Ch 20 & 21 Peds final

The nurse is educating the parents of a child requiring renal replacement. The parents express concern because they live in a remote, rural area with no access to pediatric specialty dialysis units. Which would the nurse recommend to the parents?

Peritoneal dialysis

In caring for a child with a urinary tract infection, the nurse would perform all of the following nursing interventions. Which two interventions would the nurse identify as the priority?

- Collect a clean catch voided urine - observe the child for signs of any reactions to the abx

The nurse is talking with a pregnant client about cleft lips and palates. The client has asked if these can be tested for. What information should be included in the nurse's response? Select all that apply.

- Ultrasounds can be used to assess for these conditions. - Most cleft lips and palates are found at delivery.

The healthcare provider prescribes an abdominal radiographs for a newborn to check for Hirschsprung's disease. The nurse examines the newborn and finds which symptoms that are indicated of this disease select all that apply

- abdominal distention - absence of stool in the rectum - bilious vomitting - enterocolitis

When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply.

- intermittent hematuria - abdominal mass

The nurse is caring for a child who has been admitted to the acute care facility with manifestations consistent with hydronephrosis. Which tests will confirm the diagnosis? Select all that apply.

- intravenous pyelogram (IVP) - voiding cystourethrogram (VCUG) - renal ultrasound

The nurse is positioning an infant who has just had his left-sided cleft lip repaired. Which position are acceptable for this infant select all that apply.

- right side lying - supine

he nurse is reviewing the blood urea nitrogen (BUN) results of an assigned client. The test is elevated. What factors may be associated with this result? Select all that apply.

- the child may be dehydrated - the child's diet contains high levels of protein. - there may be an infectious process in the child

The nurse is caring for six-year-old client diagnosed with acute renal failure. During assessment the nurse notes temperature 99, you're an output less than 0.4 mL/kg/hr, blood pressure 130/88, Perry orbital Adema, and respirations 28 breaths/minute. Which prescriptions would the nurse anticipate from the primary health care provider? Select all that apply.

- urinalysis - dialysis - furosemide - serum electrolyte levels - labetalol

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician?

Absence of thrill

A mother brings her three-year-old son to the ER until the triage nurse that he has been vomiting blood. Medical history determines that the three-year-old has no history of G.I. disturbances and only symptoms are slightly elevated fever and vomiting bright red blood. Based on the symptoms what condition might be a nurse suspect

Acute upper GI bleeding.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of a child with celiac syndrome? Select all that apply

Applesauce bananas skim milk The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, and oats (unless specifically gluten-free) are not included in the diet

The nurse is taking a health history of a 2-year-old girl presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction?

Bilious vomiting The contents and character of the vomitus may give clues to the cause of vomiting. Bilious vomiting is never considered normal and suggests an obstruction.

A 10-year-old child in renal failure is on continuous ambulatory peritoneal dialysis (CAPD). What would be important to teach the parents?

Cramping should not occur with an infusion.

A child presents with intermittent abdominal pain, severe anorexia, and diarrhea. The child's height and weight are significantly behind standards for age. There is skin breakdown in the anal region. The nurse explains that this presentation is consistent with which diagnosis?

Crohn disease Intermittent abdominal pain, anorexia, diarrhea, growth delays, and perianal lesions are characteristic of Crohn disease.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?

Hirschsprung disease No meconium in the first 24 hours, bilious vomiting, abdominal distention, and feeding intolerance with bilious aspirates and vomiting.

A nurse is reviewing the medical record of an infant with hydronephrosis. Which finding(s) will the nurse anticipate in the history and physical examination? Select all that apply.

History of repeated urinary tract infections Abdominal mass on palpation Crying on voiding

A parent brings it to your old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in local daycare center. Business information, what gastrointestinal condition might the nurse suspect?

Gastroenteritis

A child with severe vomiting for 3 days presents with hypopnea and hypokalemia. The nurse reports to the provider that this child is exhibiting signs of which condition?

Metabolic alkalosis With extended vomiting, there is a shift in Cl and K ions resulting in metabolic alkalosis. Metabolic acidosis is more commonly seen in severe diarrhea, and respiratory alkalosis and respiratory acidosis are caused by conditions that impact ventilation.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child history, what would the nurse identify as a risk factor for this condition?

Mother age 42 with pregnancy Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anti-convulsant, steroids, and other medication's during early pregnancy are considered wrist factors.

The nurse is providing care to a child with acute me no failure. What assessment would be the priority for the nurse to determine if this child is developing hyperkalemia?

Pulse rate and rhythm Hyperkalemia occurs when the potassium levels rise. Symptoms such as weak irregular pulse muscle weakness and abdominal cramping. Increased muscle twitching would be associated with hypocalcemia.

Which nursing diagnosis would be the priority when caring for a child in renal failure following kidney transplant?

Risk for infection related to immunocompromise state

A nurse is caring for a 12-year-old girl recently diagnosed with end-stage kidney disease. The nurse is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching?

She can eat whatever she wants on dialysis days. The girl cannot eat whatever she wants on dialysis days. She can eat what she wants during the few hours she is actively undergoing treatment in the hemodialysis unit. The other statements regarding a high sodium diet and potassium intake are correct.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac disease. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac disease?

She loves hot dogs, and we always cut hers up into small pieces. Commercially canned creamed soups, cold cuts, frankfurters, and pudding mixes generally contain wheat products and should not be included in the diet

The nurse is caring for a 10-year-old boy with end-stage kidney disease with metabolic acidosis. What would the nurse expect to administer is ordered?

Sodium bicarbonate tablets Bicitra or sodium bicarb tablets are used for correction of acidosis.

The nurse is caring for a 6-month-old infant with diarrhea and dehydration. The parent is concerned because the infant has some patches on the tongue. Which feature indicates a geographic tongue?

Some patches are light in color and other patches are dark in color A geographic tongue is a benign, noncontagious condition characterized by a reduction in the filiform papillae

The nurse is assessing a 10 day old infant for dehydration. Which finding indicates severe dehydration?

Tenting of skin severe dehydration - tenting of skin mild dehydration - soft and flat fontanelles mild or moderate dehydration - pale and slightly dry mucosa

The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis

The child can live a more normal lifestyle. this is a seven day a week procedure, but there are less diet restrictions and more freedom with this type of procedure. Can be performed at home.

A child needs to undergo peritoneal dialysis. What type of education would the nurse provide to the family about this process?

The peritoneal dialysis should help the child with his or her growth and blood pressure. The advantages of peritoneal dialysis over hemodialysis include improved growth as a result of more dietary freedom, increased independence in daily activities, and a steadier state of electrolyte balance. However, the risk for infection (peritonitis and sepsis) is a continual concern with peritoneal dialysis.

What occurs in the gastrointestinal system of the child with Hirschsprung disease?

There is a partial or complete mechanical obstruction in the intestine.

While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication?

Uremia Uremia may result in depression of the central nervous system leading to symptoms such as headache or coma or gastrointestinal or neuromuscular disturbances. Metabolic acidosis causes lethargy, dull headache, and confusion. Immunosuppression is not involved with end-stage kidney disease. Hypocalcemia is manifested by muscle twitching, or tetany.

The nurse is caring for a 2-year-old child with a gastrointestinal infection resulting in 4 to 5 liquid stools per day over the past 3 days. Based on this information, which important concern(s) will the nurse address in the child's care? Select all that apply.

fluid deficiency risk: dehydration diarrhea and loss of electrolytes the risk for skin maceration in the perineum

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

monitor of intake and output IV fluid administration daily weight assessment

The nurse is obtaining the history of an infant with a suspected intestinal obstruction. Which response regarding newborn stool patterns would indicate a need for further evaluation for Hirschsprung disease?

passed a meconium plug

A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has:

severe dehydration A loss of more than 10% of body weight in a day is a sign of severe dehydration.