs antibiotics for 7 days D. I shouldn't be surprised if the rash lasts weeks to months

D. I shouldn't be surprised if the rash lasts weeks to months The characteristic rash of the fifth disease, or erythema infectiosum, is self-resolving but may last weeks to months. It is caused by Parvovirus B19. No vaccine is available against this. Once the rash appears, the child is no longer contagious. The typical presentation is mild fever and cold symptoms for 3-4 days followed by a symptom free period of 10 days, after which the rash appears. Doesn't respond to antibiotics.

The nurse is instructing the mother of a school-aged child diagnosed with Lyme disease. Which of the following should the nurse include in these instructions? A. lyme disease does not cause any long-term effects if left untreated B. antibiotics are needed for 7 days after diagnosis of disease C. schedule the child for a Lyme disease vaccine D. avoid sun exposure while taking the antibiotic

D. avoid sun exposure while taking the antibiotic Lyme disease therapy could take up to 4 weeks. Avoid sun exposure. If left untreated, Lyme can cause neurologic deficits and chronic arthritis.

A health care provider prescribes an IV solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering the IV? A. obtains a weight B. takes the temperature C. takes the blood pressure D. checks the amount of urine output

D. checks the amount of urine output in hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering potassium chloride would be to assess the status of urine output. Potassium chloride should never be administered in the presence of oliguria or anuria. If the urine output is less than 1-2 ml/kg/hr, potassium chloride should not be administered.

Benjamin was rushed to the emergency department with possible increased intracranial pressure (ICP); which of the following is an early clinical manifestation of increased ICP in older children? A. Macewen's sign B. setting sun sigh C. papilledema D. diplopia

D. diplopia Diplopia is an early sign of increased ICP in an older child. Visual changes can range from blurred vision, double vision from cranial nerve defects, photophobia to optic disc edema and eventually optic atrophy. Clinical suspicion for intracranial hypertension should be raised if a patient presents with the following signs and symptoms: headaches, vomiting, and altered mental status varying from drowsiness to coma.

Which developmental characteristic would the nurse recognize as contributing to a 4-year-old child's difficulty relating to some of the children in the playroom? A. preschools engage only in parallel play B. preschoolers are extremely dependent on their parents C. fierce temper tantrums and negativism are typical behavior of preschoolers D. exaggerating and boasting to impress others are typical behaviors of preschoolers

D. exaggerating and boasting to impress others are typical behaviors of preschools It's common for a 4 year old to boast and exaggerate, be impatient, noisy and selfish. The play is cooperative play at this age. The child is striving for more initiative and less dependence. Tantrums and negativism should have waned by this age.

The clinic nurse review the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's Disease. The nurse reviews the assessment findings documented in the record, knowing which sign most likely led the mother to seek health care for the infant? A. diarrhea B. projectile vomiting C. regurgitation of feedings D. foul-smelling ribbon-like stools

D. foul-smelling ribbon-like stools

A premature newborn is intubated and receiving mechanical ventilation for acute respiratory distress syndrome. Which assessment finding indicates improvement of the client's condition? A. oxygen saturation level >95% B. flaccid muscle tone C. skin color cyanotic D. increase in urine output

D. increase in urine output Oxygen saturation levels in premature infants should be between 90-93%, higher could lead to hypoxia. An increase in urination is an early clue that the baby's condition is improving because fluid moves out of the lungs and into the bloodstream, increasing kidney perfusion.

Which of the following applies to the defect emerging from residual peritoneal fluid confined within the lower segment of the processus vaginalis? A. inguinal hernia B. incarcerated hernia C. communicating hydrocele D. noncommunicating hydrocele

D. noncommunicating hydrocele With a noncommunicating hydrocele, most commonly seen at birth, residual peritoneal fluid is trapped within the lower segment of the processus vaginalis (the tunica vaginalis). There is no communication with the peritoneal cavity and the fluid usually is absorbed during the first months after birth.

A child was brought to the emergency department with complaints of nausea, vomiting, fruity-scented breath. The resident on duty diagnosed the child with diabetes ketoacidosis. Which of the following should the nurse expect to administer? A. potassium chloride IV infusion B. Dextrose 5% IV infusion C. Ringer's lactate D. normal saline IV infusion

D. normal saline IV infusion The initial priority in the treatment of diabetic ketoacidosis is the restoration of extracellular fluid volume through the intravenous administration of a normal saline(0.9 percent sodium chloride) solution. Treatment for DKA begins with ABCs and fluid resuscitation. Insulin therapy, usually by continuous infusion, can begin once the patient is stabilized.

A child with type 1 diabetes mellitus is brought to the ED by the mother who states the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of IV infusion? A. potassium infusion B. NPH insulin infusion C. dextrose infusion D. normal saline infusion

D. normal saline infusion Rehydration is the first step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. Dextrose solutions are added to the treatment when blood glucose has decreased to an acceptable level.

Stephen was diagnosed with minimal-change nephrotic syndrome; which of the following signs and symptoms are characteristics of the said disorder? A. hypertension, edema, hematuria B. hypertension, edema, proteinuria C. gross hematuria, fever, proteinuria D. poor appetite, edema, proteinuria

D. poor appetite, edema, proteinuira Clinical manifestations of nephrotic syndrome include loss of appetite due to edema of the intestinal mucosa, proteinuria, and edema. The classic NS presentation is edema, in the early phase is located in the face in the morning on waking with puffiness of the eyelids and the impression of the folds of sheets on the skin and ankles at the end of the day.

The nurse is instructing the parents of a child diagnosed with fluid volume deficit on types of gluids to aid in rehydration. Which of the following should the nurse include in these instructions? A. provide the child with diet sodas B. provide the child with clear water C. provide the child with liquid gelatin mixture D. provide the child with half-strength juice

D. provide the child with half-strength juice Juice can be used as an oral rehydration solution howver because of sugar content, should be reduced to half strength. Full strength juice should not be used because it can promote diarrhea and more water loss. Plain water will not be absorbed as well as orange juice, since it lacks electrolytes.

You have learned that in babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. Which of the following is the most common form of DDH? A. acetabular dysplasia B. dislocation C. preluxation D. subluxation

D. subluxation DDH is a group of congenital abnormalities of the hip joints, which includes subluxation, dislocation, and preluxation. Of the types of congenital hip abnormalities, subluxation is the most common. In mild cases of DDH, the head of the femur is simply loose in the socket. During a physical examination, the bone can be moved within the socket, but it will not dislocate.

The nurse is instructing parents of a 12 year old girl diagnosed with asthma on the use of inhaled corticosteroids. Which statement indicates teaching has been effective? A. this medication should be used only in case of an exacerbation B. this medication may be addictive if used for long periods of time C. the steroids may cause acne D. this medication may cause oral yeast infections

D. this medication may cause oral yeast infections Some children develop a hoarse voice and oral yeast infections while taking inhaled corticosteroids. Rinsing the mouth after each dose will reduce the likelihood of developing that infection. Inhaled corticosteroids should be used DAILY for LONG-TERM asthma control. Systemic corticosteroids may cause acne.

What is the most serious complication of Hirschsprung's disease?

Enterocolitis Fever, severe prostration, GI bleed, explosive, watery diarrhea

Which virus is responsible for mononucleosis?

Epstein-Barr

What is phenylketonuria and what are the interventions?

Genetic disorder causing CNS damage from toxic levels of phenylalanine in the blood. >20 mg/dL is considered toxic Screenings of newborn infants. If positive, a repeat test is performed. If positive, restrict phenylalanine intake; high protein foods (meat and diary) and aspartame

Incomplete development or absence of the anus in its normal position in the perineum

Imperforate anus

Descended portion of the bowel becomes tightly caught in the hernial sac, compromising blood supply

Incarcerated hernia

Jelly-like stools: ____________ Ribbon-like and foul-smelling stools: __________

Jelly=intussusception Ribbon=Hirschsprung's

How is the diagnosis of Rheumatic Fever made?

Jones Criteria (2 major or 1 major with 2 minor)

Thalassemia is a disorder find primarily in which group of people?

Mediterranean

Which medication is not recommended for a patient with sickle cell disease?

Meperidine, due to risk of seizures

What is the antidote for acetaminophen toxicity?

N-acetylcysteine (Mucomyst)

What is the normal temperature range for a child? What is considered a fever?

Normal range: 36.4-37.0 (97.5-98.6) Fever: 38.0 (100.4)

What is the classic characteristic of Hodgkin's disease (a type of lymphoma)?

Presence of giant, multinucleated cells (Reed-Sternberg cells).

Bronchiolitis is caused by

RSV

Treatment for thalassemia

Supportive, the goal is to maintain normal hemoglobin levels by the administration of blood transfusions. Bone marrow transplant could be an option, or splenectomy for a child with severe splenomegaly who requires repeated tranfusions

Acetylsalicylic acid (aspirin) toxic dose and cure

acute: severe toxicity with 300-500 mg/kg chronic: 100 mg/kg per day for 2 days or more Cure: activated charcoal

Esophageal Atresia and Tracheoesophageal Fistula

failure of the esophagus to develop as a continuous passage during fetal development. The esophagus ends before it is supposed to reach the stomach.

sinus arrhythmia

heart rate faster upon inspiration than expiration. it is often seen in children and it decreases with age.

Neuroblastoma

highly malignant tumor of the sympathetic nervous system. Firm, nontender, irregular mass in abdomen that crosses the midline.

Rheumatic heart disease

triggered by rheumatic fever (strep throat) that leads to an autoimmune response that affects connective tissues of joints, skin, heart and CNS. the mitral valve is particularly susceptible and with time it narrows and leakage occurs. this can lead to pulmonary venous congestion

match the following: metabolic acidois/metabolic alkalosis diarrhea/vomit

vomiting=metabolic alkalosis (loss of hydrochloric acid) diarrhea=metabolic acidosis (loss of bicarb)

Assessment findings of imperforate anus

1. failure to pass meconium stool 2. absence or stenosis of the anal rectal canal 3. Presence of an anal membrane 4. External fistula to the perineum

How would patients present with lead encephalopathy?

Delirium, altered mental status, or seizures

Assessment of Hodgkins Disease

1. painless, enlarged of lymph nodes 2. "sentinel" node near left clavicle may be first enlarged or enlarged, firm, nontender, movable nodes in supraclavicular area 3. nonproductive cough 4. abdominal pain 5. Reed-Sternberg cells

Two phases for hepatitis

1. prodromal/anicteric phase -five to seven days -no jaundice -anorexia, malaise, lethargy -fever -n/v -epigastric or RUQ pain -hepatomegaly -arthralgia and rash 2. Icteric Phase -jaundice -dark urine and pale stools -pruritus

Toxic dose of acetaminophen in children

150 mg/kg or higher 2-4 hours: malaise, n/v, sweating, pallor, weak latent period 24-36 hours: child gets better hepatic involvement: may last 7 days and be permanent (RUQ pain, jaundice, elevated liver enzyme and bili levels)

The clinic nurse is reviewing the health care provider's prescription for a child who has been diagnosed with scabies. Lindane has been prescribed for the child. The nurse questions the prescription if which is noted in the child's record? A. the child is 18 months old B. the child is being bottle fed C. a sibling is using Lindane for the treatment of scabies D. the child has a history of frequent respiratory infections

A. the child is 18 months old. Lindane is a pediculicide product that may be prescribed to treat scabies. It is contraindicated for children younger than 2 years old because they have permeable skin and high systemic absorption may occur, placing the child at risk for CNS toxicity and seizures. Siblings and other household members should be treated at the same time.

The nurse is unable to quiet an infant long enough to assess breath sounds. Which of the following can the nurse assess while the infant continues to cry? A. vocal resonance and tactile fremitus at the end of each cry B. reflexes C. muscle tone D. abdominal muscle tone and bowel sounds

A. vocal resonance and tactile fremitus at the end of each cry If the infant continues to cry while attempting to assess breath sounds, the nurse can assess the sounds at the end of each cry as the infant takes a deep breath

The nurse is monitoring a 3 year old child for signs and symptoms of increased intracranial pressure after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? A. vomiting B. bulging anterior fontanelle C. increasing head circumference D. complaints of a frontal headache

A. vomiting Vomiting is an early sign of increased ICP and can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center.

The nurse is seeing a father and his school-age child for administration of the flu shot. Upon reviewing the child's records, the nurse learns that the child is HIV positive and on anti-retroviral therapy. Which action should the nurse take? A. administer flu shot to father only B. administer flu shot to both father and child C. explain that both the father and child should not take the flu shot D. explain that the child's blood work needs to be reviewed before the flu shot can be administered to the child

B. administer flu shot to both father and child Injectible influenza vaccines are approved in people with HIV. However, the live attenuated influenza vaccine (nasal spray) should never be used in people with HIV.

Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely? A. at 1 to 2 years of age B. at 1 week to 1 year of age, peaking at 2-4 months C. at 6 months to 1 year of age, peaking at 10 months D. at 6-8 weeks

B. at 1 week to 1 year of age, peaking at 2-4 months SIDS can occur any time between 1 week and 1 year of age. The incidence peaks at 2 to 4 months of age. Sudden infant death syndrome (SIDS) is the abrupt and unexplained death of an infant less than 1-year old. Despite a thorough investigation (a careful review of clinical history, death scene investigation, and a complete autopsy), a cause for the patient's demise is not identified.

Katie is admitted to the intensive care unit of Nurseslabs Medical Center for diabetic ketoacidosis. Which of the following is of primary importance when caring for the child? A. giving IV NPH insulin in high doses B. evaluating the child for cardiac abnormalities C. limiting fluids to prevent aggravating cerebral edema D. monitoring and recording the child's vital signs for hypertension

B. evaluating the child for cardiac abnormalities As the fluid volume deficit is improved, total body potassium deficiency may occur, leaving the child vulnerable to hypokalemia and, afterward, cardiac arrest. The nurse should monitor the cardiac cycle for prolonged QT interval, low T wave, and depressed ST segment, which indicate weakened heart muscle and potential irregular heartbeat.

A mother brings her 3-week old infant to a clinic for a phenylketournia rescreening blood test. The test indicated a serum phenylalnine level of 1 mg/dL (60.5 mcmol/L). The nurse reviews this result and makes which interpretation? A. it is positive B. it is negative C. it is inconclusive D. it requires rescreening at age 6 weeks

B. it is negative Phenylketonuria is a genetic (autosomal recessive) disorder that results in CNS damage from toxic levels of phenylalnine (an essential amino acid) in the blood. It is characterized by blood phenylalanine levels greater than 20 mg/dL. Normal level is 0-2 mg/dL.

A child diagnosed with intellectual disability (ID) is under the supervision of Nurse Tasha. The nurse is aware that the signs and symptoms of mild ID include which of the following? A. few communication skills B. lateness in walking C. mental age of toddler D. noticeable developmental delays

B. lateness in walking Mild intellectual disability is minimally noticeable in young children, with one of the signs being a delay in achieving developmental milestones, such as walking at a later stage. Individuals with an intellectual disability have neurodevelopmental deficits characterized by limitations in intellectual functioning and adaptive behavior. These disabilities originate and manifest before the age of 18 and can be associated with a considerable number of related and co-occurring problems.

Mrs. Cooper is concerned about her 4-month-old son's unusual condition; which of the following statements made by her would indicate that the child may have cerebral palsy? A. he holds his left leg so stiff that I have a hard time putting on diapers B. my baby won't lift his head up and look at me, he's so floppy C. my baby's left hip tilts when I pull him to stand D. i'm worried he hasnt rolled over yet

B. won't lift his head up and look at me, he's so floppy Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts his head to a 90-degree angle by age 4 months with only a partial head lag by age 2 months. Clinical signs and symptoms of cerebral palsy can include micro- or macrocephaly, excessive irritability or diminished interaction, hyper- or hypotonia, spasticity, dystonia, muscle weakness, the persistence of primitive reflexes, abnormal or absent postural reflexes, incoordination, and hyperreflexia.

Which instructions should the nurse provide when discharging an infant recovering from hypospadias repair? SATA A. remove the stent on day 3 at home B. straddle the baby over the hip when carrying C. use a double-diapering technique D. provide the prescribed antibiotics until the urine is clear E. resume all activities except swimming and sandbox play

C and E Hypospadias is a congenital condition where the male infant's urethral meatus (opening) is not positioned correctly on the penis. After surgery, infants can go home the same day. Double diapering can provide extra cushioning. Stent would remain in place until day 7-10 in which a nurse would remove it.

The nurse is monitoring a child with burns during treatment for burn shock. Which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation? A. skin turgor B. level of edema at burn site C. adequacy of capillary filling D. amount of fluid tolerated in 24 hours

C. adequacy of capillary filling Parameters such as vital signs (esp heart rate), urinary output, adequacy of capillary refilling and state of sensorium determine adequacy of fluid resuscitation. HINT: the word "most" in the question, think of ABC (airway, breathing, circulation)

To decrease the likelihood of bradyarrhythmias in children during endotracheal intubation, succinylcholine (Anectine) is used with which of the following agents? A. epinephrine B. isoproterenol C. atropine sulfate (Atropine) D. Lidocaine hydrochloride (Xylocaine)

C. atropine sulfate Succinylcholine is an ultra-short-acting depolarizing agent used for rapid-sequence intubation. Bradycardia can occur, especially in children. Atropine is the drug of choice in treating succinylcholine-induced bradycardia. Atropine is occasionally used as a premedication. Its anticholinergic effects reduce ACH-mediated bradycardia that can accompany endotracheal intubation.

A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted? A. the child has no tears B. urine specific gravity is 1.035 C. cap refill is less than 2 seconds D. urine output is less than 1 ml/kg/hr

C. capillary refill is less than 2 seconds Indicators that fluid volume deficit is resolving would be capillary refill less than 2 seconds, specific gravity between 1.003-1.030, urine output of at least 1 ml/kg/hour and adequate tear production.

Which is the most important for the nurse to attempt to prevent for a child with JIA? A. infection B. hemarthrosis C. contracture deformities D. delayed intellectual development

C. contracture deformities Severe joint pain and swelling causes the child to immobilize the affected parts for prolonged periods, resulting in joint deformities.

A pre-adolescent child is diagnosed with a 15-degree spinal curvature, consistent with mild scoliosis. What shuld the nurse instruct the client regarding the diagnosis? A. surgery will be needed in a year B. a brace will need to be worn for 23 hours a day C. exercises can be done to improve tone and increase spine flexibility D. no treatment is indicated

C. exercises can be done to improve tone and increase spine flexibility Curvatures of 10-20 degrees (mild) require a treatment of exercises to improve posture and muscle tone and to maintain or increase spine flexibility. Surgery is indicated for degrees greater than 40. Bracing is for moderate scoliosis, 20-40 degrees.

The long-term complications seen in thalassemia major are associated to which of the following? A. anemia B. Growth retardation C. hemochromatosis D. splenomegaly

C. hemochromatosis Long-term complications arise from hemochromatosis, excessive iron deposits precipitating in the tissues, and causing destruction. Hemochromatosis is a disorder associated with deposits of excess iron that causes multiple organ dysfunction. Hemochromatosis occurs when there are high pathologic levels of iron accumulation in the body. Hemochromatosis has been called "bronze diabetes" due to the discoloration of the skin and associated disease of the pancreas.

Nurse Karen is providing postoperative care for Dustin who has cleft palate (CP); she should position the child in which of the following? A. in an infant seat B. in the supine position C. in the prone position D. on his side

C. in the prone position Postoperatively, children with a CP should be placed on their abdomens to facilitate drainage. A child who has had a cleft lip repair should be positioned on their side or back to keep them from rubbing their face in the bed. A child with only a cleft palate repair may sleep on their stomach. It is important to keep the stitches clean and without crusting.

When creating a teaching program for the parents of Jessica who is diagnosed with pulmonic stenosis (PS), Nurse Alex would keep in mind that this disorder involves which of the following? A. a single vessel arising from both ventricles B. obstruction of blood flow from left ventricle C. obstruction of blood flow from the right ventricle D. return of blood to the heart without entry to the left atrium

C. obstruction of blood flow from the right ventricle PS refers to an obstruction of blood flow from the right ventricle. Pulmonic stenosis is a defect of the pulmonic valve in which the valve is stiffened, causing an obstruction to flow. This disease is typically congenital, benign, and diagnosed in pediatric patients with potentially curative treatments.

Which assessment finding would the nurse report to the primary health care provider because it likely indicates pyloric stenosis? A. loud bowel sounds B. sudden expulsion of diarrheal stool C. peristaltic waves that transverse the epigastrium D. regurgitation of a portion of a feeding when burped

C. peristaltic waves that transverse the epigastrium Left to right peristalsis is noted as the stomach tries to force the feeding into the duodenum. Bowel activity is minimal because little of the feeding passes through the pyloric sphincter. Projectile vomiting is a classic manifestation

The nurse is caring for a child with a Category A Near Drowning. She should do which of the following? A. give furosemide as ordered B. check for increased intercranial pressure C. plan for discharge in 12-24 hours D. check for electrolyte imbalances E. keep mechanical ventilation F. provide oxygen as ordered

C. plan for discharge in 12-24 hours D. check for electrolyte imbalances F. provide oxygen as ordered Near-drowning is defined as survival for at least 24 hours from suffocation by submersion. Aspiration of water causes the plasma to be pulled into the lungs, resulting in hypoxemia, acidosis, and hypovolemia. Hypoxemia results from the decrease in pulmonary surfactant caused by the absorbed water that leads to damage of the pulmonary capillary membrane. Children with Category A Near Drowning are awake with minimal injury. Care includes checking electrolyte status, administering oxygen and warming, and preparing for discharge in 12 to 24 hours.

Dr. Jones prescribes corticosteroids for a child with nephritic syndrome. What is the primary purpose of administering corticosteroids to this child? A. to increase BP B. to reduce inflammation C. to decrease proteinuria D. to prevent infection

C. to decrease proteinuria The primary purpose of administering corticosteroids to a child with nephritic syndrome is to decrease proteinuria. It helps relieve the inflammation in the kidney and promotes healing. The proteinuria usually ranges in the sub nephrotic range (less than 3.5 g/day), but it can go up to the nephrotic range. A 24-hours urinary protein assay is required if the attendant nephrotic syndrome is suspected.

A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse in charge anticipates that the doctor will order which laboratory test? A. total iron-binding capacity B. hemoglobin C. total protein D. serum transferrin

C. total protein A negative nitrogen balance may result from inadequate protein intake and is best detected by measuring the total protein level. An increase in the protein intake produces an increase in nitrogen losses via higher amino acid oxidation, especially in the fed state, and a trend toward positivation of the nitrogen balance. Nitrogen balance and nitrogen levels at four levels of nitrogen intake in healthy adult subjects (data from Price et al. 1994).

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? A. incessant crying B. coughing at nighttime C. choking with feedings D. severe projectile vomiting

C: Choking with feedings "3 C's" coughing and choking with feedings, and unexplained cyanosis

The mother of a 6 year old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? A. hold the next dose of insulin B. come to the clinic immediately C. encourage the child to drink liquids D. administer an additional dose of regular insulin

C: encourage the child to drink liquids When the child is sick, the mother should check for urinary ketones with each voiding. If ketones are present, liquids are essential to aid in clearing the ketones.

A child with Thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate to be prescribed? A. Fragmin B. Meropenem C. Metoprolol D. Defereoxamine

D. Deferoxamine This is an antidote for iron toxicity.

A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart from the identified symptoms of the disease, she may also likely develop which of the following? A. sepsis B. meningitis C. mitral valve disease D. aneurysm formation

D. aneurysm formation Kawasaki disease is a rare childhood illness that affects the blood vessels. 20% to 25% of children can develop aneurysm formation if not intervened. Treatment depends on the degree of the disease but is often immediate treatment with IV gamma globulin or aspirin. Corticosteroids can sometimes lessen impending complications. Children who experience the disease usually need lifelong follow-up appointments to keep an eye on heart health.

Which education would the nurse provide the parents of an infant with cleft lip and palate about the infant's predisposition to infection? A. waste products accumulate along the defect B. circulation to the defective area is insufficient C. inefficient feeding behaviors result in inadequate nutrition. D. mouth breathing dries the oropharyngeal mucous membranes.

D. mouth breathing dries the oropharyngeal mucous membranes Infants with cleft lip and palate breathe through their mouths, bypassing the natural humidification and filtration provided by the nose, as a result the mucous membranes become dry and cracked and are at risk for infection.

When performing a physical examination on an infant, the nurse in charge notes abnormally low-set ears. This finding is associated with...? A/ Otogenous tetanus B. Tracheoesophageal fistula C. congenital heart defect D. renal anomalies

D. renal anomalies. Normally the top of the ear aligns with an imaginary line drawn across the inner and outer canthus of the eye. Ears set below this line are associated with renal anomalies or mental retardation. This is due to the observation that auricular malformations often are associated with specific MCA syndromes that have high incidences of renal anomalies.

Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation? A. aortic stenosis B. coarctation of aorta C. patent ductus arteriosus (PDA) D. tetraology of Fallot

D. tetralogy of fallot Tetralogy of Fallot consists of four major anomalies: ventricular septal defect, right ventricular hypertrophy, pulmonic stenosis (PS), aorta overriding the ventricular septal defect. PS impedes the flow of blood to the lungs, causing increased pressure in the right ventricle, forcing deoxygenated blood through the septal defect in the left ventricle. As a result of this decreased pulmonary flow, deoxygenated blood is shunted into the systemic circulation. The increased workload on the right ventricle causes hypertrophy. The overriding aorta receives blood from both the right and left ventricles. This is the definition of a defect with decreased pulmonary blood flow where unoxygenated blood is shunted into the systemic circulation.

Reye's syndrome is a rare and severe illness affecting children and teenagers. Its development has been linked with the use of aspirin and which of the following A. meningitis B. encephalitis C. strep throat D. varicella

D. varicella viral infections like varicella and influenza A and B Reye's syndrome has been linked with the ingestion of aspirin in children with viral infections like varicella. Epidemiologic studies found a link between the use of salicylate and the development of Reye syndrome. While less than 0.1% of children who took aspirin developed Reye syndrome, more than 80% of children diagnosed with Reye syndrome had taken aspirin in the preceding 3 weeks.