NUR353: Exam 3

if a baby has Hirschsprung disease what don't you do?

rectal temp

Which are sources of lead the nurse should assess for when providing care to a toddler-age client who is admitted with lead poisoning? Select all that apply. 1 Water 2 Pottery 3 Stained glass 4 Collectable toys 5 Vinyl miniblinds

1,2,4,5

Which blood gas result should the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1 pH 7.30, CO2 40 mm Hg, HCO3- 20 mEq/L (20 mmol/L) 2 pH 7.35, CO2 47 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 3 pH 7.46, CO2 30 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 4 pH 7.50, CO2 50 mm Hg, HCO3- 22 mEq/L (22 mmol/L)

1. acidic pH, low HCO3 (normal ph 7.35-7.45, CO 35-45, HCO3 22-26)

Fluid admin for vaso occlusive crisis

1.5x more than MDFR

While performing preoperative teaching a nurse explores a young adolescent's concern about changes in appearance after surgery to correct scoliosis. What is the most appropriate statement by the nurse? 1 "After surgery your back will be much straighter." 2 "You're concerned about how you'll look after surgery." 3 "Many teenagers who have this type of surgery do very well." 4 "Your parents think it's important for you to have this surgery."

2.

An infant has had surgery for repair of a myelomeningocele. For which early sign of impending hydrocephalus should the nurse monitor the infant? 1 Frequent crying 2 Bulging fontanels 3 Change in vital signs 4 Difficulty with feeding

2. After closure, spinal fluid may accumulate and reach the brain, increasing intracranial pressure (ICP) and causing the fontanels to bulge.

A nurse is caring for a 3-week-old infant with hypertrophic pyloric stenosis who is severely dehydrated. What finding does the nurse expect when assessing the infant? 1 Weight loss of 5% 2 Severe allergic reactions 3 Depressed anterior fontanel 4 Urine specific gravity of 1.014

3. Depressed fontanels related to decreased cerebral spinal fluid are a classic sign of fluid volume deficiency in infants. A 5% weight loss indicates mild dehydration; a severely dehydrated infant will have a 15% weight deficit. Dehydration is unrelated to allergic reactions. This specific gravity is within the expected limits of 1.005 to 1.020.

A 4-month-old infant is admitted to the pediatric unit with a diagnosis of congestive heart failure. Which nursing assessment would most accurately demonstrate improvement in the infant's condition? 1 Decreased tremors 2 Increased hours of sleep 3 Weight loss during next 2 days 4 More rapid heart rate within 2 days

3. Weight loss indicates fluid loss. Water retention is a classic sign of congestive heart failure.

What is the priority of care for a 7-year-old child with recently diagnosed celiac disease? 1 Preventing celiac crisis and resulting problems 2 Minimizing complications of respiratory involvement 3 Teaching the parents to establish a diet that promotes optimal growth 4 Helping the parents and child adjust to the long-term dietary restrictions

4. Adherence to dietary restrictions can prevent future complications and celiac crisis. Celiac crisis usually develops as a result of nonadherence to the diet, so adherence to the diet, rather than preventing celiac crisis, is the primary objective

how will an infant being immobilized from broken bone impact them long term?

Delays with milestones such as walking

post cleft lip repair hands need to be restrained so they do not touch face. what about restraints?

Do not release both restraints at the same time

projectile vomiting is seen with?

Hypertrophic pyloric stenosis

parent concerned with 3 year old not potty trained should you be concerned?

No, full bladder control is at age 4-5. More than 6 is concerning (enuresis)

iron supplements cause

black tarry stools

what precautions is a child with meningitis on?

droplet

what should women take during child bearing years to prevent neural tube defects?

folic acid

what type of supplementation is recommended for those with sickle cell anemia?

folic acid

glomerulonephritis occurs after

streptococcal infection

An infant who has undergone surgery for hypertrophic pyloric stenosis (HPS) is being bottle fed by the mother. What should the nurse teach the mother about feedings to decrease the chance of the infant vomiting? 1 Start with small, frequent feedings. 2 Rock for 20 minutes after a feeding. 3 Keep the infant awake for 30 minutes after feeding. 4 Position the infant flat on the right side during feedings

1. Starting with small feedings will decrease the risk of vomiting. Rocking, keeping the infant awake, and positioning the infant horizontally all increase the chance of vomiting.

A nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. When does the nurse explain that insulin needs will decrease? 1 When puberty is reached 2 When infection is present 3 When emotional stress occurs 4 When active exercise is performed

4. Exercise reduces the body's need for insulin. Increased muscle activity accelerates transport of glucose into muscle cells, thus producing an insulin-like effect

The urinary output of a 9-year-old child with acute glomerulonephritis decreases to 250 mL/24 hr. A diet low in sodium and potassium is prescribed. What should the nurse encourage the child to have for lunch? 1 Baked chicken, green beans, and lemonade 2 Cream of tomato soup, salami sandwich, and cola 3 Grilled cheese sandwich, sliced tomatoes, and milk 4 Peanut butter and jelly sandwich, celery, and orangeade

1.

A child is admitted to the pediatric intensive care unit with acute bacterial meningitis. What is the nurse's priority intervention? 1 Offering clear fluids whenever the child is awake 2 Checking the child's level of consciousness hourly 3 Assessing the child's blood pressure every four hours 4 Administering the prescribed oral antibiotic medication

2. Checking the level of consciousness is part of a total neurological check. It can reveal increasing intracranial pressure, which may occur as a result of cerebral inflammation.

assessment after cast put on?

CNM checks Q2 hours for 24-48 hours for Compartment syndrome

What should the plan of care for a newborn with hypospadias include? 1 Preparing the infant for insertion of a cystostomy tube 2 Explaining to the parents the genetic basis for the defect 3 Keeping the infant's penis wrapped with petrolatum gauze 4 Giving the parents reasons why circumcision should not be performed

Giving the parents reasons why circumcision should not be performed. -The parents need to know why circumcision should not be performed. The foreskin may be needed for repair and reconstruction of the penis. A cystostomy tube is not inserted, because there is no interference with voiding. Hypospadias is not a genetic disorder, although there appears to be some evidence that it is familial. The penis is generally wrapped in petrolatum gauze after, not before, surgical correction of hypospadias.

A 7-year-old child was recently found to have juvenile idiopathic arthritis. The parents are concerned about the lifelong effects of the disorder and are investigating other therapies to use with the medications. What referral should the nurse recommend? 1 Physical therapy 2 Special education 3 Nutritional therapy 4 Herbal supplements

1. A physical therapist can prescribe an exercise protocol to keep the joints as mobile as possible; a routine can be developed to help the child alleviate morning stiffness.

An infant with hydrocephalus has a ventriculoperitoneal shunt surgically inserted. What nursing care is essential during the first 24 hours after this procedure? 1 Medicating the infant for pain 2 Placing the infant in a high Fowler position 3 Positioning the infant on the side that has the shunt 4 Monitoring the infant for increasing intracranial pressure

Monitoring the infant for increasing intracranial pressure. -The shunt may become obstructed, leading to an accumulation of cerebrospinal fluid and increased intracranial pressure. Although providing pain relief for the infant is an important part of postsurgical care, monitoring for potentially severe complications such as increased intracranial pressure takes precedence. Positioning the infant flat helps prevent complications that may result from a too-rapid reduction of intracranial fluid. The infant is positioned off the shunt to prevent pressure on the valve and incision area.

barium instilled to see intestines with intussusception, then the child passes a normal brown stool. What happened?

The barium spontaneously resolved the issue.

what to do at birth for spina bifida

keep in a prone position, sterile gauze, warm saline. They are at risk of latex allergy.

teaching for epispadias or hypospadias:

no circumcision until surgical repair

child is having severe pain with appendicitis then all of a sudden feels better. Is this good?

no, appendix bursted

A 1-month-old infant is admitted to the pediatric unit with a tentative diagnosis of Hirschsprung disease (congenital aganglionic megacolon). What procedure does the nurse expect to be used to confirm the diagnosis? 1 Colonoscopy 2 Rectal biopsy 3 Multiple saline enemas 4 Fiberoptic nasoenteric tube

Rectal Biopsy

A young child from a developing country is admitted to the pediatric unit for surgery to correct a congenital heart defect. The mother asks the nurse why her child squats after exertion. The nurse responds, in language that the mother understands, that this position does what? 1 Decreases the number of muscle aches 2 Improves walking capacity and hip mobility 3 Reduces how hard the heart must work 4 Helps more blood return to the heart

3. When the child squats, blood pools in the lower extremities because of hip and knee flexion which causes less blood to return to the heart and reduces how hard the heart must work (cardiac workload). For this young child, squatting after exertion does not reduce muscle aches, it is unrelated to walking capacity and hip mobility, and it decreases (not increases) blood return to the heart.

An 8-year-old child is being discharged after recovery from a sickle cell vaso-occlusive (painful crisis) episode. The nurse teaches the parents the do's and don'ts of the child's care. What statement by the parents satisfies the nurse that they understand the principles of care? 1 Have the child schooled by a private tutor 2 Restrict the child's fluid intake during the night 3 Permit the child to play with just one peer at a time4 Encourage the child to engage in low-intensity activities

4. low intense bec strenuous activities = increased cellular metabolism, tissue hypxia, sickling. dont restruct fluids, fluids prevent sickling

Before discharging a 9-year-old child who is being treated for acute poststreptococcal glomerulonephritis (APSGN), what information should the nurse plan to give the parents? 1 How to obtain the vital signs daily 2 Date on which to return to prepare for renal dialysis 3 Instructions about which high-sodium foods to avoid 4 List of activities that will encourage the child to remain active

Instructions about which high-sodium foods to avoid -Sodium is usually limited to control or prevent edema or hypertension until the child is asymptomatic. The child is usually on a regular diet with sodium restrictions (e.g., salty snacks [potato chips, pretzels, tortilla chips] and hot dogs, bacon, bologna, and other processed meats). child should rest and not be active

when diagnosing celiac, kid should ingest __ before procedure to see allergic reaction under microscope to diagnose

gluten

telescoping=

intussuception

The mother of a 5-year-old girl child reports to a nurse that her daughter has a genital discharge and recurrent urinary tract infections. What should the nurse suspect from the mother's statement? 1 The child may be a victim of sexual abuse. 2 The child may be a victim of physical abuse. 3 The child may be a victim of physical neglect. 4 The child may be a victim of emotional neglect.

1. Genital discharge and recurrent urinary tract infections are signs of sexual abuse. Bruises, burns, fractures, or dislocation may indicate physical abuse. Malnutrition and poor hygiene may indicate physical neglect. Enuresis and sleep disorders may indicate emotional neglect.

Spinal fusion is performed in an adolescent with scoliosis. What postoperative nursing intervention is specifically related to surgery for scoliosis? 1 Log-rolling every 2 hours 2 Checking the dressing frequently 3 Supervising deep-breathing exercises 4 Maintaining the adolescent in the supine position for 3 days

1. Log-rolling is necessary to prevent movement of the newly aligned and instrumented vertebrae and should be done frequently to prevent skin breakdown

A 7-year-old child survives a near-drowning episode in a cold pond. What factor does the nurse identify that will have the greatest effect on the child's prognosis? 1 Hypoxia 2 Hyperthermia 3 Emotional trauma 4 Aspiration pneumonia

1. child was hypOthermic. degree of hypoxia will determine other body system damages

is a headache a symptom for an infant for ICP?

no. older child symptom since they have to be able to express it

An 8-month-old infant undergoes surgical correction for hypospadias. What is a priority nursing intervention during the postoperative period? 1 Ensuring that privacy is maintained 2 Minimizing pain with adequate analgesia 3 Restricting fluid intake until the stent is removed 4 Gradually increasing the time that the urinary catheter is clamped

2. Although analgesia is important to minimize pain, it also relaxes the infant, who may be immobilized to maintain the position of the urethral stent and to ensure optimal healing of the newly formed urethra

A 3-year-old child with mild iron deficiency anemia is seen by a nurse in the clinic. In addition to weakness and fatigue, what should the nurse expect the child to exhibit? 1 Cold, clammy skin 2 Increased pulse rate 3 Increased blood pressure 4 Cyanosis of the nail beds

2. Increased pulse rate (tachycardia) occurs as the body tries to compensate for hypoxia due to mild iron deficiency anemia. Severe anemia however can manifest as pale, cool, and clammy skin. Increased blood pressure is not a response associated with anemia. Cyanosis of the nail beds is a sign of carbon monoxide poisoning.

What findings should a nurse expect when examining the laboratory report of a preschooler with rheumatic fever? 1 Negative C-reactive protein 2 Increased reticulocyte count 3 Positive antistreptolysin titer 4 Decreased sedimentation rate

3. A positive antistreptolysin titer is present with rheumatic fever because of the previous infection with streptococc

An 11-year-old child with juvenile idiopathic arthritis will be receiving continued nonsteroidal antiinflammatory drug (NSAID) therapy at home. Which important toxic effect of NSAIDs must be included in the nurse's discharge instructions to the child and family? 1 Diarrhea 2 Hypothermia 3 Blood in the urine 4 Increased irritability

3. Hematuria may result from the use of NSAIDs because they may cause nephrotoxicity. Diarrhea can occur but is not a sign of toxicity. Hypothermia does not occur with NSAIDs. Drowsiness, not hyperactivity, may occur.

The day after undergoing abdominal appendectomy a school-aged child is prepared for ambulation. Which nursing action would be most effective before the start of ambulation? Providing a rest period 2 Offering a reward for walking 3 Encouraging use of the spirometer 4 Administering the prescribed pain medication

Administering the prescribed pain medication

After several episodes of abdominal pain and vomiting, a 5-month-old infant is admitted with a tentative diagnosis of intussusception. What assessment should the nurse document that will aid confirmation of the diagnosis? After several episodes of abdominal pain and vomiting, a 5-month-old infant is admitted with a tentative diagnosis of intussusception. What assessment should the nurse document that will aid confirmation of the diagnosis? 1 Frequency of crying 2 Amount of oral intake 3 Characteristics of stools 4 Absence of bowel sounds

Characteristics of stools -Because intussusception creates intestinal obstruction in which the intestine "telescopes" and becomes trapped, passage of intestinal contents is lessened; stools are red and look like currant jelly because of the mixing of stool with blood and mucus. bowel sounds are not affected

What is the priority of preoperative nursing care for an infant with a cleft lip? 1 Preventing crying 2 Modifying feeding 3 Preventing infection 4 Minimizing handling

Modifying feeding -difficulty sucking on a nipple. cleft pallat=infection, not lip

Which nursing action should be included in the plan of care for a child with acute poststreptococcal glomerulonephritis? 1 Encouraging fluids 2 Monitoring for seizures 3 Measuring abdominal girth 4 Checking for pupillary reactions

Monitoring for seizures -Cerebral edema from hypertension or cerebral ischemia may occur, which may result in seizures. Increasing fluid intake may lead to an increase in blood pressure and edema. Measuring abdominal girth is appropriate for children with nephrotic syndrome, in which the child has hypoalbuminemia that causes fluid to shift from plasma to the abdominal cavity. Glomerulonephritis will not alter pupillary reactions.

A child with hip dysplasia has undergone a closed reduction surgery. The nurse assesses the child 2 days after the surgery and feels that the treatment and care provided for the child were not effective. The nurse made this conclusion based on what findings? 1 The child has a staggering gait. 2 The child is unable to walk independently. 3 The child has impaired muscle tone and flexibility. 4 The child's femoral head did not return to the hip socket

The child's femoral head did not return to the hip socket -If the laboratory reports indicate that the femoral head did not return to the hip socket, it implies that the surgery was ineffective and useless. Normal for child to have staggering gait, pain and lose muscle tone / flexbility

An infant with congenital hypothyroidism receives levothyroxine for three months. During the return appointment, which statement by the mother indicates to the nurse that the drug is effective? 1 The infant is alert and interactive. 2 The skin is cool to the touch. 3 The baby's fine tremor has ceased. 4 The baby's thyroid stimulating hormone level has increased.

The infant is alert and interactive -Infants with congenital hypothyroidism are lethargic and may even need to be awakened and stimulated to nurse; therefore, an infant who is alert and interacts appropriately for its age would demonstrate improvement.

At the beginning of the first formula feeding a newborn begins to cough and choke, and the lips become cyanotic. What is the nurse's priority action in response to this situation? 1 Stimulate crying 2 Substitute sterile water for the formula 3 Suction and then oxygenate the newborn 4 Stop the feeding momentarily and then restart it

suction and then oxygenate the newborn - Cyanosis, choking, and coughing are signs of aspiration and hypoxia. Suctioning and oxygenation are needed. Crying may add to the distress. Water could be aspirated, worsening the problem. Stopping the feeding momentarily and then restarting it is unsafe; the newborn is showing signs of a blocked airway.

for cleft palate / lip: post cleft __ repair first for __, and then __ to __

lip, feeding. palate/talk

A 6-year-old child is hospitalized with nephrotic syndrome. The mother asks the nurse what she may bring for her child to play with during the hospitalization. In light of the child's age, what should the nurse suggest? Select all that apply. 1 Checkers 2 Wooden puzzles 3 Paper and crayons 4 Simple card games 5 CDs and a CD player

1,3,4

A nurse provides dietary instruction to a client who has iron deficiency anemia. Which food choices by the client does the nurse consider most desirable? Select all that apply. 1 Raw carrots 2 Boiled spinach 3 Dried apricots 4 Brussels sprouts 5 Asparagus spears

2,3 the food sources highest in iron are, "Liver and muscle meats, dried fruits (apricots), legumes, dark green leafy vegetables (spinach), whole-grain and enriched bread and cereals, and beans." Although carrots, Brussels sprouts, and asparagus spears contain some iron, they are not considered high sources of iron.

The nurse is reviewing discharge instructions for a mother whose lactose intolerant school-aged child was recently found to have celiac disease. Which statements by the mother demonstrate understanding of the child's nutritional needs? Select all that apply. 1 "Rolled-up lunch meat with cheese is a good alternative to sandwiches." Correct2 "I'll try to provide meals that are lower in fats and higher in carbohydrates." 3 "I'll start giving her milk with meals so she gets enough calcium in her diet." 4 "She loves raw carrots for snacking, so I'll have to avoid those when the disease is worse." Correct5 "I'll be sure to look at the labels more closely from now on—we need to avoid hydrolyzed vegetable protein."

2,4,5. Celiac disease is characterized by bowel irritation on exposure to protein gluten. Dietary management generally consists of a diet high in protein and carbohydrates and low in fats. When the bowel is inflamed, high-fiber foods should be avoided; this includes carrots. Gluten is added to many foods as hydrolyzed vegetable protein; therefore the mother needs to read the ingredient list to identify the presence of this substance. Lunch meat should be avoided because it contains gluten. Since the child is also lactose intolerant, milk also needs to be avoided.

A toddler is found to have coarctation of the aorta. What does the nurse expect to identify when taking the child's vital signs? 1 Irregular heartbeat 2 Weak femoral pulse 3 Thready radial pulses 4 Increased temperature

2. Coarctation of the aorta is a narrowing of the aorta, usually in the thoracic segment, resulting in decreased blood flow below the constriction and increased blood volume above it. The femoral pulses are weak or absent. An irregular heartbeat and increased temperature are not related to coarctation of the aorta. The radial pulses are bounding in coarctation of the aorta.

During discharge planning the parents of an infant with spina bifida express concern about skin care and ask the nurse what can be done to avoid problems. What is the best response by the nurse? 1 Diapers should be changed at least every 4 hours. 2 Frequent diaper changes with cleansing are needed. 3 Medicated ointment should be applied six times a day. 4 Powder may be used in the perineal area when it becomes wet.

2. Infants with spina bifida often exhibit dribbling of urine; they need meticulous skin care and frequent diaper changes to prevent skin breakdown. Changing diapers every 4 hours is insufficient and may result in skin breakdown.

A client is admitted to the hospital with a head injury sustained while playing soccer. For which early sign of increased intracranial pressure should the nurse monitor this client? 1 Nausea 2 Lethargy 3 Sunset eyes 4 Hyperthermia

2. Lethargy is an early sign of a changing level of consciousness; changing level of consciousness is one of the first signs of increased intracranial pressure. Nausea is a subjective symptom, not a sign, that may be present with increased intracranial pressure. Sunset eyes are a late sign of increased intracranial pressure that occur in children with hydrocephalus. Hyperthermia is a late sign of increased intracranial pressure that occurs as compression of the brainstem increases.

A toddler-age child presents in the emergency department (ED) with an infected wound. The child's mother states, "I don't have time to take care of this." A review of the child's medical record indicates that each appointment related to the wound was cancelled. Which should the nurse suspect based on the current data? 1 Physical abuse 2 Physical neglect 3 Emotional neglect 4 Psychologic abuse

2. Physical neglect involves the deprivation of necessities, such as food, clothing, shelter, supervision, medical care, and education.

The parent of a child with hemophilia asks the nurse, "If my son hurts himself, is it all right if I give him two baby aspirins?" What is the best response by the nurse? 1 "You seem concerned about giving drugs to your child." 2 "It's all right to give him baby aspirin when he hurts himself." 3 "Aspirin may cause more bleeding. Give him acetaminophen instead." 4 "He should be given acetaminophen every day. It'll prevent bleeding."

3.

A 3-month-old infant with tetralogy of Fallot is admitted for a diagnostic workup in preparation for corrective surgery. The morning after cardiac catheterization the infant suddenly becomes cyanotic and begins breathing rapidly. In what position should the nurse immediately place the infant? 1 Supine 2 Lateral 3 Knee-chest 4 Semi-Fowler

3. The knee-chest position decreases venous return from the legs, which increases systemic vascular resistance, thereby increasing pulmonary blood flow.

currant jelly stools are seen with?

intussuception

more than 24 ozs of cows milk a day decreases iron absorption and can cause

iron deficient anemia

high fever in Kawaski disease is NOT first priority,

it is expected (priority question)

The nurse is performing the nursery intake assessment of a 1-hour-old newborn. The assessment reveals that the newborn's hands and feet are cyanotic, and there is circumoral pallor when the infant cries or feeds. What action should the nurse perform based on these findings? 1 Notify the practitioner, because circumoral pallor may indicate cardiac problems 2 Notify the practitioner, because both signs are indicative of increased intracranial pressure 3 Take no specific action, because both signs are expected in a newborn until 2 weeks of age 4 Take no specific action, because circumoral pallor is an expected finding during feedings and periods of crying

1. Although acrocyanosis (cyanotic hands and feet) is common in the newborn, circumoral pallor is not a normal newborn finding. Circumoral pallor is one sign of cardiac pathology and indicates a need for further assessment and investigation by the healthcare provider.

The mother of a school-aged child with type 1 diabetes asks why it was recommended that her child use an insulin pump rather than insulin injections. What will the nurse tell the mother concerning the greatest advantage of the insulin pump? 1 Independence is fostered. 2 Fear of daily injections is allayed. 3 Dietary restrictions are minimized. 4 Blood glucose monitoring can be eliminated

1. Continuous insulin therapy allows the child to become independent of parental control and anxiety regarding insulin injections

A nurse is assessing a toddler with vesicoureteral reflux. What clinical finding does the nurse expect to identify? 1 Dysuria 2 Oliguria 3 Glycosuria 4 Proteinuria

1. Discomfort during urination (dysuria) is a symptom of a urinary tract infection (UTI), which is common with vesicoureteral reflux.

The nurse assesses a newborn and observes central cyanosis. What type of congenital heart defect usually results in central cyanosis? 1 Shunting of blood from right to left 2 Shunting of blood from left to right 3 Obstruction of blood flow from the left side of the heart 4 Obstruction of blood flow between the left and right sides of the heart

1. Right-to-left shunting results in inadequate perfusion of blood; not enough blood flows to the lungs for oxygenation. Left-to-right shunting results in too much blood flowing to the lungs; blood is adequately perfused.

The nurse is teaching the parents of a toddler-age client about food safety related to choking. Which parental statement indicates the need for further education? 1 "Hot dogs are safe and do not present a choking hazard for my child." 2 "Ice cream is safe and does not present a choking hazard for my child." 3 "Chicken nuggets are safe and do not present a choking hazard for my child." 4 "Mashed potatoes are safe and do not present a choking hazard for my child."

1. chocking hazard

The nurse is conducting discharge teaching with an adolescent with hemophilia. Which statement by the client indicates a need for further teaching? 1 "I'll use a straight razor when I start shaving." 2 "I plan on trying out for the swim team next year." 3 "If I injure a joint, I'll keep it still, elevate it, and apply ice." 4 "If I get a little scratch, I can apply gentle pressure for 10 to 15 minutes."

1. electric razor should be used. swimming is good since non-contact. gentle prolonged pressure good. injury=immobilized, elevated, iced

Which of these age groups has the highest incidence of lead poisoning? 1 Adult 2 Toddler 3 Adolescent 4 School-age child

2

A 4-year-old child who barely survived a near-drowning episode is in critical condition in the pediatric intensive care unit. Suddenly the child opens her eyes and smiles, prompting a parent to say to the nurse, "Look! I think she'll get better now." What is the best response by the nurse? 1 "You're right; that's a very good sign." 2 "Try to have your child hold your hand." 3 "We're doing everything we can to promote recovery." 4 "God certainly must be watching over your child today.

3

Which explanation should the nurse consider when formulating a response to a client's inquiry about intussusception of the bowel? 1 Kinking of the bowel onto itself 2 A band of connective tissue compressing the bowel 3 Telescoping of a proximal loop of bowel into a distal loop 4 A protrusion of an organ or part of an organ through the wall that contains it

3. Intussusception is the telescoping or prolapse of a segment of the bowel into the lumen of an immediately connecting segment of the bowel. Volvulus is a twisting of the bowel onto itself. Adhesions are bands of scar tissue that can compress the bowel. Herniation describes protrusion of an organ through the wall that contains it.

The nurse is providing discharge instructions to the parents of a child who has undergone surgical correction of hypospadias. What is the priority information for the nurse to include? 1 Ensuring that the child's privacy is maintained 2 Increasing the time that the catheter is clamped 3 Maintaining the surgically implanted tension device 4 Teaching parents how to care for the catheterization system

4.

An infant who has a congenital heart defect with left-to-right shunting of blood is admitted to the pediatric unit. What early sign of heart failure should the nurse identify? 1 Cyanosis 2 Restlessness 3 Decreased heart rate 4 Increased respiratory rate

4. Because the lungs are stressed by pulmonary edema, a quicker respiratory rate is the first and most reliable indicator of early heart failure in infants. Cyanosis is a late sign of heart failure; with early failure there is still adequate perfusion of blood. Infants with early heart failure do not move about; they become fatigued quickly, especially when feeding, because of a decrease of oxygen to body cells. The heart rate of an infant in early heart failure increases, not decreases, in an attempt to increase oxygen to body cells.

A nurse is caring for a 3-month-old infant with congenital hypothyroidism. What should the parents be taught about the probable long-term effect of the condition if treatment is not begun immediately? 1 Myxedema 2 Thyrotoxicosis 3 Spastic paralysis 4 Cognitive impairment

4. Congenital hypothyroidism is the result of insufficient secretion by the thyroid gland because of an embryonic defect.

A 2½-year-old toddler is admitted with a fever of 103° F (39.4° C), stiffness of the neck, and general malaise. The diagnosis is acute bacterial meningitis. What is the priority nursing intervention for this child? 1 Increasing fluids 2 Administering oxygen 3 Giving a tepid sponge bath 4 Instituting droplet precautions

4. Droplet precautions prevent the spread of infection to others; isolation is a priority and should be implemented immediately. There is no indication that the child is dehydrated; fluid maintenance is a continuing goal. There is no indication that the child needs oxygen. Oxygen is not given routinely; it is given if the child has a decreased oxygen saturation level. A sponge bath is not given because these children are sensitive to stimuli, and movement causes increased discomfort.

An infant with a cardiac defect is fed in the semi-Fowler position. After the nurse feeds and burps the infant and changes the infant's position, the infant has a bowel movement and almost immediately becomes cyanotic, diaphoretic, and limp. Which activity most likely caused the infant's response? 1 Burping 2 Feeding 3 Position change 4 Bowel movement

4. During a bowel movement the Valsalva maneuver can occasionally initiate a hypercyanotic spell ("tet spell," "blue spell") by inducing an increase in intrathoracic pressure, a decrease in the return of blood to the heart, an increase in venous pressure, and a decrease in heart rate

The nurse takes into consideration that the effect PKU has on the infant's development will depend primarily upon which factor? 1 Blood phenylalanine levels in utero 2 Excessive levels of epinephrine at birth 3 Diagnosis within the first 2 days after birth 4 Adherence to a corrective diet instituted early

4. In phenylketonuria (PKU), adherence to a specific diet is necessary for optimal physical growth with little or no adverse effects on mental development

The nurse is counseling the parents of a 12-year-old child with Duchenne muscular dystrophy about problems that may develop during adolescence. What body system does the nurse expect will be affected? 1 Neurological 2 Integumentary 3 Gastrointestinal 4 Cardiopulmonary

4. Muscle degeneration is advanced in the adolescent with Duchenne muscular dystrophy. The disease process involves the diaphragm, auxiliary muscles of respiration, and the heart, resulting in life-threatening respiratory infections and heart failure.

A 16-year-old adolescent with recently diagnosed type 1 diabetes will receive NPH insulin subcutaneously. The nurse teaches the adolescent about peak action of the drug and the risk for hypoglycemia. How many hours after NPH insulin administration does the insulin peak? 1 1 to 2 hours 2 2 to 4 hours 3 5 to 10 hours 4 4 to 12 hours

4. NPH insulin onset is 1.5 to 4 hours, peaks in 4 to 12 hours with a duration of 12 to 18 hours.

A nurse is preparing an infant for a lumbar puncture. In what position should the nurse hold the infant? 1 Sitting with the buttocks at the table's edge and the head flexed 2 Prone with the head extended over the table's edge and the extremities swaddled 3 Lateral recumbent with the back at the table's edge and the head and legs extended 4 Side-lying with the back at the table's edge and the head flexed with the knees brought to the chin

4. The side-lying position with the head and hips flexed separates the vertebrae, making needle insertion easier; it also permits better restraint by the nurse

The mother of an infant who just underwent cleft lip repair tells the nurse, "He seems restless. May I hold him?" What information influences the nurse's response? 1 Holding may meet needs and reduce tension on the suture line. 2 Sedation limits activity and decreases tension on the suture line. 3 Handling may increase irritability, causing tension on the suture line. 4 Arm movements cannot be controlled, placing tension on the suture line.

Holding may meet needs and reduce tension on the suture line. -Touching and cuddling provide a sense of well-being and relieve strain on the suture line that results from restlessness and crying. It is inappropriate to sedate an infant for its calming effect or to decrease activity. Careful handling will not damage the suture line. Arm movement can be controlled by applying elbow restraints to prevent the infant's hands from touching the suture line.

what med do you not give a child with chicken pox?

apririn

priority concern for TEF:

aspiration, put in continuous suction NG tube, start IV, NPO, surgery