W&C1 pediatric info
Which of the following is TRUE about sickle cell disease (SCD)? Select all that apply. A. Sickle cell anemia (SCD) is an inherited disorder of the hemoglobin in blood. B. Sickle cell anemia requires the inheritance of two sickle cell genes. C. Sickle cell trait, which is the inheritance of one sickle gene, almost never causes problems. D. Virtually all of the major symptoms of sickle cell anemia are the direct result of the abnormally-shaped sickled red blood cells obstructing the flow of blood. E. The contemporary treatment of sickle cell anemia is focused primarily toward managing the individual features of the illness as they occur.
Correct Answer: A, B, C, D, and E Sickle cell disease (SCD) refers to a group of hemoglobinopathies that include mutations in the gene encoding the beta subunit of hemoglobin. The Cooperative Study of Sickle Cell Disease (CSSCD) (between 1978-88) reported the median age of death for women and men as 42 and 48 years, respectively.
Scott is a teenager suffering from osteomyelitis; the nurse would expect which of the following symptoms? Select all that apply. A. Fever B. Irritability C. Pallor D. Tenderness E. Swelling
Correct Answer: A, B, D, & E The symptoms for acute and chronic osteomyelitis are very similar and include fever, irritability, fatigue, nausea, tenderness, redness (not pallor in option C), and warmth in the area of the infection, swelling around the affected bone, and lost range of motion.
Which of the following should be included when developing a teaching plan to prevent urinary tract infection? Select all that apply. A. Maintaining adequate fluid intake B. Avoiding urination before and after intercourse C. Emptying bladder with urination D. Wearing underwear made of synthetic material such as nylon E. Keeping urine alkaline by avoiding acidic beverages F. Avoiding bubble baths and tight clothing
Correct Answer: A, C, & F Even with proper antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the quality of life is poor. About 25% of women experience such recurrences. Many cases of uncomplicated UTIs will resolve spontaneously, without treatment, but many patients seek therapy for symptom relief.
A nurse provides medication instructions to a first-time mother. Which statement made by the mother indicates a need for further instructions? A. "I should mix the medication in the baby food and give it when I feed the child". B. "I should administer the oral medication sitting in an upright position and with the head elevated". C. "I will give my child a toy after giving the medication". D. "I will offer my child a juice drink after swallowing the medication".
Correct Answer: A. "I should mix the medication in the baby food and give it when I feed the child". The nurse would teach the mother to avoid putting medications in foods because it may cause an unpleasant taste to the food, and the child may refuse to accept the same food in the future. Additionally, the child may not consume the entire serving and would not require medication dosage.
Hydrocortisone cream 1% is given to a child with eczema. The nurse gives instruction to the mother to apply the cream by? A. Apply a thin layer of cream and spread it into the area thoroughly. B. Avoid cleansing the area before the application. C. Apply a thick layer of the cream to affected areas only. D. Apply the cream to other areas to avoid occurrence.
Correct Answer: A. Apply a thin layer of cream and spread it into the area thoroughly. Topical corticosteroids are administered sparingly and rubbed into the area thoroughly. Topical steroid creams and ointments should be applied in a thin layer and massaged into the affected area.
Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse in charge detects dry mucous membranes and lethargy. What other findings suggest a fluid volume deficit? A. A sunken fontanel B. Decreased pulse rate C. Increased blood pressure D. Low urine specific gravity
Correct Answer: A. A sunken fontanel In an infant, signs of fluid volume deficit (dehydration) include sunken fontanels, increased pulse rate, and decreased blood pressure. They occur when the body can no longer maintain sufficient intravascular fluid volume. When this happens, the kidneys conserve water to minimize fluid loss, which results in concentrated urine with high specific gravity.
In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following? A. Anterior pituitary gland hypofunction B. Posterior pituitary gland hyperfunction C. Parathyroid gland hyperfunction D. Thyroid gland hyperfunction
Correct Answer: A. Anterior pituitary gland hypofunction Short stature usually results from diminished or deficient growth hormone, which is released from the anterior pituitary gland. Growth hormone production from the anterior pituitary is regulated by the stimulatory and inhibitory control of the hypothalamus. Hypothalamus produces growth hormone-releasing hormone that stimulates the somatotrophs of the anterior pituitary to secrete growth hormone.
A nurse is handling a child who is on furosemide (Lasix) IV infusion. The nurse instructs the mother to encourage the child to eat which of the following? A. Apricot and baked potato skin. B. Bread and butter. C. Gelatin and Cauliflower. D. Ginger ale and cereal.
Correct Answer: A. Apricot and baked potato skin. One of the side effects of taking furosemide is hypokalemia, so a supplemental food rich in potassium is encouraged. Many fresh fruits and vegetables are rich in potassium: Bananas, oranges, cantaloupe, honeydew, apricots, grapefruit (some dried fruits, such as prunes, raisins, and dates, are also high in potassium).
Nurse Cheryl is assessing Fred, a 14-year-old boy who had scoliosis; besides checking neurologic status directly after Harrington rod instrumentation and spinal fusion, she should be regarded with which of the following factors? A. Comfort level B. Dietary tolerance C. Physical therapy needs D. Understanding of the procedure
Correct Answer: A. Comfort level Instrumentation and spinal fusion cause considerable pain. Therefore, the adolescent needs vigorous pain management, which involves assessment, administration of pain medication, and evaluation of the response. In the immediate postoperative period, the child is conscious of sensation and surroundings.
A child with thalassemia was given deferoxamine (Desferal); which of the following should alert the nurse to notify the physician? A. Decreased hearing B. Hypertension C. Red urine D. Vomiting
Correct Answer: A. Decreased hearing Deferoxamine is ototoxic. Thus, any hearing problem should be immediately addressed to the physician. Chronic deferoxamine therapy can lead to sensorineural hearing loss and retinopathy. Hearing and vision loss can be reversible if the patient discontinues DFO early in the course. A screening hearing exam should be performed in the clinic every six months and a formal audiogram every 12 months.
Beta-adrenergic agonists such as albuterol are given to Reggie, a child with asthma. Such drugs are administered primarily to do which of the following? A. Dilate the bronchioles B. Reduce secondary infections C. Decrease postnasal drip D. Reduce airway inflammation
Correct Answer: A. Dilate the bronchioles Beta-adrenergic agonists, such as albuterol, are highly effective bronchodilators and are used to dilate the narrow airways associated with asthma. Albuterol and levalbuterol are examples of short-acting bronchodilators. They have a quick onset of action, within 5 to 15 minutes, and a duration of action of 4 to 6 hours. Their administration is most often by nebulizer or inhaler.
Patient S is a sexually active adolescent. Which of the following instructions would be included in the preventive teaching plan about urinary tract infections? A. Drinking acidic juices B. Avoiding urinating before intercourse C. Wearing nylon underwear D. Wiping back to front
Correct Answer: A. Drinking acidic juices Drinking acidic juices, such as cranberry juice, helps keep the urine at its desired pH and reduces the chance of infection. Pure cranberry juice, cranberry extract, or cranberry supplements may help prevent repeated UTIs in women, but the benefit is small. It helps about as much as taking antibiotics to prevent another UTI.
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
Correct Answer: 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.
Nurse Kim is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature? A. Eustachian tubes B. Nasopharynx C. Tympanic membrane D. External ear canal
Correct Answer: A. Eustachian tubes In a child, Eustachian tubes are short and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media. Due to the constricted anatomical space of the middle ear, the edema caused by the inflammatory process obstructs the narrowest part of the Eustachian tube leading to a decrease in ventilation.
Arvic who is diagnosed with diabetes mellitus type 1 displays symptoms of hypoglycemia. Which of the following actions should the nurse instruct the parents? A. Give the child honey (simple sugar) B. Give the child milk (complex sugar). C. Contact the healthcare provider before doing anything. D. Give the child nothing by mouth.
Correct Answer: A. Give the child honey (simple sugar). Immediate action is important. Therefore, providing little sugar temporarily corrects low serum glucose levels. Simple sugar is preferred because it is converted to glucose more quickly than complex sugar. A child with hyperglycemia needs fluid to prevent dehydration. Patients should be advised to wear a medical alert bracelet and to carry a glucose source like gel, candy, or tablets on their person in case symptoms arise.
Nurse Christine is planning a client education program for sickle cell disease (SCD) in children. Which of the following interventions would be included in the care plan? A. Health teaching to help reduce sickling crises B. Avoidance of the use of opioids C. Administration of an anticoagulant to prevent sickling D. Observation of the imposed fluid restriction
Correct Answer: A. Health teaching to help reduce sickling crisis. Prevention is one of the principal goals of therapeutic management because there is no cure for sickle cell disease. Consequently, health education to help lessen the sickling crisis is key. Early detection and rapid initiation of appropriate treatment for several acute conditions including the vaso-occlusive crisis, aplastic crisis, sequestration crisis, and hemolytic crisis is needed. These crises, if not treated early, can result in mortality.
A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first? A. Heart rate, respiratory rate, and blood pressure B. Recent exposure to communicable diseases C. Number of immunizations received D. Height and weight
Correct Answer: A. Heart rate, respiratory rate, and blood pressure The most important data to obtain on a child's arrival in the emergency department are vital sign measurements. Salicylate toxicity is a medical emergency. Intentional ingestion or accidental overdose can cause severe metabolic derangements, making treatment difficult. In an acute salicylate overdose, the onset of symptoms will occur within 3 to 8 hours. The severity of symptoms is dependent on the amount ingested.
The nurse is evaluating a female child with acute post streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? A. Increased urine output B. Increased appetite C. Increased energy level D. Decreased diarrhea
Correct Answer: A. Increased urine output Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving. PSGN typically presents with features of the nephritic syndrome such as hematuria, oliguria, hypertension, and edema, though it can also present with significant proteinuria.
Nurse Hannah is administering a steroid to a child diagnosed with idiopathic thrombocytopenic purpura (ITP); which of the following should the nurse monitor? A. Infection B. Anemia C. Bleeding D. Bruising
Correct Answer: A. Infection Steroids may promote immunosuppression, making the child more susceptible to infections. The desired immune-suppressing and anti-inflammatory effects of corticosteroids can also predispose patients to infection. A meta-analysis of 2000 patients found that the infection rate is significantly higher in patients using systemic corticosteroids when the daily dose was 10 mg/day.
A 1-year-old child is diagnosed with scabies. Which of the following medicines is expected to be prescribed? A. Permethrin B. Lindane C. Both D. None
Correct Answer: A. Permethrin Permethrin and Lindane are used against scabies, but lindane is contraindicated for children below two years old because of the risk of seizures and neurotoxicity. Topical permethrin 5% cream is effective and widely used. The cream is typically applied once a week for two weeks (a total of 2 treatments). However, this treatment is occasionally associated with scabies resistance, poor patient compliance, and rare allergic reactions.
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
Correct Answer: 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.
Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child? A. Pulmonary secretions are abnormally thick. B. Elevated levels of potassium are found in sweat. C. CF is an autosomal dominant hereditary disorder. D. Obstruction of the endocrine glands occurs.
Correct Answer: A. Pulmonary secretions are abnormally thick. CF is identified by abnormally thick pulmonary secretions. Researchers now know that cystic fibrosis is an autosomal recessive disorder of exocrine gland function most commonly affecting persons of Northern European descent at a rate of 1 in 3500. It is a chronic disease that frequently leads to chronic sinopulmonary infections and pancreatic insufficiency. The most common cause of death is end-stage lung disease.
Nurse Walter should expect a 3-year-old child to be able to perform which action? A. Ride a tricycle B. Tie the shoelaces C. Roller-skates D. Jump rope
Correct Answer: A. Ride a tricycle At age 3, gross motor development and refinement in eye-hand coordination enable a child to ride a tricycle. Most 3-year-olds are able to walk a line, balance on a low balance beam, skip or gallop, and walk backward. They can usually pedal a tricycle, catch a large ball, and jump with two feet.
Alice is rushed to the emergency department during an acute, severe prolonged asthma attack and is unresponsive to usual treatment. The condition is referred to as which of the following? A. Status asthmaticus B. Reactive airway disease C. Intrinsic asthma D. Extrinsic asthma
Correct Answer: A. Status asthmaticus Status asthmaticus is an acute, prolonged, severe asthma attack that is unresponsive to usual treatment. Typically, the child requires hospitalization. One of the most common causes of emergency room visits in the United States is status asthmaticus, an acute, emergent episode of bronchial asthma that is poorly responsive to standard therapeutic measures.
Kim is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include: A. tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. B. tachycardia, headache, dyspnea, temp. 101 F, and wheezing. C. blurred vision, tachycardia, hypertension, headache, insomnia, and oliguria. D. restlessness, insomnia, blurred vision, hypertension, chest pain, and muscle weakness.
Correct Answer: A. Tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. Bronchodilators can produce the side effects listed in answer choice (A) for a short time after the patient begins using them. The adverse effects of bronchodilators are due to sympathetic system activation. The most frequent and common adverse effects include trembling, nervousness, sudden, noticeable heart palpitations, and muscle cramps.
Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares to the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following? A. The child should be allowed to play because doing so can foster healthy self-esteem. B. The risk for fractures is increased because a GH deficiency results in fragile bones. C. Activity could aggravate insulin sensitivity, causing hyperglycemia. D. Activity would aggravate the child's joints, already over tasked by obesity.
Correct Answer: A. The child should be allowed to play because doing so can foster healthy self-esteem. Engaging in peer-group activities can aid foster a sense of belonging and a positive self-concept. T-ball is a good sport to choose because physical stature is not an important consideration in the ability to participate, unlike some other sports, such as basketball and football. Physical examination may not reveal any significant findings as the presentation is usually subtle.
Mrs. Johnson tells the nurse that she is very worried because her 2-year old child does not finish his meals. What should the nurse advise the mother? A. Make the child seat with the family in the dining room until he finishes his meal B. Provide quiet environment for the child before meals C. Do not give snacks to the child before meals D. Put the child on a chair and feed him
Correct Answer: Answer C. Do not give snacks to the child before meals. If the child is hungry he/she is more likely to finish his meals. Therefore, the mother should be advised not to give snacks to the child. Set times for meals and snacks and try to stick to them. A child who skips a meal finds it reassuring to know when to expect the next one. Avoid offering snacks or pacifying hungry kids with cups of milk or juice right before a meal — this can diminish their appetite and decrease their willingness to try a new food being offered.
In pediatric gastroesophageal reflux disease (GERD), the immaturity of lower esophageal sphincter function is manifested by frequent transient lower esophageal relaxations, which result in retrograde flow of gastric contents into the esophagus. Which statement about the esophagus is true? Select all that apply. A. It is a cartilaginous tube. B. It has upper and lower sphincters. C. It lies anterior to the trachea. D. It extends from the nasal cavity to the stomach. E. It is a highway for food and drinks to travel along to make it to the stomach. F. All statements describe the esophagus.
Correct Answer: B & E Upper and lower esophageal sphincters, located at the upper and lower ends of the esophagus, respectively, regulate the movement of food into and out of the esophagus. If the mouth is the gateway to the body, then the esophagus is a highway for food and drink to travel along to make it to the stomach.
The Andrews family has been taking good care of their youngest, Archie, who was diagnosed with asthma. Which of the following statements indicate a need for further home care teaching? A. "He should increase his fluid intake regularly to thin secretions." B. "We'll make sure that he avoids exercise to prevent attacks." C. "He is to use his bronchodilator inhaler before the steroid inhaler." D. "We need to identify what things trigger his attacks."
Correct Answer: B. "We'll make sure that he avoids exercise to prevent attacks." Additional teaching is needed if the family states that the child with asthma should avoid exercise to prevent attacks. Children with asthma should be encouraged to exercise as tolerated. Encourage the child to be active while also keeping asthma symptoms under control by following the asthma action plan. Ask a doctor which exercises, sports, and activities are safe for the child.
When developing a plan of care for a hospitalized child, nurse Mary knows that children in which age group is most likely to view illness as a punishment for misdeeds? A. Infancy B. Preschool age C. School age D. Adolescence
Correct Answer: B. Preschool age Preschool-age children are most likely to view illness as a punishment for misdeeds. When children in this age group become seriously ill, they may think it's punishment for something they did or thought about. They don't understand how their parents could not have protected them from this illness.
Archie is a child with iron deficiency anemia. He is required to receive elemental iron therapy at 6 mg/kg/day in three divided doses. He weighs 44 lbs. How many milligrams of iron should he receive per dose? A. 20 mg/dose B. 40 mg/dose C. 60 mg/dose D. 120 mg/dose
Correct Answer: B. 40 mg/dose The child weighs 44 lbs, which is equal to 20 kg (1 kg=2.2 lb;44/2.2=20kg). Elemental iron therapy is ordered at 6 mg/kg/day in three doses. Therefore, the child receives 120 mg/day (6 mg/20 kg/day=120), divided into three doses (120/3), which is equal to 40 mg/dose.
Mr. and Mrs. Robertson's son was diagnosed with idiopathic thrombocytopenic purpura. They should be aware that the drug to be avoided is: A. Acetaminophen B. Aspirin C. Codeine D. Morphine
Correct Answer: B. Aspirin Aspirin exerts an antiplatelet action and therefore may increase platelet destruction in ITP. Aspirin inhibits platelet function by acetylating platelet cyclooxygenase, increasing the risk of bleeding because it adds a prolonged platelet functional defect to the quantitative defect already present from the severe thrombocytopenia.
Nurse Kathy is assessing infantile reflexes in a 9-month-old baby; which of the following would she identify as normal? A. Persistent rooting B. Bilateral parachute C. Absent moro reflex D. Unilateral grasp
Correct Answer: B. Bilateral parachute The parachute reflex appears to be normal at about 9 months of age. Persistence of primitive reflexes past 4 to 6 months or absence before this time when they should have been present is predictive of cerebral palsy. The presence of 5 or more abnormal reflexes correlated with the development of cerebral palsy or mental delays.
The 6-year-old son of Mr. and Mrs. Peters is admitted to the healthcare facility with the diagnosis of idiopathic hypopituitarism. His height is measured below the third percentile and weight at the 40th percentile. Which of the following would be the first action of his attending nurse? A. Recommend orthodontic referral for underdeveloped jaw. B. Collaborate with a dietician to access his caloric needs. C. Provide for a tutor for his precocious intellectual ability. D. Place him in a room with a 2-year-old boy.
Correct Answer: B. Collaborate with a dietician to access his caloric needs. Because the child's weight is excessive for his height, he needs a dietary assessment and a weight-loss program. Weight gain typically is out of proportion to growth, resulting in relative obesity. This obesity is truncal in distribution; skull and head circumference growth are typically preserved, producing the impression of a large head.
What is most likely the underlying physiology of primary enuresis? A. Psychogenic stress B. Delayed bladder maturation C. Urinary tract infection D. Vesicoureteral reflux
Correct Answer: B. Delayed bladder maturation The most likely cause of primary enuresis is delayed or incomplete maturation of the bladder. Primary enuresis is that which occurs in a child who has not been dry for at least 6 months, whereas secondary enuresis is the one that has an onset after a period of nocturnal dryness of at least 6 months.
In diagnosing seizure disorder, which of the following is the most beneficial? A. Skull radiographs B. EEG C. Brain scan D. Lumbar puncture
Correct Answer: B. EEG The EEG recognizes abnormal electrical activity in the brain. The pattern of multiple spikes can assist in the diagnosis of particular seizure disorders. Electroencephalography (EEG) is a biomarker for epilepsy. Focal or generalized epileptiform discharges constitute the EEG hallmark of seizure activity. Frequently EEG is obtained as a risk-stratification tool for a patient with a seizure of possibility of seizures.
When developing a plan of care for a male adolescent, the nurse considers the child's psychosocial needs. During adolescence, psychosocial development focuses on: A. Becoming industrious B. Establishing an identity C. Achieving intimacy D. Developing initiative
Correct Answer: B. Establishing an identity According to Erikson, the primary psychosocial task during adolescence is to establish a personal identity confusion. The adolescent attempts to establish a group identity by seeking acceptance and approval from peers and strives to attain a personal identity by becoming more independent from the family.
Nurse Jeremy is evaluating a client's fluid intake and output record. Fluid intake and urine output should relate in which way? A. Fluid intake should double the urine output. B. Fluid intake should be approximately equal to the urine output. C. Fluid intake should be half the urine output. D. Fluid intake should be inversely proportional to the urine output.
Correct Answer: B. Fluid intake should be approximately equal to the urine output. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. One general principle for all patient scenarios is to replace whatever fluid is being lost as accurately as possible. The strategy of managing a patient's fluid differs depending on each patient's clinical condition. If they can drink adequate fluid volumes by mouth, this should be the first choice. Some patients can tolerate other enteral options, such as feeding tubes. IV plus oral orders are effective for those unable to meet their total daily fluid requirements enterally.
When educating parents regarding known antecedent infections in acute glomerulonephritis, which of the following should the nurse cover? A. Scabies B. Impetigo C. Herpes simplex D. Varicella
Correct Answer: B. Impetigo Impetigo, a bacterial infection of the skin, may be caused by streptococci and may precede acute glomerulonephritis. Although most streptococcal infections do not cause acute glomerulonephritis, when they do, a latent period of 10 to 14 days occurs between the infection, usually of the skin (impetigo) or upper respiratory tract, and the onset of clinical manifestations.
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 a toddler D. Noticeable developmental delays
Correct Answer: 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.
Mr. and Mrs. Smith's child has hemophilia; which of the following actions would you instruct them to avoid? A. Immobilizing the joint B. Lowering the injured area C. Applying cold to the area D. Applying pressure
Correct Answer: B. Lowering the injured area With hemophilia, the injured area must be elevated, not lowered. If bleeding is in a joint (hemarthrosis), elevate and immobilize the affected limb. Repeated hemarthrosis can result in severe and crippling deformity.
Dustin who was diagnosed with Hirschsprung's disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first? A. Administer an antidiarrheal. B. Notify the physician immediately. C. Monitor the child every 30 minutes. D. Nothing. (These findings are common in Hirschsprung's disease.)
Correct Answer: B. Notify the physician immediately. For the child with Hirschsprung's disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly. Further important pointers in the history of patients with suspected HD include clinical features of Hirschsprung's associated enterocolitis (HAEC), multiple episodes of overflow constipation, and soft distended abdomen.
The nurse is aware that the most common assessment finding in a child with ulcerative colitis is: A. Intense abdominal cramps B. Profuse diarrhea C. Anal fissures D. Abdominal distention
Correct Answer: B. Profuse diarrhea The most common assessment finding in a child with ulcerative colitis is profuse diarrhea. The main symptom of ulcerative colitis is bloody diarrhea, with or without mucus. Other symptoms include blood in the toilet, on toilet paper, or in the stool. Characteristically, it involves inflammation restricted to the mucosa and submucosa of the colon. Typically, the disease starts in the rectum and extends proximally in a continuous manner.
Which type of diabetes mellitus (DM) most likely results from heterogenous risk factors, making it preventable? A. Type 1 B. Type 2 C. Type 1 and 2 D. Gestational diabetes
Correct Answer: B. Type 2 Type 2 DM is a complex disorder of various causes with social, behavioral, and environmental risk factors. The disorder may be prevented by encouraging lifestyle modification for children at risk. Hyperglycemia results when there is a relative lack of insulin compared to glucose in the blood. In type 2 diabetes mellitus, insulin resistance first leads to increased insulin production by the beta cells of the pancreas. When the beta cells are unable to produce enough insulin to maintain euglycemia, hyperglycemia results.
Which of the following parameters would Nurse Max monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)? A. Urine B. Vomiting C. Weight D. Stools
Correct Answer: B. Vomiting Thickened feedings are used with GER to stop the vomiting. Therefore, the nurse would monitor the child's vomiting to evaluate the effectiveness of using the thickened feedings. The feeding management strategy has been shown to represent an effective approach in otherwise healthy infants with both GER and GERD. It involves modifying feeding frequency and volume, ensuring the intake of feed per kilogram of weight is appropriate. There is some evidence for the efficacy of feed thickeners on reducing visible regurgitation
An 11-year-old girl with celiac disease was discharged from the hospital. An appropriate teaching was carried out by the nurse if the parents are aware of avoiding which of the following? A. Chicken B. Wheat C. Milk D. Rice
Correct Answer: B. Wheat Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content, wheat and wheat-containing products must be avoided. Celiac disease is an autoimmune condition that causes severe damage to the lining of the small intestine. Gluten — a protein found in wheat, barley, and rye — triggers its symptoms.
Neurovascular assessment for a fracture patient includes: Select all that apply. A. Prosthesis B. Polyps C. Pain D. Pallor E. Pulselessness F. Paresthesia G. Paralysis H. Poikilothermia
Correct Answer: C, D, E, F, G, and H When damage occurs to a muscle or muscle group within the fascial compartment, the resulting swelling and bleeding can create an increased pressure that, if left untreated, can choke off circulation, eventually leading to localized cellular hypoxia and death. The six P's of compartment syndrome for warning signs to watch for are Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia.
Nurse Charlotte suspects that a child, age 4, is being neglected physically. To best assess the child's nutritional status, the nurse should ask the parents which question? A. "Has your child always been so thin?" B. "Is your child a picky eater?" C. "What did your child eat for breakfast?" D. "Do you think your child eats enough?"
Correct Answer: C. "What did your child eat for breakfast?" The nurse should obtain objective information about the child's nutritional intake, such as by asking about what the child ate for a specific meal. In order to assess the adequacy of a child's nutritional intake, dietitians require detailed information about all food and drink consumed. As all children admitted to the hospital are at risk of nutritional deficit, a dietary record should be started on all in-patients, although this may subsequently be discontinued when deemed appropriate.
Tara is an 11-year-old girl diagnosed with type 1 diabetes mellitus (DM). She asks her attending nurse why she can't take a pill rather than shots like her grandmother does. Which of the following would be the nurse's best reply? A. "If your blood glucose levels are controlled, you can switch to using pills." B. "The pills correct fat and protein metabolism, not carbohydrate metabolism." C. "Your body does not make insulin, so the insulin injections help to replace it." D. "The pills work on the adult pancreas, you can switch when you are 18."
Correct Answer: C. "Your body does not make insulin, so the insulin injections help to replace it." The child has type 1 DM, indicating a lack of functioning pancreatic beta cells and an absolute insulin deficiency. Type 1 diabetes is an autoimmune condition that leads to the destruction of pancreatic beta cells which in turn causes insufficient insulin production, resulting in hyperglycemia. Type 1 diabetes is a chronic disease requiring insulin replacement and intensive effort by the patient.
Among toddlers and children up to age five, femur fractures usually result from a low energy fall. In most cases, the orthopedic surgeon realigns the fracture using fluoroscopy or x-ray imaging as a guide and immobilizes the leg in a type of cast called a spica cast. Approximately how many weeks does it take for a fractured femur to heal in a 3-year-old? A. 1-2 weeks B. 2-4 weeks C. 3-8 weeks D. 10-12 weeks
Correct Answer: C. 3-8 weeks In most cases, three to six weeks of early healing is necessary before the child can begin walking on the injured leg. When the bone is completely healed, usually around one year after the injury occurs, the child returns to the hospital to have the nails removed. Following treatment, the orthopedic surgeon continues to monitor the patient for a period of several years to ensure that there is no limb length discrepancy.
Molly, with suspected rheumatic fever, is admitted to the pediatric unit. When obtaining the child's history, the nurse considers which information to be most important? A. A fever that started 3 days ago B. Lack of interest in food C. A recent episode of pharyngitis D. Vomiting for 2 days
Correct Answer: C. A recent episode of pharyngitis A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Activation of the innate immune system begins with a pharyngeal infection that leads to the presentation of S. pyogenes antigens to T and B cells. CD4+ T cells are activated and production of specific IgG and IgM antibodies by B cells ensues (Cunningham, Pathogenesis of group A streptococcal infections, 2000).
Janae has a seizure disorder; which of the following would be the lowest priority when caring for her? A. Observing and taking down data on all seizures B. Assuring safety and protection from injuring C. Assessing for signs and symptoms of increased intracranial pressure (ICP) D. Educating the family about anticonvulsant therapy
Correct Answer: C. Assessing for signs and symptoms of increased intracranial pressure (ICP) Signs and symptoms of increased intracranial pressure (ICP) are not associated with seizure activity and therefore would be the lowest priority. A sudden alteration in consciousness with associated motor movements is the common description of a convulsive seizure. For generalized seizures with associated motor movements, the convulsion typically has a stiffening or tonic phase followed by clonic movements - rhythmic phased motor movements.
How should the nurse prepare a suspension before administration? A. By diluting it with normal saline solution B. By diluting it with 5% dextrose solution C. By shaking it so that all the drug particles are dispersed uniformly D. By crushing remaining particles with a mortar and pestle
Correct Answer: C. By shaking it so that all the drug particles are dispersed uniformly. The nurse should shake a suspension before administration to dispersed drug particles uniformly. First, the bottle should be tabbed a few times to loosen the powder, then approximately, half the volume of water should be added, the bottle is shaken vigorously, the remaining water should be added and shaken well.
Which of the following is the most common permanent disability in childhood? A. Scoliosis B. Muscular dystrophy C. Cerebral palsy D. Developmental dysplasia of the hip (DDH)
Correct Answer: C. Cerebral palsy Cerebral palsy is the most common permanent disability of childhood. It is a group of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy. A cerebral palsy is a group of permanent disorders affecting the development of movement and causing a limitation of activity. Non-progressive disturbances that manifest in the developing fetal or infant brain lead to cerebral palsy.
Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would Nurse Nica expect to assess? A. Mild cough B. Slight fever C. Chest pain D. Bulging fontanel
Correct Answer: C. Chest pain Older children with pneumococcal pneumonia may complain of chest pain. Physical findings also vary from patient to patient and mainly depend on the severity of lung consolidation, the type of organism, the extent of the infection, host factors, and the existence or nonexistence of pleural effusion.
After explaining to the parents about their child's unique psychological needs related to a seizure disorder and possible stressors, which of the following interests uttered by them would indicate further teaching? A. Feeling different from peers B. Poor self-image C. Cognitive delays D. Dependency
Correct Answer: C. Cognitive delays Children with seizure disorders do not necessarily have cognitive delays. Epilepsy is one of the most serious neurological conditions and has an impact not only on the affected individual but also on the family and, indirectly, on the community. A global approach to the individual must take into account cognitive problems, psychiatric comorbidities and all psychosocial complications that often accompany epilepsy.
Mr. and Mrs. Andrews' child was diagnosed with Duchenne's muscular dystrophy; which of the following usually is the first indication of the condition? A. Inability to suck in the newborn B. Lateness in walking in the toddler C. Difficulty running in the preschooler D. Decreasing coordination in the school-age child
Correct Answer: C. Difficulty running in the preschooler Usually, signs and symptoms of Duchenne's muscular dystrophy are not noticed until ages 3 to 5 years. Typically weakness starts with the pelvic girdle, evidenced as difficulty running in the preschooler. Duchenne's muscular dystrophy usually is not diagnosed in the infant or toddler period.
Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions? A. Bronchiolitis B. Laryngotracheobronchitis (LTB) C. Epiglottitis D. Pneumonia
Correct Answer: C. Epiglottitis Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis. By the early 1990s, the use of the Hib conjugate vaccine caused a 99% drop in infections caused by Hib. Widespread use of the Hib vaccine has also been shown to significantly decrease rates of epiglottitis, which usually occurs in children.
Which of the following respiratory conditions is always considered a medical emergency? A. Asthma B. Cystic fibrosis (CF) C. Epiglottitis D. Laryngotracheobronchitis (LTB)
Correct Answer: C. Epiglottitis Epiglottitis, acute and severe inflammation of the epiglottis, is always considered an acute medical emergency because it can lead to acute, life-threatening airway obstruction. Epiglottitis is a life-threatening condition that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.
Which of the following organisms is the most common cause of urinary tract infection (UTI) in children? A. Klebsiella B. Staphylococcus C. Escherichia coli D. Pseudomonas
Correct Answer: C. Escherichia coli E. coli is the most common organism associated with the development of UTI. Escherichia coli is the most common organism in uncomplicated UTI by a large margin. Pathogenic bacteria ascend from the perineum, causing the UTI. Women have shorter urethras than men and therefore are far more susceptible to UTI. Very few uncomplicated UTIs are caused by blood-borne bacteria.
Buck's traction with a 10 lb. weight is securing a patient's leg while she is waiting for surgery to repair a hip fracture. It is important to check circulation-sensation-movement: A. Every shift B. Every day C. Every 4 hours D. Every 15 minutes
Correct Answer: C. Every 4 hours The patient can lose vascular status without the nurse being aware if left for more than 4 hours, yet checks should not be so frequent that the patient becomes anxious. Vital signs are generally checked q4h, at which time the CSM checks can easily be performed.
Which of the following would Nurse Tony suppose to regard as a cardinal manifestation or symptom of digoxin toxicity to his patient Clay diagnosed with heart failure? A. Headache B. Respiratory distress C. Extreme bradycardia D. Constipation
Correct Answer: C. Extreme bradycardia Extreme bradycardia is a cardinal sign of digoxin toxicity. Increased intracellular calcium from the poisoning of the Na-K transporter and AV nodal blockade from increased vagal tone are the primary causes of digoxin toxicity. The former leads to increased automaticity and inotropy; the latter leads to decreased dromotropy.
Which of the following is not true regarding the varicella vaccine? A. It is administered subcutaneously. B. Children 13 years and older (With no history of chickenpox or have not previously vaccinated) need two doses given at least 28 days apart. C. Give aspirin for any injection-related pain. D. The most common mild side effects are pain, redness, or swelling at the injection site.
Correct Answer: C. Give aspirin for any injection-related pain. Children receiving the varicella vaccine should avoid aspirin or aspirin-containing products because of the risk of Reye's syndrome. After administration of the vaccine, it is recommended to avoid salicylates for five weeks due to the risk of Reye's syndrome and to avoid contact with susceptible high-risk individuals.
The nurse is drawing blood from the diabetic patient for a glycosylated hemoglobin test. She explains to the woman that the test is used to determine: A. the highest glucose level in the past week. B. her insulin level. C. glucose levels over the past several months. D. her usual fasting glucose level.
Correct Answer: C. Glucose levels over the past several months. The glycosylated hemoglobin test measures glucose levels for the previous 3 to 4 months. The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person's level of glucose control. The test shows an average of the blood sugar level over the past 90 days and represents a percentage. The test can also be used to diagnose diabetes.
Olivia is an adolescent who has seizure disorder; which of the following would not be a focus of a teaching program? A. Ability to obtain a driver's license B. Drug and alcohol abuse C. Increased risk of infections D. Peer pressure
Correct Answer: C. Increased risk of infections Adolescents with seizure disorders are at no greater risk for infections than other adolescents. Adolescence is the period during which the child's identity as an individual in his/her own right should be consolidated. Achieving independence from parents, establishing healthy interpersonal relationships outside the family and choosing a vocation are essential developmental tasks of adolescence.
While Lawrence is being assessed at the clinic, Nurse Rachel observed that the child appears to be small, with an immature face and chubby body build. Her parents stated that their child's rate of growth of all body parts is somewhat slow, but her proportions and intelligence remain normal. As a knowledgeable nurse, you know that the child has a deficiency of which of the following? A. Antidiuretic hormone (ADH) B. Parathyroid hormone (PTH) C. Growth hormone (GH) D. Melanocyte-stimulating hormone (MSH)
Correct Answer: C. Growth hormone (GH) GH stimulates protein anabolism, promoting bone and soft-tissue growth. A lack of GH would lead to decreased synthesis of somatomedin, resulting in decreased linear growth and decreased fat metabolism, and increased glucose uptake in muscles, resulting in excessive subcutaneous fat hypoglycemia.
The long-term complications seen in thalassemia major are associated to which of the following? A. Anemia B. Growth retardation C. Hemochromatosis D. Splenomegaly
Correct Answer: 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.
Mr. and Ms. Byers' child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following? A. Celiac disease B. Intussusception C. Hirschsprung's disease D. Abdominal-wall defect
Correct Answer: C. Hirschsprung's disease Failure to pass meconium within the first 24 hours after birth may be a sign of Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to weak motility in an intestinal segment. History of the colonic obstruction, which might occur during the early neonatal period till adulthood, along with failure to pass meconium during the first 48 hours of the life, which presents in up to 90% of the affected patients, is highly compatible with the impression of HD.
Preferred nurses at the Nurseslabs Medical Center are about to perform a procedure related to a genitourinary (GU) problem to a group of pediatric patients. Which of the following groups would find it especially extra stressful? A. Infants B. Toddlers C. Preschoolers D. School-age children
Correct Answer: C. Preschoolers In general, preschoolers have more fears because of their fantasies, contributing to fears of the simplest procedures. Castration fears are also prominent at this age and may be heightened by procedures related to GU problems. The human brain is wired to alert us to and protect us from danger. Back in the day, that could mean a panther or wolf attack—so some trepidation around furry creatures is clearly in order. While babies and toddlers are usually scared of animals, too, things get turned up a notch when an active imagination kicks in at this age, explains Dr. Chansky.
The nurse is aware that the following laboratory values support a diagnosis of pyelonephritis? A. Myoglobinuria B. Ketonuria C. Pyuria D. Low white blood cell (WBC) count
Correct Answer: C. Pyuria Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. A urinary specimen should be obtained for a urinalysis. On urinalysis, one should look for pyuria as it is the most common finding in patients with acute pyelonephritis.
eronica's parents were told that their daughter needs ribavirin (Virazole). This drug is used to treat which of the following? A. Cystic fibrosis B. Otitis media C. Respiratory syncytial virus (RSV) D. Bronchitis
Correct Answer: C. Respiratory syncytial virus (RSV) Ribavirin is an antiviral medication used for treating RSV infection and for children with RSV who are compromised (such as children with bronchopulmonary dysplasia or heart disease). There is a single antiviral medication approved for use against RSV in the United States, ribavirin. It is a nucleoside analog with application in several RNA viruses, and it shows in vitro activity against RSV and may be administered in aerosolized form.
During a well-baby visit, Liza asks the nurse when she should start giving her infant solid foods. The nurse should instruct her to introduce which solid food first? A. Applesauce B. Egg whites C. Rice cereal D. Yogurt
Correct Answer: C. Rice cereal Rice cereal is the first solid food an infant should receive because it is easy to digest and is associated with few allergies. Next, the infant can receive pureed fruits, such as bananas, applesauce, and pears, followed by pureed vegetables, egg yolks, cheese, yogurt, and finally, meat.
Spina bifida is one of the possible neural tube defects that can occur during early embryological development. Which of the following definitions most accurately describes meningocele? A. Complete exposure of spinal cord and meninges B. Herniation of the spinal cord and meninges into a sac C. Sac formation containing meninges and spinal fluid D. Spinal cord tumor containing nerve roots
Correct Answer: C. Sac formation containing meninges and spinal fluid. Meningocele is a sac formation containing meninges and cerebrospinal fluid (CSF). Meningocele is the simplest form of open neural tube defects characterized by cystic dilatation of meninges containing cerebrospinal fluid without any neural tissue. A complex meningocele is associated with other spinal anomalies. Meningocele is a typically asymptomatic spinal anomaly and is not associated with acute neurologic conditions.
The nurse is assessing a 9-month-old boy for a well-baby check-up. Which of the following observations would be of most concern? A. The baby cannot say "mama" when he wants his mother. B. The mother has not given him finger foods. C. The child does not sit unsupported. D. The baby cries whenever the mother goes out.
Correct Answer: C. The child does not sit unsupported. Over 90% percent of babies can sit unsupported by nine months. At 4 months, a baby typically can hold his/her head steady without support, and at 6 months, he/she begins to sit with a little help. At 9 months he/she sits well without support, and gets in and out of a sitting position but may require help.
It is considered as the bluntly rounded portion of the heart. A. Base B. Pericardium C. Aorta D. Apex
Correct Answer: D. Apex The blunt, rounded point of the heart is the apex. The apex (the most inferior, anterior, and lateral part as the heart lies in situ) is located on the midclavicular line, in the fifth intercostal space. It is formed by the left ventricle. The general structure of the heart is quite uniform in healthy individuals. However, some variations do occur.
A female child, age 6, is brought to the health clinic for a routine checkup. To assess the child's vision, the nurse should ask: A. "Do you have any problems seeing different colors?" B. "Do you have trouble seeing at night?" C. "Do you have problems with glare?" D. "How are you doing in school?"
Correct Answer: D. "How are you doing in school?" A child's poor progress in school may indicate a visual disturbance. Most children do not have 20/20 vision until after six years of age, but at any age, visual acuity should be approximately equal between the eyes. The Multi-Ethnic Pediatric Eye Disease Study provided updated norms for visual acuity in children two and a half to six years of age.
Veronica is a 14-year-old girl who wears a brace for structural scoliosis; which of the following statements indicate effective use of the brace? A. "I sure am glad that I only have to wear this awful thing at night." B. "I'm really glad that I can take this thing off whenever I get tired." C. "I wonder if I can take the brace off when I go to the homecoming dance." D. "I'll look forward to taking this thing off to take my bath every day."
Correct Answer: D. "I'll look forward to taking this thing off to take my bath every day." The brace should be dropped for simply 1 hour of every 24-hour period for hygiene and skincare. It is recommended to wear the Milwaukee brace 23 hours a day. The one hour that the child spends out of the brace should be spent doing exercises. Studies have proven that this protocol is effective for the conservative treatment of adolescent idiopathic scoliosis.
The following are considered functions of the Urinary System, EXCEPT: A. Vitamin D synthesis B. Regulation of red blood cell synthesis C. Excretion D. Absorption of digested molecules E. Regulation of blood volume and pressure
Correct Answer: D. Absorption of digested molecules This is a function of the digestive system. The small molecules that result from digestion are absorbed through the walls of the intestine for use in the body. Digestion is the process of mechanically and enzymatically breaking down food into substances for absorption into the bloodstream.
Which of the following instructions should Nurse Cheryl include in her teaching plan for the parents of Reggie with otitis media? A. Placing the child in the supine position to bottle-feed B. Giving prescribed amoxicillin (Amoxil) on an empty stomach C. Cleaning the inside of the ear canals with cotton swabs D. Avoiding contact with people who have upper respiratory tract infections
Correct Answer: D. Avoiding contact with people who have upper respiratory tract infections. Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection. Acute otitis media is the second most common pediatric diagnosis in the emergency department following upper respiratory infections. Although otitis media can occur at any age, it is most commonly seen between the ages of 6 to 24 months.
When assessing a child's cultural background, the nurse in charge should keep in mind that: A. Heritage dictates a group's shared values B. Physical characteristics mark the child as part of a particular culture C. Cultural background usually has little bearing on a family's health practices D. Behavioral patterns are passed from one generation to the next
Correct Answer: D. Behavioral patterns are passed from one generation to the next. A family's behavioral patterns and values are passed from one generation to the next. Pediatric health care providers must be aware of the demographic trends and be culturally competent to deliver the safest, highest quality care possible to children of widely differing groups.
When a child injures the epiphyseal plate from a fracture, the damage may result in which of the following? A. Rheumatoid arthritis B. Permanent nerve damage C. Osteomyelitis D. Bone growth disruption
Correct Answer: D. Bone growth disruption The epiphyseal plate is a significant region of bone growth. Hence, any disruption may result in limb shortening. Sometimes, changes in the growth plate from the fracture can cause problems later. For example, the bone could end up a little crooked or a bit longer or shorter than expected.
Sickle cell disease (SCD) primarily affects: A. children of African descent and Hispanics of Caribbean ancestry. B. children of Middle-Eastern and Indian descent. C. children of Asian descent. D. both African descent and Hispanics of Caribbean ancestry and Middle-Eastern and Indian descent.
Correct Answer: D. Both African descent and Hispanics of Caribbean ancestry and Middle-Eastern and Indian descent. Sickle cell disease primarily affects children of African descent and Hispanics of Caribbean ancestry. It also occurs in children of Middle-Eastern and Indian descent. Sickle cell anemia is the most common monogenic disorder. Prevalence of the disease is high among the people of Sub-Saharan Africa, South Asia, the Middle East, and the Mediterranean.
A child with known hemophilia A was brought to the emergency room with complaints of nose bleeding and some bruises in the joints. Which of the following should the nurse anticipate to be given to the child? A. Oral iron supplement B. Cyclosporine C. Factor X Factor VIII
Correct Answer: D. Factor VIII Hemophilia A, also called factor VIII (FVIII) deficiency or classic hemophilia, is a genetic disorder caused by missing or defective factor VIII, a clotting protein. The initial treatment is the administration of factor VIII to replace the missing factor and decrease the bleeding episode.
Which of the following is the best method for performing a physical examination on a toddler A. From head to toe B. Distally to proximally C. From abdomen to toes, the to head D. From least to most intrusive
Correct Answer: D. From least to most intrusive When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Stay at the child's level as much as possible. Do not tower. Examine painful areas last-get general impression of overall attitude. Be honest. If something is going to hurt, tell them that in a calm fashion.
Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and takes steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following? A. Sodium bicarbonate from renal compensation B. Potassium from cell death C. Glucose from carbohydrate metabolism D. Ketone bodies from fat metabolism
Correct Answer: D. Ketone bodies from fat metabolism. Inability to use glucose causes lipolysis, fatty acid oxidation, and release of ketones, resulting in metabolic acidosis and coma. Ketones accumulate and cause metabolic acidosis. The body tries to compensate by hyperventilation to eliminate carbon dioxide. When the blood glucose is low or cannot be used due to a lack of insulin, ketones are the major source of energy for the brain. The brain does not have any fuel stores and has no other non-glucose-derived energy sources.
In children diagnosed with sickle cell disease (SCD), tissue damage results from which of the following? A. Air hunger and respiratory alkalosis due to deoxygenated red blood cells. B. Hypersensitivity of the central nervous system (CNS) due to elevated serum bilirubin levels C. A general inflammatory response due to an autoimmune reaction from hypoxia D. Local tissue damage with ischemia and necrosis due to obstructed circulation
Correct Answer: D. Local tissue damage with ischemia and necrosis due to obstructed circulation Characteristic sickle cells tend to clump, which results in weak and inadequate blood flow to the tissue, local tissue damage, and eventual ischemia and necrosis. There is increased adhesion of erythrocytes followed by the formation of heterocellular aggregates, which physically cause small vessel occlusion and resultant local hypoxia.
The adolescent patient has symptoms of meningitis: nuchal rigidity, fever, vomiting, and lethargy. The nurse knows to prepare for the following test: A. blood culture. B. throat and ear culture. C. CAT scan. D. lumbar puncture.
Correct Answer: D. Lumbar puncture. Meningitis is an infection of the meninges, the outer membrane of the brain. Since it is surrounded by cerebrospinal fluid, a lumbar puncture will help to identify the organism involved. The CSF findings expected in bacterial, viral, and fungal meningitis are listed in the chart: Expected CSF findings in bacterial versus viral versus fungal meningitis.
A spica cast was put on Baby Betty after an unfortunate incident to immobilize her hips and thighs. Which of the following is the priority nursing action immediately after application? A. Keep the cast dry and clean. B. Cover the perineal area. C. Elevate the cast. D. Perform neurovascular checks.
Correct Answer: D. Perform neurovascular checks. A neurovascular assessment is always a priority in the assessment of a freshly applied cast to ensure adequate circulation and neurologic function and prevent complications or injury. Neurovascular observations should be conducted hourly for the first 24 hours then 2-4 hourly for the next 48 hours depending on the condition. Document findings on appropriate limb observation flowsheet.
Nurse Emma is planning a client education program for sickle cell disease (SCD); What topic should be included in the plan of care? A. Aerobic exercise to improve oxygenation B. Fluid restraint to 1 qt (1 L)/day C. A high-iron, high-protein diet D. Proper hand washing and infection avoidance
Correct Answer: D. Proper handwashing and infection avoidance Prevention of infection is vital in the prevention of sickle cell crisis. Patients with SCD are especially at risk for infections with encapsulated organisms because of their functional asplenia, as well as because of functionally immunocompromised state (increased bone marrow turnover and altered complement activation).
Hannah, age 12, is 7 months pregnant. When teaching parenting skills to an adolescent, the nurse knows that which teaching strategy is least effective? A. Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model B. Initiating a teenage parent support group with first and second-time mothers C. Using audiovisual aids that show discussions of feelings and skills D. Providing age-appropriate reading materials
Correct Answer: D. Providing age-appropriate reading materials. Because adolescents absorb less information through reading, providing age-appropriate reading materials is the least effective way to teach parenting skills to an adolescent. The Adolescent Family Life (AFL) demonstration projects, organized through the Office of Adolescent Pregnancy Programs (OAPP), are aimed to support young families through social support and medical care.
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 defects D. Renal anomalies
Correct Answer: 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.
The twelve-year-old boy has fractured his arm because of a fall from his bike. After the injury has been casted, the nurse knows it is most important to perform all of the following assessments on the area distal to the injury except: A. capillary refill. B. radial and ulnar pulse. C. finger movement. D. skin integrity.
Correct Answer: D. Skin integrity Capillary refill, pulses, and skin temperature and color are indicative of intact circulation and absence of compartment syndrome. Skin integrity is less important. Check the edges of the cast and all skin areas where the cast edges may cause pressure. If there are signs of edema or circulatory impairment, notify the charge nurse or physician immediately.
A 6-year-old child is scheduled to have measles, mumps, and rubella (MMR) vaccine. Which of the following routes will you expect the nurse to administer the vaccine? A. Intramuscularly in the vastus lateralis muscle. B. Intramuscularly in the deltoid muscle. C. Subcutaneously in the gluteal area. D. Subcutaneously in the outer aspect of the upper arm.
Correct Answer: D. Subcutaneously in the outer aspect of the upper arm. (MMR) the vaccine is administered subcutaneously in the outer aspect of the upper arm. The dosage for both MMR and MMRV is 0.5 mL. Both vaccines are administered by the subcutaneous route.
A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts? A. Always keep insulin vials refrigerated B. Increase the amount of insulin before exercise C. Ketones in the urine signify a need for less insulin D. Systematically rotate injection sites
Correct Answer: D. Systematically rotate injection sites. It is necessary to rotate injection sites because injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop. Insulin delivery is by multiple daily injections (MDI) or an insulin pump to simulate endogenous insulin physiology. Multiple daily injections include basal insulin once or twice daily, and bolus insulin typically is given at meals three or more times daily and is based on carbohydrate content and current blood glucose.
The nurse answers a call bell and finds a frightened mother whose child, the patient, is having a seizure. Which of these actions should the nurse take? A. The nurse should insert a padded tongue blade in the patient's mouth to prevent the child from swallowing or choking on his tongue. B. The nurse should help the mother restrain the child to prevent him from injuring himself. C. The nurse should call the operator to page for seizure assistance. D. The nurse should clear the area and position the client safely.
Correct Answer: D. The nurse should clear the area and position the client safely. The primary role of the nurse when a patient has a seizure is to protect the patient from harming him or herself. Support head, place on soft area or assist to the floor if out of bed. Supporting the extremities lessens the risk of physical injury when the patient lacks voluntary muscle control.
A physician prescribes an IV solution of 500 ml 0.45% Saline with an incorporation of 20mEq potassium chloride for a child with dehydration. The nurse should check which of the following before administering this IV prescription? A. Blood pressure B. Height C. Weight D. Urine output
Correct Answer: D. Urine output When it comes to hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment for the nurse is to check the urinary output before the administration. Potassium chloride is contraindicated for patients with oliguria or anuria. The body becomes dehydrated when it loses more fluids than it consumes. When the body doesn't have enough fluids, it can't process potassium properly, and potassium builds up in the blood, which can lead to hyperkalemia.
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
Correct Answer: D. Varicella 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.
When administering an I.M. injection to an infant, the nurse in charge should use which site? A. Deltoid B. Dorsogluteal C. Ventrogluteal D. Vastus lateralis
Correct Answer: D. Vastus lateralis The recommended injection site for an infant is the vastus lateralis or rectus femoris muscles. Skeletal muscle can accommodate larger volumes of medication than subcutaneous tissue, and absorption is faster because muscle tissue is highly vascular. Muscle has fewer pain-sensing nerves than subcutaneous tissue and is less sensitive to irritating and viscous medications, so pain is lessened.
Steve is diagnosed with celiac disease and experiences celiac crisis secondary to upper respiratory tract infection; which of the following would Nurse Nancy expect to assess? A. Lethargy B. Weight gain C. Respiratory distress D. Watery diarrhea
Correct Answer: D. Watery diarrhea Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergics. Celiac crisis is typically characterized by severe watery diarrhea. Celiac crisis is a life-threatening syndrome in which patients with celiac disease have profuse diarrhea and severe metabolic disturbances.
Mrs. Baker was instructed by the nurse on foods to encourage her child's diet concerning the latter's iron deficiency anemia. which of the following if stated by the mother would indicate the need for further instruction? A. Fish B. Lean meats C. Whole-grain breads D. Yellow vegetables
Correct Answer: D. Yellow vegetables If a parent states that she should stress the intake of yellow vegetables, she needs additional teaching because yellow vegetables are not a good source of iron. Leafy greens, especially dark ones, are among the best sources of nonheme iron.
