Exam 3 green book

The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which is the nurse's best response?

"Many children with CP have normal intelligence."

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply.

1. Swimming. 2. Golf. 3. Hiking. 4. Fishing.

A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a clinical manifestation of von Willebrand disease? Select all that apply.

1. The child bruises easily. 2. Excessive menstruation. 3. The child has frequent nosebleeds.

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply.

1. The extremity should be immobilized. 2. The extremity should be elevated. 5. Factor VIII should be administered.

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis?

Intravenous fluids at 11⁄2 times regular maintenance.

Which of the following will be abnormal in a child with the diagnosis of hemophilia?

Partial thromboplastin time (PTT).

A school-age child comes in with a sore throat and fever. The child was recently diagnosed with Graves disease and is taking propylthiouracil. What concerns should the nurse have about this child?

The child may have leukopenia.

The nurse tells a family of a child with cerebral palsy (CP) that since the 1960s the incidence of CP has:

increased

The nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. Which would be a priority nursing diagnosis before surgery?

risk of infection

Which would the nurse teach a patient when NSAIDs are prescribed for treating juvenile idiopathic arthritis (JIA)?

take with food

The parent of an infant asks the nurse what to watch for to determine whether the infant has CP. Which is the nurse's best response?

"If the infant has clenched fists after 3 months."

The nurse has completed discharge teaching for the family of a 10-year-old diagnosed with diabetes insipidus (DI). Which statement best demonstrates the family's correct understanding of DI?

"My child will have to use the bathroom more often than other children."

The parents of a child with meningitis and multiple seizures ask if the child will likely develop cerebral palsy (CP). Select the nurse's best response.

"Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis."

A 5-year-old is discharged from the hospital following the diagnosis of hemolytic uremic syndrome (HUS). The child has been free of diarrhea for 1 week, and renal function has returned. The parent asks the nurse when the child can return to school. Which is the nurse's best response?

"Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet."

Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply.

3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

A 10-kg toddler is diagnosed with AKI, is afebrile, and has a 24-hour urine output of 110 mL. After calculating daily fluid maintenance, which would the nurse expect the toddler's daily allotment of fluids to be?

350 mL of oral and intravenous fluids.

The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due to which of the following?

Increased permeability of the glomeruli.

The manifestations of hemolytic uremic syndrome (HUS) are due primarily to which event?

The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia.

The nurse is taking care of a 10-year-old diagnosed with Graves disease. Which could the nurse expect this child to have recently had?

Weight loss, difficulty sleeping, and heat sensitivity.

What should the parent of a child with diabetes insipidus (DI) be taught about administering desmopressin acetate nasal spray? Select all that apply.

1. The use of the flexible nasal tube. 2. Nasal congestion causes this route to be ineffective. 4. The medication should be administered every 8 to 12 hours. 5. Overmedication results in signs of SIADH.

Which priority item should be placed at the bedside of a newborn with myelomeningocele? Select all that apply.

A bottle of normal saline. Latex-free gloves.

Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed?

Apply pressure to the nose for at least 10 minutes.

Which finding requires immediate attention in a child with glomerulonephritis?

Complaining of a severe headache and photophobia.

The school nurse notices that a 14-year-old who used to be an excellent student and very active in sports is losing weight and acting very nervous. The teen was recently checked by the primary care provider (PCP), who noted the teen had a very low level of TSH. The nurse recognizes that the teen has which condition?

Graves disease

Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is?

It is a fracture that does not go all the way through the bone.

The nurse prepares baclofen for a child with cerebral palsy (CP) who just had her hamstrings surgically released. The child's parents ask what the medication is for. Select the nurse's best response.

It is a medication that will help control her spasms."

Which is included in the plan of care for a newborn who has a myelomeningocele?

Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

Which should be the priority nursing diagnosis for a 12-hour-old newborn with a myelomeningocele at L2?

Potential for infection related to the physical defect.

The nurse is developing a plan of care for a child recently diagnosed with cerebral palsy (CP). Which should be the nurse's priority goal?

Teach appropriate parenting strategies for a special-needs child.

The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals?

Cheese, banana slices, rice cakes, and whole milk.

The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby's head circumference. Select the nurse's best response:

"Babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size."

The parents of a child hospitalized with minimal change nephrotic syndrome (MCNS) ask why the last blood test revealed elevated lipids. Which is the nurse's best response?

"Because your child is losing so much protein, the liver is stimulated and makes more lipids."

A child fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which is a priority for the triage nurse to say at this time?

"Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?"

The school nurse is talking to a 14-year-old about managing type 1 diabetes mellitus. Which statement indicates the student's understanding of the disease?

"It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin."

Which statement by a parent is most consistent with minimal change nephrotic syndrome (MCNS)?

"My child missed 2 days of school last week because of a really bad cold."

The parent of a young child with CP brings the child to the clinic for a checkup. Which parent's statement indicates an understanding of the child's long-term needs?

"My child will grow up and need to learn to do things independently."

The parent of a child diagnosed with AKI asks the nurse why peritoneal dialysis was selected instead of hemodialysis. Which is the nurse's best response?

"Peritoneal dialysis removes fluid at a slower rate than hemodialysis, so many complications are avoided."

The nurse is administering omeprazole (Prilosec) to a 3-month-old with gastroesophageal reflux (GER). The child's parents ask the nurse how the medication works. Which is the nurse's best response?

"Prilosec decreases stomach acid, so it will not be as irritating when your child spits up."

The nurse is caring for an infant with pyloric stenosis. The parent asks if any future children will likely have pyloric stenosis. Which is the nurse's best response?

"Pyloric stenosis can run in families. It is more common among males."

The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis?

"The baby is always hungry after vomiting, so I feed her again."

The parent of a child being evaluated for celiac disease asks the nurse why it is important to make dietary changes. Which is the nurse's best response?

"The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems."

The nurse is caring for a 2-month-old infant who is at risk for cerebral palsy (CP) due to extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the nurse's best response.

"The speech therapist will help with tongue and jaw movements to assist with feeding."

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse's best response?

"There is blood in your child's urine that causes it to be tea-colored."

A parent asks the nurse how to prevent the child from having minimal change nephrotic syndrome (MCNS) again. Which is the nurse's best response?

"Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

The nurse is doing a follow-up assessment of a 9-month-old. The infant rolls both ways, sits with some support, pushes food out of the mouth, and pushes away when held. The parent asks about the infant's development. The nurse responds by saying which of the following?

"Your child needs to see the primary care provider."

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse's best responses? Select all that apply.

"Your child's urine output will increase, and the urine will become less tea-colored."

The nurse is interviewing the parent of a 9-year-old girl. The parent expresses concern because the daughter already has pubic hair and is starting to develop breasts. Which statements would be most appropriate?

"Your daughter is experiencing body changes that are appropriate for her age."

17. Which should the nurse include in the plan of care to decrease symptoms of gastroesophageal reflux (GER) in a 2-month-old? Select all that apply.

- Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. -Suggest that the parents burp the infant after every 1-2 ounces consumed.

A parent of a newborn diagnosed with myelomeningocele asks what is/are common long-term complication(s)? The nurse's best response is which of the following? Select all that apply.

- urinary tract infections - hydrocephalus

Which should the nurse expect as an intervention in a child in the recovery phase of GBS? Select all that apply.

-Arrange for in-home schooling. -Begin active PT.

Which would the nurse most likely find in the history of a child with hemolytic uremic syndrome (HUS)? Select all that apply.

-Vomiting and diarrhea before admission. -Anorexia and bruising.

Nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes which of the following? Select all that apply.

-assess pain -assess pulses -monitor capillary refill -provide pain meds as needed

One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical mobility. Select all that apply.

1. Give pain medication prior to ambulation. 2. Assist with range-of-motion activities. 5. Use non-pharmacological methods, such as heat.

The nurse is caring for a 4-month-old with gastroesophageal reflux (GER). The infant is due to receive rantadine (Zantac). Based on the medication's mechanism of action, when should this medication be administered?

30 mins before the feeding

Which child is at increased risk for cerebral palsy (CP)?

A 17-day-old infant with group B Streptococcus meningitis.

Which child is at risk for developing glomerulonephritis?

A 3-year-old who had impetigo 1 week ago.

Which child requires continued follow-up because of behaviors suspicious of cerebral palsy (CP)?

A 6-month-old who always reaches for toys with the right hand.

Which of the following measures should the nurse teach the parent of a child with hemophilia to do first if the child sustains an injury to a joint causing bleeding?

Administer factor per the home-care protocol.

A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving furosemide (Lasix) twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema?

Administration of intravenous albumin.

A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse's assessment follows: awake; pale, thin child lying in bed; multiple contractures; drooling; coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which nursing diagnosis is most important?

Alteration in nutrition: less than body requirements.

A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats per minute.

An 8-year-old male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 years ago.

The nurse evaluates teaching of parents of a child newly diagnosed with CP as successful when the parents state that CP is which of the following?

An increase in muscle tone and deep tendon reflexes.

A 7-year-old is diagnosed with central precocious puberty. The child is to receive a monthly intramuscular (IM) injection of leuprolide acetate (Lupron). The child has great fear of pain and needles and requires considerable stress reduction techniques each time an injection is due. What could the nurse suggest that might help manage the pain?

Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection.

A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which would the nurse expect in an infant with hydrocephalus?

Bulging fontanel and downwardly rotated eyes.

A child diagnosed with acute kidney injury (AKI) complains of "not feeling well," having "butterflies in the chest," and arms and legs "feeling like Jell-O." The cardiac monitor shows that the QRS complex is wider than it was and that an occasional premature ventricular contraction (PVC) is seen. Which would the nurse expect to administer?

Calcium gluconate via slow intravenous push.

The nurse is caring for an unconscious 6-year-old who has had a severe closed-head injury and notes the following changes: Heart rate has dropped from 120 to 55, blood pressure has increased from 110/44 to 195/62, and respirations are becoming more irregular. Which should the nurse do first after calling the physician?

Call for additional help and prepare to administer mannitol (Osmitrol).

A child with GBS has had lots of oral fluids but has not urinated for 8 hours. Which is the nurse's first action?

Catheterize the child in and out.

The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type 1 diabetes mellitus. What information should the nurse provide about this condition?

Characterized mainly by insulin deficiency.

The nurse caring for a 14-year-old girl with diabetes insipidus (DI) understands which of the following about this disorder?

DI is treated with vasopressin on a lifelong basis.

Brain damage in a child who sustained a closed-head injury can be caused by which factor?

Decreased perfusion of the brain and increased metabolic needs of the brain.

Which needs to be present to diagnose hemolytic uremic syndrome (HUS)?

Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure.

The family of a young child has been told the child has diabetes insipidus (DI). What information should the nurse emphasize to the family?

Diabetes insipidus is different from diabetes mellitus.

The nurse caring for a client with type 1 diabetes mellitus is teaching how to self- administer insulin. Which is the proper injection technique?

Elevate the subcutaneous tissue before injection.

A 12-year-old comes to the clinic with a diagnosis of Graves disease. What information should the nurse discuss with the child?

Encourage the child to take responsibility for daily medications.

The nurse is caring for a child who complains of constant hunger, constant thirst, frequent urination, and recent weight loss without dieting. Which can the nurse expect to be included in care for this child?

Frequent blood glucose testing.

Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis (JIA)?

Immune suppression.

The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the:

Immune-stimulated inflammatory response in the joint.

The nurse is planning care for a child who was recently admitted with GBS. Which is a priority nursing diagnosis?

Impaired skin integrity related to infectious disease process.

A 7-year-old is tested for diabetes insipidus (DI). Twenty-four hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale, with a low specific gravity. Which is the most likely reason for this?

In DI, fluid restriction does not cause urine concentration.

4. Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)?

Increasing fluids will help prevent and treat UTIs.

A child with hemolytic uremic syndrome (HUS) is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects administration of blood products and what else to be added to the plan of care?

Initiation of dialysis.

The parent of a child with hemophilia is asking the nurse what caused the hemophilia. Which is the nurse's best response?

It is an X-linked recessive disorder.

The parent of a toddler newly diagnosed with CP asks the nurse what caused it. The nurse should answer with which of the following?

It is commonly caused by perinatal factors.

Which should the nurse do first when caring for an infant who just had a repair of a myelomeningocele?

Measure head circumference.

Which combination of signs is commonly associated with glomerulonephritis?

Mild proteinuria, hematuria, decreased urinary output, and lethargy.

Which laboratory results besides hematuria are most consistent with hemolytic uremic syndrome (HUS)?

Mild proteinuria, increased blood urea nitrogen and creatinine.

Which should the nurse prepare the parents of an infant for following surgical repair and closure of a myelomeningocele shortly after birth? The infant will:

Need lifelong management of urinary, orthopedic, and neurological problems.

Which would the nurse expect to be included to make the diagnosis of celiac disease in a child?

Obtain stool sample and prepare child for jejunal biopsy.

A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan?

Obtain urinalysis and urine culture.

Which intervention should be included in the plan of care for a newborn with a newly repaired myelomeningocele?

Offer formula/breast milk every 3 hours.

An 8-year-old with type 1 diabetes mellitus is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first?

Offer the child 8 oz of milk.

The nurse is caring for a 1-year-old diagnosed with AKI. Edema is noted throughout the child's body, and the liver is enlarged. The child's urine output is less than 0.5 mL/kg/hr, and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is noted to have nasal flaring and retractions with inspiration. The lung sounds are coarse throughout. Despite receiving oral sodium polystyrene sulfonate (Kayexalate), the child's serum potassium continues to rise. Which treatment will provide the most benefit to the child?

Placement of a Tenckhoff catheter for peritoneal dialysis.

Select the best room assignment for a newly admitted child with bacterial meningitis.

Private room that is dark and quiet with minimal stimulation.

The most appropriate nursing diagnosis for a child with type 1 diabetes mellitus is which of the following?

Risk for infection related to reduced body defenses.

Why are chemotherapeutic agents such as methotrexate (Trexall) and cyclophosphamide (Cytoxan) sometimes used to treat juvenile idiopathic arthritis (JIA)?

Suppress the immune system.

Over the past week, an infant with a repaired myelomeningocele has had a high- pitched cry and been irritable. Length, weight, and head circumference have been at the 50th percentile. Today, length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following?

Tell the parent this might mean the baby has increased intracranial pressure.

A child with a repaired myelomeningocele is in the clinic for a regular examination. The child has frequent constipation and has been crying at night because of pain in the legs. After an MRI, the diagnosis of a tethered cord is made. Which should the nurse tell the parent?

Tethered cord is a postsurgical complication.

The nurse anticipates that the child who has had a kidney removed will have a high level of pain and will require invasive and noninvasive measures for pain relief. The nurse anticipates that the child will have pain because of which of the following?

There is a postoperative shift of fluids and organs in the abdominal cavity, leading to increased discomfort.

A nurse is caring for a 5-year-old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that:

This is a serious injury that could cause long-term growth issues.

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)?

Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample.