NUR 225 comprehensive review
The best way for a toddler's parents to help successfully complete this developmental task, according to Erickson, includes which of the following? a. Teach her to always follow directions. b. Give her small household chores to do. c. Help her learn to count or add. d. Allow her to make simple decisions
D Allowing toddlers to make simple decisions allows them to feel independent.
The best way for a 5-year-old's parents to help successfully complete this developmental task, according to Erickson, includes which of the following? a. Encourage them to work with creative materials. b. Help them follow rules such as coloring between lines. c. Teach them beginning school skills such as simple addition. d. Buy clothes that are closed with snaps rather than buttons.
A Learning a sense of initiative is learning how to do things. The experience of creating helps preschoolers to learn this
The nurse is providing care for a child with nephrotic syndrome. When addressing the factor that causes the edema associated with this problem, the nurse should assess which of the following? a. Serum protein level b. LDL cholesterol level c. Vitamin A level d. White blood cell count
A Children lose protein in urine, depleting protein levels in the circulatory system. This causes fluid to osmose into interstitial tissue from blood vessels. Cholesterol, vitamin A, and WBC levels are not directly relevant to this process
A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform? A. Assess the level of consciousness (LOC). B. Notify the primary health care provider. C. Place the child on fall precaution. D. Place a patch over the client's affected eye.
A. Decreased LOC is frequently the first sign of a major neurologic problem after head trauma. The nurse would assess the client's LOC before notifying the health care provider. The child may need to be placed on fall precaution, depending on the results of the assessment. The child's eyes will correct themselves when the ICP is reduced; therefore, an eye patch is not necessary.
A nurse is taking vital signs on a 7-year-old and collects the following data: Temp 36.8C (98.2F), heart rate 100/bpm, respiratory rate 20/min, blood pressure 100/60 mmHg. What is the nurse's best action? A. elevate the head of bed to 30° B. notify the physician C. document the findings D. re-position blood pressure cuff and re-check
C-all WNL
Parents of a 4-month-old wonder why she doesn't sit yet. Which statement best reflects average sitting ability of infants? a. Most sit steadily at 3 months; Tina is delayed. b. Most do not sit well until 8 months; she is normal. c. Sitting and the age of first tooth eruption correlate. d. Most infants sit steadily by the end of the fourth month
B A major milestone of development is sitting at 8 months of age.
If a child were diagnosed with celiac disease, the nurse would anticipate the need to educate the family about what dietary modification? a. A low-fat, low-carbohydrate diet b. A diet free of wheat, rye, and barley c. A diet free of dairy and dairy products d. A diet high in simple carbohydrates
B Celiac disease is an apparent allergic response to gluten, the protein portion of wheat, oats, barley, and rye.
A nurse has admitted a child with rheumatic fever. The nurse will need to give the parents' instructions on administering which medication? a. A corticosteroid b. An oral penicillin c. An oral NSAID d. Antiretrovirals
B Children are prescribed oral penicillin to prevent them from contracting a streptococci infection again
When the nurse is completing an assessment of a child suspected of having diabetes mellitus, which of the following is most suggestive of the disease? a. The child has been obese for at least 4 or 5 years. b. The child has to void more than the average child. c. The child reports feeling constantly "full" or "stuffed." d. The child has abdominal pain from an enlarged liver.
B The characteristic triad of symptoms with diabetes mellitus is polyphagia, polyuria, and polydipsia.
A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful? A. "RSV season occurs primarily April through September." B. "Exposure to second- or thirdhand smoke increases the risk for developing RSV." C. "Infants are less affected by RSV than older children." D. "Early initiation of antibiotics can lessen the severity ofthe infection."
B. An infant exposed to second- or thirdhand smoke is at risk for developing RSV. RSV season runs from September through April. Current treatment recommendations for RSV do not include antibiotics. Infants are susceptible to RSV much more than older children.
An infant's parents ask when their child will be able to pick up small objects. By 10 months of age, infants typically pick up small objects by what method? a. "Hitching" them forward b. "Scooping" them up c. Using a thumb and finger d. Using only a thumb
C A "pincer grasp" is picking up objects by a thumb and finger and is acquired by infants at about 10 months
The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider? A. White blood cells: 8,000 million/uL B. Urine culture positive for contaminants C. Positive culture for group A streptococcus D. Platelets: 250,000/mm3
C. Acute glomerulonephritis may result as an autoimmune response to the invasion of group A streptococcus. This group of streptococci affect the glomeruli of the kidneys. This would be addressed by the health care provider and is the most important of the laboratory results presented. If there is an active strep infection, it would need to be treated with an antibiotic. The white blood cell count is within normal limits. It is good to be negative for respiratory syncytial virus. The urine culture would have to be redone due to contamination. It does not provide an accurate status of the child's urine.
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? A. Gastroenteritis B. Ulcerative colitis (UC) C. Hirschsprung disease D. Intussusception
C. The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain.
The nurse is assessing a pediatric client's ability to relieve the symptoms of her atopic dermatitis. What action by the client would deem most appropriate and effective? a. She avoids wearing cotton clothing. b. She only uses organic products and eats organic food. c. Sarah uses a plastic scouring pad to scratch her skin when it feels itchy. d. Sarah knows to use a skin emollient.
D Applying a skin emollient or moisturizer such as Eucerin helps to increase comfort and healing. Abrasives should be avoided, and there is no need to use organic products exclusively or to avoid cotton
The nurse is reviewing an infant's electronic health record since his admission. Which of the signs from the health history is most clearly representative of pyloric stenosis? a. Refusing feedings b. Intense crying 2 to 3 hours after feeding c. Diarrhea for 2 or more days d. Vomiting after a full feeding
D Because food cannot pass through the pyloric valve, it is vomited immediately after feeding.
A 4-year-old boy with nephrotic syndrome has extensive edema. The best intervention to reduce periorbital edema would be to: A. apply cool, sterile soaks to his head. B. encourage him to eat low-protein foods. C. apply warm compresses to his eyes at bedtime. D. elevate the head of the bed.
D because edema tends to be dependent, elevating an edematous body part usually reduces swelling in that part.
The stools of a child with aganglionic megacolon are usually described as being ________________.
ribbon like
The nurse is assessing a 5-year-old girl who is anxious, has a high fever, speaks in a whisper, and sits up with her neck thrust forward. Based on these findings, what would be least appropriate for the nurse to perform? A. Providing 100% oxygen B. Obtaining a throat culture C. Having the child sit forward D. Auscultating for lung sounds
B The child is exhibiting signs and symptoms of epiglottitis, which can be life-threatening. Under no circumstances should the nurse attempt to visualize the throat. Reflex laryngospasm may occur, precipitating immediate airway occlusion. Providing 100% oxygen in the least invasive manner that is most acceptable to the child is a sound intervention, as is allowing the child to assume a position of sitting forward with the neck extended. Auscultation would reveal breath sounds consistent with an obstructed airway.
The nurse is planning care for an adolescent client recently diagnosed with infectious mononucleosis. The plan of care should include which of the following? A. Avoid lifting heavy weights to reduce cardiac stress. b. Do not break open the rash crusts because this could leave scars. c. Avoid high-protein foods until liver inflammation fades. d. Engaging in swim team is acceptable, but football is not
D A child's spleen swells in size with this disorder so it could be ruptured easily with contact sports. The rash does not crust.
The best way for a 9-year-old's parents to help successfully complete this developmental task, according to Erickson, includes which of the following? a. Give him jobs that he can successfully complete. b. Be certain that he knows to pay attention in school. c. Complete any unfinished homework so he does not fall behind. d. Set up a strict schedule of rules for Warren to follow.
A A sense of accomplishment is best built by tackling and feeling rewarded by completing small projects.
A client's father asks the nurse what the usual therapy is for pyloric stenosis. You encourage to discuss specifics with the pediatrician but should also describe what typical intervention? a. Rest for the duodenum for 24 hours and supplementation by IV fluids b. Small, frequent feedings administered orally or by nasogastric tube c. Surgery to free the pyloric valve and allow better passage of milk d. Surgery to remove the lower half of the stomach, which is often ulcerated
C Surgery corrects the disorder by enlarging the size of the pyloric valve. Older methods of medical therapy rarely used today as surgery is so successful in correcting the problem.
Kawasaki syndrome occurs most frequently in school-age children. A nurse should be aware that this is most often manifested in children by which of the following signs and symptoms? a. Cardiac arrhythmias or chest pain b. Developmental delays c. Swelling of the parotid glands d. Shortness of breath accompanied by normal oxygen saturation levels
A Children with Kawasaki syndrome may develop aneurysms of the coronary arteries, which manifest as arrhythmias and chest pain. The other listed signs and symptoms are atypical.
A toddler's mother has not begun toilet training yet. Before beginning this task, the mother should assess whether: a. The toddler has the cognitive capacity to understand what is being asked of them. b. The toddler has enough vocabulary to explain when they need to void. c. The toddler's motor development has progressed to where they can grasp small items. d. The toddler's awareness of their comfort level makes them want to remain to be dry at night
A Cognitive development is an important part of toilet training. Success depends on the child being able to comprehend what is being asked of her.
Children who develop chronic renal disease often develop anemia. Anemia occurs with chronic renal disease for which of the following reasons? a. The kidneys are no longer able to produce erythropoietin. b. Kidneys no longer produce aldosterone so many red cells die. c. The spleen is stimulated to destroy damaged red blood cells. d. The liver is no longer stimulated to produce red blood cells.
A Erythropoietin, produced by the kidneys, can no longer stimulate the production of red blood cells.
Newborns are occasionally born with hypospadias. When reviewing the primary care provider's orders for a child with this health problem, what order should the nurse question? a. Prepare the infant for circumcision in 2 days. b. Monitor the infant's urinary output closely. c. Instruct the mother on exclusive breastfeeding. d. Instruct the parents on the need for meatotomy
A Hypospadias is placement of the urinary meatus along the shaft of the penis. Circumcision is contraindicated because the prepuce skin may be needed for the plastic repair (meatotomy) to correct the hypospadias
A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure? A. Encouraging fluid intake after dinner B. Practicing bladder-stretching exercises C. Giving desmopressin intranasally D. Engaging the child in stress-reduction measures
A In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to: A. notify a health care provider if the child develops an upper respiratory infection. B. prevent the child from drinking an excess amount of fluids per day. C. encourage the child to participate in school activities, such as long-distance running. D. administer an iron supplement daily.
A Infections caused by the Streptococcus pneumoniae can be lethal to a child with sickle cell, because they can cause overwhelming sepsis or meningitis. By 2 months of age the child should be started on Penicillin V as prophylaxis against pneumococcal infections. The child should receive the 7 valent pneumococcal series in infancy. After 2 years of age the child should receive the 23 valent pneumococcal vaccine. He or she should also be immunized against meningitis. Participating in strenuous activities such as running and limiting the amount of fluids leads to a reduction of oxygen and dehydration. This can lead to the increased sickling of cells. The anemia of sickle cell disease is not the result of iron deficiency. It is the result of the abnormal shape of the red blood cell. Administering iron will not correct the anemia.
The nurse is reviewing a 5-year-old's electronic health history. Which of the following symptoms would be most consistent with rheumatic fever? a. Swelling and pain in her knees b. Pain and distress on urination c. Tingling of her lower extremities d. Persistent nausea and vomiting
A Polyarthritis means several joints or joints in succession are inflamed and swollen. Children may have abdominal pain from swollen lymph nodes, but nausea and vomiting would be rare.
A boy with iron-deficiency anemia is prescribed ferrous sulfate. When assessing for therapeutic effects, which of the following assessment findings should the nurse prioritize? a. His reticulocyte count increases. b. His neutrophil level stabilizes. c. His stools appear dark and loose. d. His appetite increases.
A Reticulocytes are immature red blood cells. As soon as a child has adequate iron for cell formation, the reticulocyte count will increase
A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client? A. Hemoglobin level B. Leukocyte level C. Thrombocyte level D. Metabolic screening test
A The component of red blood cells (RBCs) that allows them to carry out the transport of oxygen is hemoglobin, composed of the protein globin and heme, an iron-containing pigment. Fetal hemoglobin differs from adult hemoglobin; for this reason, diseases such as sickle cell anemia or the Thalassemias, which are disorders of the beta chains, do not become clinically apparent until this hemoglobin change has occurred (at approximately 6 months of age). Leukocyte and thrombocyte levels are not typically tested in clients with sickle cell anemia. Metabolic screening is a test completed on newborns to assess for common metabolic disorders, such as sickle cell anemia, hypothyroidism, and phenylketonuria (PKU). However, this test is used to diagnose, not determine symptom severity or prognosis.
The nurse is caring for a client newly diagnosed with acute glomerulonephritis. When receiving the pediatric client's history, which is anticipated? A. a sports injury to the kidney two weeks ago B. onset of a streptococcus infection last week C. increased thirst, sweating, and shakiness since yesterday D. fatigue from viral infection onset 3 days ago
B The nurse is correct to anticipate a streptococcus infection 1 to 3 weeks prior to the diagnosis of acute glomerulonephritis. The presenting symptom is typically gross bloody urine. Acute glomerulonephritis is not related to a kidney infection, does not exhibit symptoms similar to diabetes, or a recent viral infection.
What action would the nurse suggest to a pediatric client's parents to if the client develops thrombocytopenia from chemotherapy? a. Maintain her on strict bed rest to ensure her safety. b. Assess all her body surfaces daily for bruising or purpura. c. Be certain that she understands this lowers her immune system. d. Urge her to eat more red meat and green, leafy vegetables.
B Thrombocytopenia is a deficiency of platelets leading to easy bruising. Safety is important, but strict bed rest is not warranted.
What would be the most appropriate anticipatory guidance to give an infant's parents at the 4-month health visit? a. She will probably develop a fear of strangers shortly. b. She will likely turn over from front to back next month. c. Most 4-month-olds become stubborn and persistent. d. Parents can expect many "blue" or moody periods next month.
B Most infants turn from the front to back by 4 months and then back to front by 5 month
According to Piaget's theory of cognitive development, when would a child have most likely used magical thinking? a. As an infant b. As a preschooler c. During middle school d. Between ages 6 and 8 years
B Preschoolers believe in "magical thinking" in which they believe what they wish will happen.
Pyloric stenosis has been diagnosed in a 3-week-old male infant who has frequent vomiting after feedings. An important preoperative nursing intervention is: A. reducing vomiting by feeding small amounts of clear liquids or breast milk frequently. B. maintaining NPO status while restoring hydration and electrolyte balance. C. assessing the abdomen hourly for distention and bowel sounds. D. providing adequate pain control.
B. NPO is needed to avoid vomiting and aspiration during surgery. Hydration and electrolyte replacement is often needed because of the history of vomiting, which causes loss of both fluid and electrolytes. Feeding when surgery is pending would not be safe. Hourly abdominal assessment would not yield needed information and would further disturb the infant. Pain is not the source of crying. The infant is hungry.
A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? A. A room with a 12-month-old infant with a urinary tract infection B. A room with an 8-month-old infant with failure to thrive . C A private room near the nurses' station D. A two-bed room in the middle of the hall
C A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until he or she has received IV antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis.
Which of the following is important to teach to a family whose child has diabetes insipidus? a. She will need daily insulin injections b. She will be susceptible to kidney disease. c. She can easily become dehydrated. d. She will be susceptible to absence seizures.
C A major symptom of diabetes insipidus is excessive urination as children are unable to concentrate urine due to lack of antidiuretic hormone. This leads to dehydration.
A nurse is caring for a school-age child who had an arm cast applied 8 hours ago. Which of the following should alert the nurse to a complication related to casting? A. The child reports a pain level of 5 on a scale of 0-10 B. The child's hands are cool bilaterally C. The child reports tightness at the wrist D. The child's grasp is weak
C At risk for compartment syndrome Mild to mod pain is expected- however, it is extreme or unrelieved by analgesics then that's a big concern. Bilateral cooling isn't bad. Weak grasp is expected
An infant with bladder exstrophy is awaiting surgical repair. What is the priority nursing intervention for the nurse to complete in the care for this infant? A. Clean the area well with soap and water. B. Apply a barrier/healing cream or paste on the skin. C. Keep the bladder moist and covered with a sterile bag. D. Change soiled diapers frequently.
C Bladder exstrophy is a condition where the infant is born with the bladder exposed outside the skin on the abdomen. It can only be corrected by surgery. A priority nursing intervention is to cover the bladder with a sterile plastic bag and keep it moist. This will help protect the bladder and prevent infection. The nurse will also apply a protective barrier cream to the skin around the bladder to help prevent skin breakdown. In addition, the nurse will sponge-bathe the infant rather than immerse the infant in water to prevent pathogens from the water possibly entering the bladder. The nurse will change soiled diapers frequently to prevent cross-contamination from stool to urine.
An infant presents to the clinic with a bright red diaper rash. Which advice would the nurse give to the parents? a. They should select a more expensive brand of disposable diaper. b. Applying scented talcum powder after diaper changes will reduce discomfort. c. They need to alert their care provider because this could be a fungal infection. d. Most infants develop diaper rash in the summer; it will fade with cooler weather.
C Bright red diaper rashes can be fungal infections, and they will need a prescription medicine (usually Nystatin) for this.
A child with hemophilia A bumped his knee when he fell. What statement by his mother would assure the nurse that the mother understands the best emergency measure to do for this type of injury? a. "I apply warm soaks for at least 20 minutes." b. "I apply a tourniquet to stop blood flow to the knee." c. "I can expect an administration of an intravenous infusion of factor VIII." d. "I give an oral dose of factor X followed by water."
C Children with hemophilia A are deficient in factor VIII, necessary for blood clotting. Warm soaks would increase bleeding. Applying a tourniquet with a bleeding disorder could cause purpura or ecchymoses from pressure.
Which statement by a pediatric client with asthma would assure the nurse he understands how to use cromolyn sodium best? a. "I should take it as soon as an asthma attack starts." b. "I can't take it if I have a fever more than 101°F." c. "I should take it to prevent attacks from occurring." d. "I should use it for only 24 hours after an attack."
C Cromolyn sodium prevents asthma attacks. It is not effective after an acute attack begins.
A nurse instructor is teaching pregnant women how HIV can spread from mother to fetus without treatment. For the untreated child who contracts HIV through placental transmission, when will the child test positive for HIV? A. After 10 years B. In early adult years C. By 6 months of age D. Immediately after delivery
C HIV appears to progress more rapidly in untreated infants and children who contract it through placental transmission. These children usually are HIV positive by 6 months old and develop clinical signs by 1 to 3 years old. If a mother is treated for HIV during pregnancy, the infant will also receive HIV medication for 6 weeks after birth. The infant will need to be tested at 1 month of age and at 4 months of age. This testing will determine the absence of HIV in the infant. All infants born to infected mother test positive for antibodies to the virus bc of passive antibody transmission. However, diagnosis occurs by recovering the HIV antigen in young children (PCR testing) (<18mo) and antibodies to virus (ELISA test or western blot) in children over
When planning care for an infant with congenital hypothyroidism, you would stress during health education with the parents that the child will need which of the following? a. Administration of vitamin E until growth is complete b. An increased intake of calcium beginning in infancy c. Administration of thyroxine for life d. Administration of vitamin K until beginning of school age
C Infants born with inadequate thyroxine will need this supplemented for a lifetime.
The nurse is monitoring the fluid balance of a 4kg infant. When evaluating urine output in a 24-hour period, which output would the nurse identify as being within normal limits? A. 25 mL B. 75 mL C. 200 mL D. 500 mL
C Normal urine output for an infant is 1-3ml/kg/hr. 4kg x 1ml = 4ml/hr x24hr = 96ml/day, 4kg x 2ml = 8ml/hr x24h = 192, 4kg x 3ml = 12ml/hr x 24h = 288 (normal range would be 96-288ml/day)
The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? A. "Our child is contagious for 1 week after the rash appeared." B. "Acetaminophen or ibuprofen can be given to help with pain." C. "Antibiotics are needed to help our child recover from rubella." D. "Family members should wear a mask when coming to visit us."
C Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.
A nurse is preparing to administer the MMR vaccine during a 12-month-old well visit. The child presents with nasopharyngitis. What is the nurse's next action? A. hold all scheduled vaccines during this visit B. administer intramuscularly via the vastus lateralis C. ensure emergency medication is available D. ask caregiver to leave the room during administration
C Think safety!
When a pediatric child was seen in the emergency department a week ago, he weighed 4.5 kg. Today, he weighs 4.0 kg. When planning his care, how should you interpret his weight loss? a. It is not problematic because it is only 500 g. b. It is not problematic because it is less than 20% of his weight. c. It is problematic because it is 12% of his weight. d. It is problematic but likely to resolve spontaneously.
C When an infant has a weight loss more than 10%, it reflects a serious loss of fluid.
The best activity to encourage achievement of a school-age client's developmental task, according to Erickson, includes which of the following? a. A scrapbook that will take several weeks to complete. b. A puppet show that will take 2 weeks to plan. c. Watching her favorite program on television. d. Building a model car that will take one afternoon.
D Completing tasks allows a child to best experience a sense of industry. Because of short attention spans, short, easily visible projects are best.
A preschool-aged child insists her mother set a place at the table for her imaginary friend Zulu. Her mother asks the nurse if it is all right if she does this. What is the best response by the nurse? a. "Encouraging a child to believe in anything not visible isn't ultimately beneficial." b. "You should make up a second imaginary friend and invite her as well." c. "Allowing a child to believe in unreal friends is the same as approving lying." d. "You should agree to set a plate but acknowledge that you know Zulu is pretend."
D Imaginary friends arise from a child's keen imagination. Acknowledging the child's imagination but also helping her separate facts from fantasy is a good approach
The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed? A. "When our child is sick, we may need to check glucose levels more frequently." B. "Our child should eat three meals and midafternoon and bedtime snacks each day. C. "We and our child need to learn to identify carbohydrate, protein, and fat foods." D. "Our child should not participate ni sports or physical activity."
D The nurse would provide additional education if the parents state the child should not participate in sports or physical activity. The child with diabetes can, and should, be physically active to maintain proper health and facilitate efficient insulin usage by the body. Glucose levels should be checked more frequently during times of sickness, as well as assessing the urine for ketones. Consistency of intake can help prevent complications and maintain near-normal blood glucose levels. The parents and child should know how to identify foods to adequately monitor the child's nutritional intake. A dietitian with expertise in diabetes education should be consulted for referral as needed.
