Pedi Exam 2 Practice Questions

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. The nurse's BEST reply is: "Blood pressure changes are a common side effect of antibiotic therapy." "Blood pressure changes are a sign that the condition has become chronic." "Acute hypertension, or high blood pressure, must be anticipated and identified." "Hypotension, or low blood pressure, leading to sudden shock can develop at any time."

"Acute hypertension, or high blood pressure, must be anticipated and identified." Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations do not indicate chronic disease. Most children with glomerulonephritis fully recover. Vital signs, in particular blood pressure, provide information about the severity of the disease and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Hypertension is more likely with glomerulonephritis.

A 3-year-old child is scheduled for surgery to remove a Wilms' tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's best response is: "No additional treatments are usually necessary." "Chemotherapy may be necessary." "Chemotherapy with or without radiation therapy is indicated." "Kidney transplant is indicated eventually."

"Chemotherapy with or without radiation therapy is indicated." Additional therapy is indicated after the tumor is removed. Radiation therapy may be necessary. This determination will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiation therapy is usually indicated. Most children with Wilms' tumor do not require renal transplants.

The parent of a 13-year-old newly diagnosed with Type I diabetes asks if he will be able to continue on the basketball team. What is the appropriate response of the nurse? 1. "His condition is too unstable and unpredictable to be able to participate safely in sports." 2. "He will require extra doses of insulin before each practice and game." 3. "He will likely need to have an extra snack before practice and games." 4. "Exercise will dangerously increase his blood glucose level."

"He will likely need to have an extra snack before practice and games."

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. The nurse's BESTreply is: -"The pills work with an adult pancreas only." -"The drugs affect fat and protein metabolism, not sugar." -"Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." -"Perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

"Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." The oral medications have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes. The oral medications have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes. In type 1 diabetes, the beta-cells have been destroyed. It is necessary to supply the insulin that they no longer produce. In type 1 diabetes, the beta-cells are destroyed. Without a pancreas beta-cell transplant, it is unlikely that insulin would be produced.

An important nursing responsibility when a dysrhythmia is suspected is to: order an immediate electrocardiogram. count the radial rate at 1-minute intervals 5 times in a row. count the apical rate for 1 full minute and compare it with the radial rate. have someone else take the radial rate while the nurse simultaneously checks the apical rate.

*Count the apical rate for 1 full minute and compare it with the radial rate. This may be indicated after conferring with the practitioner. The radial pulse needs to be compared with the apical. This is the nurse's first action. If an arrhythmia is occurring, the radial pulse may be lower than the apical rate. It is the responsibility of the nurse to check both rates.

The nurse is discharging a 10-year-old patient admitted to the hospital in diabetic ketoacidosis. The child has been newly diagnosed with type 1 diabetes mellitus (DM) on this admission. The nurse should teach the child and parents which signs of type 1? (Select all that apply.) -Weight gain -Nocturia -Irritability -Cool, clammy skin -Blurred vision

- polyphagia - polyuria - polydipsia - weight loss - enuresis - nocturia - irritability - not themself - shortened attention span - lowered frustration tolerance - dry skin - blurred vision - poor wound healing - fatigue - flushed skin - headache - frequent infections - hyperlgycemia - elevated blood glucose levels - glucosuria - diabetic ketosis - ketones and glucose in urine - dehydration

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress the: importance of reducing caloric intake to decrease cardiac demands. importance of relaxing discipline and limit-setting to prevent crying. need to be extremely concerned about cyanotic spells. desirability of promoting normalcy within the limits of the child's condition.

*Desirability of promoting normalcy within the limits of the child's condition. - Child needs increased caloric intake. - Child needs discipline and appropriate limits. - Because cyanotic spells occur in children with some defects, the parents need to be taught how to manage these. The child needs to have social interactions, discipline, and appropriate limit-setting. Parents need to be encouraged to promote as normal a life as possible for their child.

The nurse is planning care for a child recently diagnosed with diabetes insipidus. The plan should include:

*Encouraging the child to wear medical identification - can be a lifelong and life threatening disease - do not restrict fluids - there is NO required urine testing that the FAMILY DOES

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. FIRST the nurse should: determine what the child has eaten. administer diphenhydramine (Benadryl). move the child to the nurse's office or hallway. have someone call for an ambulance/paramedic rescue squad.

*Have someone call for an ambulance/paramedic rescue squad. Because severe respiratory distress is occurring, treatment of the response is indicated first. The cause of the response can be determined later. Diphenhydramine will not be effective for this type of allergic reaction. The child should not be moved unless the child is in a place that puts the child at greater hazard. Because the child is in severe respiratory distress, the nurse should remain with the child while someone else calls for the rescue squad.

When assessing for hypertension in an infant, the nurse will expect the infant to exhibit which signs? (Select all that apply.) Select all that apply. Dizziness Changes in vision Irritability Head rubbing Waking up screaming in the night

*Infants: - Irritability - Head banging/rubbing - Waking up screaming in the night *Older children & Adolescents: - HA - Dizziness - Change in vision

Nursing care of the infant or child with congestive heart failure would include: forcing fluids appropriate to age. monitoring respirations during active periods. organizing activities to allow for uninterrupted sleep. giving larger feedings less often to conserve energy.

*Organizing activities to allow for uninterrupted sleep. The child who has congestive heart failure has an excess of fluid. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to facilitate a decrease in his or her energy expenditure. The child often cannot tolerate larger feedings.

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is: low Fowler's. prone. supine. squatting.

*Squatting. Low Fowler's would assist with respiratory issues but would not assist with the need for cardiac compensation. Prone does not offer any advantage to the child. Supine does not offer any advantage to the child. The squatting or knee-chest position decreases the amount of blood returning to the heart and allows the child time to compensate.

A diagnosis of rheumatic fever is being ruled out for a child. Which laboratory test(s) is/are the most reliable? (Select all that apply.) Select all that apply. Additional antistreptoccocal antibody titers C-reactive protein (CRP) Antistreptolysin-O titer (ASO) titer Elevated white blood cell count (WBC) Erythrocyte sedimentation rate (ESR)

*The most reliable and best standardized laboratory for antistreptococcal antibodies is an Antistreptolysin-O (ASO) titer. Additional antistreptococcal antibody titers also provide diagnostic confirmation. *C-reactive protein (CRP) laboratory test indicates inflammation. *An elevated white blood cell (WBC) may indicate a possible infection but does not indicate a causative agent. *An erythrocyte sedimentation rate (ESR) indicates inflammation.

Which is considered a mixed cardiac defect? Pulmonic stenosis Atrial septal defect Patent ductus arteriosus Transposition of the great arteries

*Transposition of the great arteries - Pulmonic stenosis is classified as an obstructive defect. - Atrial septal defect is classified as a defect with increased pulmonary blood flow. - Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow.

The nurse is preparing to give digoxin to a 9-month-old infant. He or she checks the dose and draws up 4 mL of the drug. The MOST appropriate nursing action is to: not give the dose; suspect dosage error. mix the dose with juice to disguise its taste. check heart rate; administer the dose by placing it to the back and side of the mouth. check heart rate; administer the dose by letting the infant suck it through a nipple.

*not give the dose; suspect dosage error. Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. Because it is a potentially dangerous drug, administration guidelines are very precise. Some institutions require that digoxin dosages be checked with another professional before administration. The nurse has drawn up too much medication. These are correct procedures, but too much medication has been prepared. These are correct procedures, but too much medication has been prepared.

A 5-year-old female child has been sent to the school nurse for urinary incontinence 3 times in the past 2 days. The nurse should recommend to her parent that the FIRST action is to have the child evaluated for: school phobia. emotional causes. possible urinary tract infection. possible structural defects of the urinary tract.

*possible urinary tract infection. A physical cause of the problem needs to be eliminated before a psychologic cause is considered. Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection. Structural defects would be explored after a urinary tract infection is confirmed.

A child is receiving cyclosporine following a kidney transplant. The nurse should include which information in the teaching plan about this medication? (Select all that apply.)

1. Purpose of medication is to suppress rejection 2. Frequent hand washing Cyclosporine is given to suppress rejection. Cyclosporine does not decrease pain, boost immunity, or improve circulation. When taking this medication, it is important to avoid others with contagious illnesses and to wash hands often, because it is an immunosuppressant medication.

A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply.) Select all that apply. Vomiting Jaundice Swelling of the face Persistent diaper rash Failure to gain weight

1. Vomiting 2. Persistent diaper rash 3. Failure to gain weight Vomiting is a clinical manifestation observed in an infant with a urinary tract infection (UTI) and can be related to poor feeding. Persistent diaper rash is a clinical manifestation of UTI in an infant. Failure to gain weight is a clinical manifestation of UTI in an infant related to poor feeding and vomiting. Jaundice is not a clinical manifestation of UTI in an infant. Swelling of the face is not a clinical manifestation of UTI in an infant. Question 8 of 16

A 6-year-old child with acute renal failure is being transferred out of the intensive care unit. Considering their diagnoses, which child would be the MOST appropriate roommate for this child? 6-year-old child with pneumonia 4-year-old child with gastroenteritis 5-year-old child who has a fractured femur 7-year-old child who had surgery for a ruptured appendix

5-year-old child who has a fractured femur These children have potentially infectious disease processes. The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin.

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed? Restraining child as necessary Discouraging parents from holding child Doing passive range-of-motion exercises once a day Adjusting activities to child's tolerance level

Adjusting activities to child's tolerance level Restraints should not be used. Parents should be encouraged to hold child. The child should be encouraged to move all extremities while in bed. The child will have a variable level of tolerance for activity. This will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child.

What should the nurse recognize as an early clinical sign of compensated shock in a child? Confusion Sleepiness Hypotension Apprehension

Apprehension (fear of something bad happening) Confusion indicates uncompensated shock. Sleepiness is not an indication of shock. Hypotension is a symptom of irreversible shock. Apprehension indicates compensated shock.

A nurse is caring for an infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? (Select all that apply.) Select all that apply. Lordosis Positive Babinski sign Asymmetric thigh and gluteal folds Positive Ortolani and Barlow tests Shortening of limb on affected side

Asymmetric thigh and gluteal folds are a clinical manifestation of DDH and seen from birth to 2 months old. Positive Ortolani and Barlow tests are clinical manifestations of DDH. Ortolani test is the abducting of the thighs to test for hip subluxation or dislocation. Barlow test is the adducting to feel if the femoral head slips out of the socket posterolaterally. Shortening of limb on affected side is another clinical manifestation of DDH. Lordosis is the inward curve of the lumbar spine just above the buttocks and is not a clinical manifestation of DDH. A negative Babinski sign is not a clinical manifestation of DDH. It is a neurologic reflex which should be present in the normal newborn

The postoperative care of a preschool child who has had a brain tumor removed should include which information? Clear drainage is to be expected. Close supervision is needed while the child is regaining consciousness. Positioning is on the side in the Trendelenburg position. Analgesics are contraindicated because of altered consciousness.

Close supervision is needed while the child is regaining consciousness. Clear drainage may be leakage of cerebral spinal fluid from the incision site. This needs to be reported as soon as possible. The child needs to be observed closely. Vital signs must be assessed carefully, and signs of increasing intracranial pressure (ICP) need to be monitored. The child should not be positioned in the Trendelenburg position after surgery. Analgesics can be used for postoperative pain.

Which is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? Increased metabolism Increased venous return Increased cardiac output Decreased exercise tolerance

Decreased exercise tolerance Metabolism decreases during periods of immobility. There is decreased venous return because of decreased muscle activity. There is decreased cardiac output. Muscle disuse leads to tissue breakdown and loss of muscle mass. It may take weeks or months to recover.

The nurse should instruct a child to remain completely still during which procedure in which high-frequency sound waves are translated into images by a transducer? Echocardiography Electrocardiography Cardiac catheterization Electrophysiology

Echocardiography Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is a tracing of the electrical path of the depolarization action of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart. Electrophysiology is an invasive procedure in which catheters with electrodes are used to record the impulses of the heart directly from the conduction system.

Which laboratory finding, in conjunction with the presenting symptoms, indicates nephrosis? Hypoalbuminemia Low specific gravity Decreased hemoglobin Decreased hematocrit

Hypoalbuminemia is a result of the large amount of protein that leak through the glomerular membrane into urine. Specific gravity is increased because of the large amount of protein. These measures would be elevated secondary to the hypovolemia. These measures would be elevated secondary to the hypovolemia.

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise? Increased food intake Decreased food intake Increased risk of hyperglycemia Decreased risk of insulin shock

Increased food intake - Food intake should be increased in the summer when the child is more active. Races and other competitions may require more food than other practice times. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid the administration of too much insulin during a time of reduced need.

The nurse who is concerned about increased intracranial pressure in an infant should assess for: irritability. photophobia. pulsating anterior fontanel. vomiting and diarrhea.

Irritability Irritability is one of the changes that may indicate increased intracranial pressure. Photophobia does not indicate increased intracranial pressure in infants. Frequently pulsations are visible in the anterior fontanel. It is not an indication of increased intracranial pressure. Vomiting is one of the signs in children but, when present with diarrhea, indicates a gastrointestinal disturbance.

Which statement is true concerning osteogenesis imperfecta? It is easily treated. It is an inherited disorder. Later-onset disease usually runs a more difficult course. Braces and exercises are of no therapeutic value.

It is an inherited disorder. It is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. Osteogenesis imperfecta is an inherited disorder. The type of disease determines the course it will take. Lightweight braces and splints can help support limbs and fractures.

The nurse should include which information when teaching a patient about Cushing's syndrome? -It is caused by excessive production of cortisol. -The major clinical feature associated with this disease is exophthalmia. -Treatment involves replacement of cortisol. -Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

It is caused by excessive production of cortisol. - Cushing's syndrome is a description of the clinical manifestations caused by too much circulating cortisol. Exophthalmia is a manifestation of hyperthyroidism, not Cushing's syndrome. The treatment is the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Hypertension and hypokalemia are expected findings.

Why are infants particularly vulnerable to acceleration-deceleration head injuries? The anterior fontanel is not yet closed. The nervous tissue is not well developed. The scalp of the head has extensive vascularity. Musculoskeletal support of head is insufficient.

Musculoskeletal support of head is insufficient. These do not have an effect on this type of injury. These do not have an effect on this type of injury. These do not have an effect on this type of injury. The relatively large head size coupled with insufficient musculoskeletal support increases the risk to the infant.

A nurse is preparing to administer IV insulin to a child. Which action is necessary for appropriate administration? 1. Prime the tubing with an insulin mixture prior to infusing. 2. Prime the tubing with normal saline. 3. Place a UV protectant bag over the mixture prior to infusing. 4. Warm the IV bag prior to administering.

Option #1 is correct. Insulin can have a chemical bind to the plastic tubing, which reduces the amount actually infused. In other words, if you have an order to infuse 100U of insulin in a 1000mLbag and you add 100U and then prime the tubing, you will lose some of those 100 units as the tubing absorbs the insulin. So, you prime with an insulin mixture to saturate the tubing, NOT counting the units you are supposed to administer and then administer your infusion.

A 10-year-old who was diagnosed at the age of 4 years is going to diabetes camp for the first time. What advice is most appropriate for him at this time? 1. Do not let anyone else use your lancet. 2. Be sure to stay well hydrated. 3. You may need extra insulin for vigorous activities. 4. It is important to get plenty of rest.

Option #1 is correct. This child will be around other children with diabetes and checking blood glucose is "normal" to them. It is important to educate and protect him from the risk of communicable bloodborne diseases. The other options are valid but these are all things he would have encountered at home.

An 8-year-old child is being treated for diabetes insipidus and is on strict fluid restrictions. The child's urine output has increased in the last 24 hours. What is the most appropriate action of the nurse? 1. Call the provider immediately. 2. Lock the door to the child's bathroom. 3. Emphasize the need for compliance to the mother. 4. Encourage ambulation.

Option #2 is correct. Small children can, sometimes, sneak fluids if they are very thirsty, drinking from sinks, flower vases, even toilets. It is important to be sure there are no accessible fluids in the room. This is not an emergent situation that necessitates an immediate call to the provider and ambulation has no effect on DI. If the condition is worsening and dehydration is occurring, ambulation could potentially be a safety risk.

A three-year-old boy is in the Pediatric Intensive Care Unit for diabetic ketoacidosis (DKA) with a blood glucose of 729. Which of these provider orders should the nurse question? 1. Neurologic assessment every 30 minutes 2. NPH insulin 12 units subcutaneously 3. Potassium replacement therapy 4. Rapid IV bolus administration

Option #2 is the correct answer. SQ insulin is not given during acute treatment for DKA. Children with DKA are at risk for developing cerebral edema and should have frequent neuro checks. Potassium replacement and IV rehydration are indicated for acute dehydration associated with DKA.

A nurse is caring for a 10-year-old patient with syndrome of inappropriate antidiuretic hormone. Upon assessment, the nurse finds that the child is complaining of nausea and malaise. One episode of vomiting has occurred. What is the priority action of the nurse? 1. Administer a prn order for an anti-emetic medication. 2. Remove the breakfast tray from the room. 3. Call the provider immediately to report. 4. Check the child's vital signs.

Option #3 is correct. Nausea, vomiting, and malaise can be signs of impending seizure and coma in patients with this disorder. All of the actions are appropriate but the priority action is to call the provider.

The mother of a 2-month-old infant with congenital hypothyroidism has been administering levothyroxine (Synthroid) daily to her baby. She asks the nurse how she can be sure that the medicine is working. What assessment data would demonstrate efficacy of the medication? 1. Sleeping at least 12 hours at a time. 2. Maintaining a heart rate of 60-90 beats per minute. 3. Having 3-4 soft formed stools per day 4. Drinking 2 ounces of formula every 4 hours.

Option #3 is correct. The other options are all signs of continuing hypothyroidism.

A 12-year-old newly diagnosed type one diabetic is being discharged to home. What is the most appropriate goal for the family at this time? 1. Eliminate simple sugars from her diet until her diabetes is well controlled. 2. Ensure the mother is comfortable with administering subcutaneous injections of insulin. 3. Maintain a fasting blood sugar between 150-250 mg/dL. 4. Self-administer insulin injections using appropriate site selection and technique.

Option #4 is correct. At 12 years of age, it is important for this child to learn to manage her diabetes. Having her mother administer injections when needed is not practical or realistic.

A 5-year-old who has been diagnosed with Type I diabetes six months ago is experiencing her first acute illness since diagnosis. She is experiencing a fever of 101.2 and a cough. Her parents call the nurse for advice. Which of the following are appropriate instructions? Select all that apply. 1. Check blood glucose every hour while febrile. 2. Omit scheduled insulin doses while febrile. 3. Call the provider if any vomiting occurs. 4. Encourage additional fluid intake 5. Call the provider if blood glucose is >240mg/dL.

Options #3, #4, and #5 are correct. Blood glucose should be checked every 3 hours during illness. Insulin should never be omitted during illness, as insulin requirements usually increase. Vomiting and BG >240 should be reported immediately, as those are potential signs of DKA. Fluid intake is essential to maintain hydration and to flush out ketones.

A 3-year-old child is status postshunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? (Select all that apply.) Select all that apply. Personality change Bulging anterior fontanel Vomiting Dizziness Fever

Personality change can be a sign of shunt malformation related to increased intracranial pressure. Vomiting can be a sign of shunt malformation related to increased intracranial pressure. Fever can be a sign of shunt malformation and is a very serious complication. The anterior fontanel closes between 12 and 18 months old. Dizziness is difficult to assess in a 3 year old and is not necessarily a sign of shunt malformation.

Which measure is important in managing hypercalcemia in a child who is immobilized? Promoting adequate hydration Changing position frequently Encouraging a diet high in calcium Providing a diet high in protein and calories

Promoting adequate hydration Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia. Changing position frequently will help manage skin integrity but will not affect calcium levels. The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk of developing hypercalcemia. The child's metabolism is slower because of the immobilization. A diet with sufficient calories and nutrients for healing is important.

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. Which treatment option should be implemented to restore fluid volume? -Provide hypertonic saline dextrose solution (5%) with parenteral hydrocortisone. -Increase rate of intravenous fluids. -Restrict intake of fluids for 8 hours. -Provide isotonic fluids as needed to restore fluid balance.

Provide hypertonic saline dextrose solution (5%) with parenteral hydrocortisone. - Treatment options to restore fluid volume for a child hospitalized with acute adrenocortical insufficiency focus on administration of 5% dextrose saline solution (hypertonic) with intravenous hydrocortisone. 5% dextrose solution is administered to replace fluid, electrolytes, and glucose. An increase in the rate of intravenous fluids could lead to fluid overload and vascular compromise resulting in cardiac failure. Restriction of intake of fluids would lead to further dehydration. Isotonic fluids would not be indicated as administration would lead to fluid volume overload.

Which is characteristic of fractures in children? Fractures rarely occur at the growth plate site, because it absorbs shock well. Rapidity of healing is inversely related to the age of the child. Pliable bones of growing children are less porous than those of the adult. Periosteum of a child's bone is thinner, weaker, and has less osteogenic potential compared with that of the adult.

Rapidity of healing is inversely related to the age of the child. The cartilage epiphyseal plate is the weakest point of the long bone. Therefore, it is a frequent site of damage. -Fractures heal in children in less time than they do in adults. As the child ages, the healing time increases. -The periosteum is thickened, and there is a great production of osteoclasts when a bone injury occurs. Bone healing in children is rapid because of the thickened periosteum and generous blood supply.

What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle? Increases the pain threshold. Increases metabolism in the tissues. Produces a deep tissue vasodilation. Reduces edema formation.

Reduces edema formation. This should have no effect on the pain threshold. This should not affect metabolism. Venous return to the heart, not vasodilation, is facilitated. Elevating the extremity uses gravity to facilitate venous return to reduce edema.

A nurse is caring for a child with syndrome of inappropriate antidiuretic hormone. Which nursing intervention has the greatest priority? 1. Restrict fluids to 1⁄4-1⁄2 normal maintenance 2. Measuring intake and output 3. Daily weights 4. Implement seizure precautions

Restrict fluids to 1⁄4-1⁄2 normal maintenance

The nurse manager on the orthopedic unit is preparing an in-service about types of traction at the next staff meeting. The nurse manager should include which information in the presentation? (Select all that apply.) Select all that apply. Skeletal traction is most likely used when closed reduction is performed. Skin traction can be applied using a pulling mechanism attached with adhesive material. Soft, foam-backed traction straps are used to distribute manual traction pull. Pins are commonly used with skeletal traction. Manual traction involves using wires or tongs inserted through the diameter of the bone distal to the fracture.

Skeletal traction is most likely used when closed reduction is performed. Pins are commonly used with skeletal traction. Types of traction include:Manual traction—Applied to the body part by the hands placed distal to the fracture site. Manual traction may be provided during application of a cast but more commonly when a closed reduction is performed.Skin traction—Applied directly to the skin surface and indirectly to the skeletal structures. The pulling mechanism is attached to the skin with adhesive material or an elastic bandage. Both types are applied over soft, foam-backed traction straps to distribute the traction pull.Skeletal traction—Applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture.

An early sign of congestive heart failure that the nurse should recognize is: tachypnea. bradycardia. inability to sweat. increased urine output.

Tachypnea -Tachycardia -Profuse sweating -Fatigue, irritability -Sudden weight gain -Resp. distress -Decreased urine output

The mother of a newborn just diagnosed with hypothyroidism is crying because she read on the internet that hypothyroidism causes mental retardation. She wants to know if this will happen to her baby. What is the appropriate response of the nurse? 1. Allow her to express her fears and concerns, showing concern for her feelings. 2. Tell her that this is unlikely because it was identified early and can be treated with medication 3. Recommend that she seek professional counseling to aid in coping with the grieving process 4. Suggest that she join a support group with parents of other children who have this disorder

Tell her that this is unlikely because it was identified early and can be treated with medication

A 17-year-old female is 2 days post-op thyroidectomy. Upon assessment, the nurse finds the adolescent anxious and vomiting with a positive Chvostek's sign. In what order should these actions be taken? 1. Call the provider. 2. Institute seizure precautions. 3. Obtain a tracheostomy set. 4. Place calcium gloconate at the bedside.

The options are ordered correctly, #1, #2, #3, #4. This is a sign of hypocalcemia. The most important thing a nurse can do is to recognize it early. Seizures can occur so before leaving the patient to obtain the other supplies, seizure precautions should be instituted. Laryngospasm can occur so preparations for an emergency airway should be close at hand.

The MOST appropriate nursing interventions when caring for a child experiencing a seizure include: (Select all that apply.) Select all that apply. restraining the child when a seizure occurs to prevent bodily harm. placing a padded tongue between the teeth if they become clenched. avoid suctioning the child during the seizure. describing and documenting the seizure activity observed. applying supplemental oxygen after inserting an artificial oral airway.

The priority nursing intervention is to observe the child and seizure, and document the activity observed. The child should not be restrained, because this may cause an injury. Nothing should be placed in the child's mouth, because this may cause an injury not only to the child but also to the nurse. To prevent aspiration, the child should be placed on the side if possible to facilitate drainage.

The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? (Select all that apply.) -Do not reuse needles. -Inject insulin when it is cold. -Flex or tense the muscle during injection. -Rotate sites. -Do not move the direction of the needle-syringe during insertion or withdrawal.

The reuse of needles leads to more discomfort on injection from decreased sharpness of the needle and being an infection control problem. Rotate sites to enhance absorption and minimize skin irritation. Keeping the direction of the syringe constant during the insertion and withdrawal minimizes discomfort. Insulin should be injected at room temperature to minimize discomfort. Flexing or tensing muscles during injections causes more discomfort.

What nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child? Suctioning child frequently Providing environmental stimulation Turning head side to side every hour Avoiding activities that cause pain or crying

Turning head side to side every hour Suctioning is a distressing procedure. In addition the resultant decrease in carbon dioxide can increase ICP. Environmental stimulation should be minimized. The child's head should not be turned side to side. If the jugular vein is compressed, ICP can rise. Nursing interventions should focus on assessment and interventions to minimize pain. These activities can cause the intracranial pressure to increase.

The nurse is explaining that the destruction of pancreatic beta-cells is the cause of which disorder? -Type 1 diabetes -Type 2 diabetes -Impaired glucose tolerance -Gestational diabetes

Type 1 diabetes - Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta-cells. Type 2 diabetes is a result of insulin resistance combined with relative (versus absolute) insulin deficiency. The insulin-producing pancreatic beta-cells are destroyed in type 1 diabetes. The insulin-producing pancreatic beta-cells are destroyed in type 1 diabetes.

A toddler is hospitalized with acute renal failure secondary to severe dehydration. The nurse should assess the child for what possible complication? Hypotension Hypokalemia Hypernatremia Water intoxication

Water intoxication The child needs to be monitored for hypertension. Hyperkalemia is a concern in acute renal failure. Hyponatremia may develop in acute renal failure. The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes.

A 6-year-old girl has been admitted to the pediatric intensive care unit as a newly diagnosed Type I Diabetic with diabetic ketoacidosis (DKA). Her orders include a fluid replacement bolus of 0.9%NS, vital signs every 15 minutes, and neuro checks every hour. Her blood glucose has decreased from 890 mg/dLto 285mg/dL after 8 hours of therapy. What orders would the nurse anticipate at this time? Select all that apply. 1. Administer oxygen @ 2Lvia nasal cannula 2. Change IV fluid to 0.45% NS 3. Add dextrose 5% to IV fluids infusing 4. Blood Glucose every 15 minutes 5. Anticipate starting potassium replacement therapy

When the Blood Glucose approaches 250mg/dL, a hypotonic solution should be started and dextrose should be added to the fluids to maintain a controlled descent. This patient's DKA is beginning to stabilize and so Option #1 would not be anticipated unless the arterial O2 is <80%. Option #4 is incorrect because this child would likely need glucose checks every hour at this point.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a prosthetic device? As soon as possible after birth When the infant begins sitting up and can maintain balance. At about age 12 to 15 months, when most children are walking. At about 4 years, when the healthy limb is not growing so rapidly.

When the infant begins sitting up and can maintain balance. The device will not be useful until the child is developmentally ready to use the leg. This is the most optimum time for the child to be fitted with a prosthetic device. The child is ready to stand, and the prosthetic device will be integrated into his or her capabilities. This may be too late. The device should be provided when the child is showing readiness to stand. This is too late.

The nurse should recognize that, when a child develops diabetic ketoacidosis, it is: -an expected outcome. -a life-threatening situation. -best treated at home. -best treated at the practitioner's office/clinic.

a life-threatening situation. This is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement. This is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. This is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment.

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. The PRIORITY of nursing care is to: initiate isolation precautions as soon as the diagnosis is confirmed. initiate isolation precautions as soon as the causative agent is identified. administer antibiotic therapy as soon as it is ordered. administer sedatives/analgesics on a preventive schedule to manage pain.

administer antibiotic therapy as soon as it is ordered. Isolation should be instituted as soon as diagnosis is suspected. Isolation should be instituted as soon as diagnosis is suspected. This is the priority action. Antibiotics are begun as soon as possible to prevent death and avoid resultant disabilities. Antibiotics are the priority function; pain should be managed if it occurs.

An advantage of continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents that require dialysis is that: hospitalization is only required several nights per week. dietary restrictions are no longer necessary. adolescents can carry out procedures themselves. insertion of catheter does not require surgical placement.

adolescents can carry out procedures themselves. Procedure can be done at home. Dietary restrictions are still required but are less strict. This type of dialysis provides the most independence for adolescents with ESRD and their families. Adolescents can carry out the procedure themselves. The catheter is surgically implanted in the abdominal cavity.

The temperature of an adolescent who is unconscious is 105° F. The PRIORITY nursing action is to: continue to monitor temperature. initiate a pain assessment. apply a hypothermia blanket. administer acetaminophen or ibuprofen.

apply a hypothermia blanket. The temperature needs to be monitored, but it also needs to be lowered. This should be ongoing; lowering the body temperature is the priority action. Brain damage can occur at temperatures this high. It is extremely important to institute temperature-lowering interventions, such as hypothermia blankets and tepid water baths. Antipyretics are not useful in cases of hyperthermia.

The nurse is caring for a child with Wilms' tumor. The MOST important nursing intervention before surgery is to: avoid abdominal palpation. closely monitor arterial blood gases. prepare child/family for long-term dialysis. prepare child/family for renal transplantation.

avoid abdominal palpation. Wilms' tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. This is not indicated before this abdominal surgery. This is not indicated unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative radiation and/or chemotherapy are used to minimize the size of the tumor. Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.

A youngster has just returned from surgery in a hip spica cast. The PRIORITY nursing intervention is to: elevate the head of the bed. check circulation. turn the child to the right side. offer sips of water.

check circulation. The nurse must be observant to the risk of increased swelling in the extremities. The chief concern is that the extremity may continue to swell. This must be assessed to ensure that the cast does not become a tourniquet. Elevating the head of the bed might help with comfort. The child's position should be changed every 2 hours. Sips of water are acceptable, but only after the assessment of the extremities is completed.

The MOST common cause of secondary hyperparathyroidism is: -diabetes mellitus. -chronic renal disease. -congenital heart disease. -growth hormone deficiency.

chronic renal disease. These conditions do not contribute to secondary hypoparathyroidism. Chronic renal disease is the most common cause of secondary hyperparathyroidism. These conditions do not contribute to secondary hypoparathyroidism. These conditions do not contribute to secondary hypoparathyroidism.

Therapeutic management of the patient with systemic lupus erythematosus includes: cold salts to suppress the inflammatory process. a high-protein, low-salt diet. an exercise regimen focusing on weight training. corticosteroids to control inflammation.

corticosteroids to control inflammation. This will not affect the inflammatory process. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation and should not focus on weight training. Currently this is the primary mode of therapy.

When discussing a child's precocious puberty with the parents, the nurse should tell them that: -the child is not yet fertile. -heterosexual interest is usually advanced. -dress and activities should be appropriate to chronologic age. -appearance of secondary sexual characteristics does not proceed in the usual order.

dress and activities should be appropriate to chronologic age. - Functioning sperm or ova may be produced, thereby making the child fertile at an early age. - Heterosexual interest is usually appropriate to chronologic age. - Because of the early sexual maturation of the child, both family and child require extensive teaching. - Included in this is the information that the child should be engaged in activities according to chronologic age. - The secondary sexual characteristics proceed in the usual order.

The MOST important nursing consideration related to congenital hypothyroidism is: -early identification of the disorder. -facilitation of parent-infant attachment. -initiating referrals for cognitive impairment. -helping parents deal with future prospects for the child.

early identification of the disorder. - Early diagnosis is imperative. Because brain growth is complete by 2 to 3 years old, the deficiency must be detected, and replacement therapy begun as soon as possible. The parent-infant attachment is important for all infants. With appropriate intervention, the child may not have any developmental deficit. With appropriate intervention, the child may not have any developmental deficit.

The nurse is caring for a 2-year-old girl who is unconscious but stable following a car accident. Her parents are staying at the bedside most of the time. An appropriate nursing intervention is to: -suggest that the parents go home until she is alert enough to know that they are present. -use ointment on her lips but do not attempt to cleanse her teeth until swallowing returns. -encourage the parents to hold, talk, and sing to her as they usually would. -position her with proper body alignment and head of bed lowered 15 degrees.

encourage the parents to hold, talk, and sing to her as they usually would. -Oral care is essential in the unconscious child. Mouth care should be done at least twice daily. -The parents should be encouraged to interact with their daughter. Senses of hearing and tactile perception may be intact, and stimulation of these senses is important. The head of the bed should be elevated, not lowered.

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, baseball, and swim. The nurse's response should be based on knowledge that: -exercise is contraindicated. -soccer and baseball are too strenuous, but swimming is acceptable. -exercise is not restricted unless indicated by other health conditions. -the level of activity depends on the type of insulin required.

exercise is not restricted unless indicated by other health conditions. - Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercises. Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. The level of activity does not depend on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events.

An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. The nurse's MOST appropriate action is to: -explain the disorder so parents can explain it to others. -help parents understand that no one knows how this occurs. -suggest that parents avoid family and friends until the gender is assigned. -encourage parents not to worry while the tests are being done.

explain the disorder so parents can explain it to others. - This is the most therapeutic approach while the parents await the gender assignment of their child. The disorder is caused by decreased enzyme activity required for adrenal cortical production of cortisol. This is impractical and would isolate the family from their support system while awaiting test results. The parents will be concerned. Telling the parents not to worry without giving them specific alternative actions would not be effective.

A neonate with a goiter has just been admitted to the newborn nursery. A PRIORITY nursing intervention is to: -position the infant on the left side. -explain transient paralysis to parents. -have tracheostomy set at bedside. -suction the infant at least every 5 to 10 minutes.

have tracheostomy set at bedside. - This position is not indicated. Hyperextension of the child's neck may facilitate breathing. Transient paralysis does not exist. The presence of the goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including a tracheostomy set at the bedside. There is no indication for suctioning.

The doctor suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent: pulmonary infection. right-to-left shunt of blood. decreased workload on left side of heart. increased pulmonary vascular congestion.

increased pulmonary vascular congestion. The increased pulmonary vascular congestion is the primary complication. The shunt of blood is left to right. The increased pulmonary vascular congestion is the primary complication. Patent ductus arteriosus (PDA) allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary congestion can occur.

The nurse is planning care for a school-age child with bacterial meningitis. The plan should include: keeping environmental stimuli at a minimum. avoiding giving pain medications that could dull sensorium. measuring head circumference to assess developing complications. having child move head side to side at least every 2 hours.

keeping environmental stimuli at a minimum. -Children with meningitis are sensitive to noise, bright lights, and other external stimuli. The nurse should keep the room as quiet as possible, with a minimum of external stimuli. -After consultation with the practitioner, pain medications can be used if necessary. A school-age child will have closed sutures. -Head circumference should not change. -The child is placed in side-lying position with the head of the bed slightly elevated. The nurse should avoid measures such as lifting the child's head that would increase discomfort.

The callus that develops at the fracture site is important because it provides: functional use of injured part. sufficient support for weight bearing. means for adequate blood supply. means for holding bone fragments together

means for holding bone fragments together. Functional use cannot occur until the fracture site is stable. Functional use cannot occur until the fracture site is stable. The callus does not provide an adequate blood supply. New bone cells are formed in large numbers and are stimulated to maximum activity. They are found at the site of the injury. In time, calcium salts are absorbed to form the callus.

An appropriate nursing intervention when caring for the child with chronic osteomyelitis is to: provide active range-of-motion exercises for the affected extremity. administer pain medications with meals. encourage frequent ambulation. move and turn the child carefully and gently to minimize pain.

move and turn the child carefully and gently to minimize pain. Active range of motion is contraindicated until pain has subsided. Pain medication should be administered as needed. Ambulation is contraindicated until pain has subsided. Osteomyelitis is extremely painful. Movement is carried out only as needed and then carefully and gently.

An important nursing consideration when caring for a child with end-stage renal disease (ESRD) is that: children with ESRD usually adapt well to the minor inconveniences of treatment. children with ESRD require extensive support until they outgrow the condition. multiple stresses are placed on children with ESRD and their families until the illness is cured. multiple stresses are placed on children with ESRD and their families because the children's lives are maintained by drugs and artificial means.

multiple stresses are placed on children with ESRD and their families because the children's lives are maintained by drugs and artificial means. ESRD is a complex disease process that requires substantial medical intervention. ESRD cannot be outgrown. Dialysis is necessary until renal transplantation is performed. ESRD cannot be cured. Dialysis is necessary until renal transplantation is performed. This is a chronic, progressive disease with dependence on technology. Families need to arrange for continuing examinations and procedures that are painful and may require hospitalization.

The nurse is doing a neurologic assessment on a 2-month-old infant following a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest: neurologic health. severe brain damage. decorticate posturing. decerebrate posturing.

neurologic health. The Moro, tonic neck, and withdrawing reflexes are usually present in infants under 3 to 4 months of age. Therefore, the presence of these reflexes indicates neurologic health. These are expected reflexes in a 2-month-old. Decorticate posturing indicates severe dysfunction of the cerebral cortex. Decerebrate posturing indicates dysfunction at the level of the midbrain.

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment, the nurse notes that the child is becoming irritable and pupils are unequal and sluggish. The MOST appropriate nursing action is to: notify the health care provider immediately. document level of consciousness. observe closely for signs of increased intracranial pressure (ICP). administer pain medication and assess for response.

notify the health care provider immediately. The worsening of symptoms may indicate that intracranial pressure (ICP) is increasing. The practitioner should be notified immediately. The health care provider should be notified first before documenting. The nurse is already noting signs of potentially increased ICP. Pain medication should not be given. Consultation with the practitioner should occur first.

The nurse should recognize which laboratory value as being abnormal? pH: 4 Specific gravity: 1.020 Protein level: absent Glucose level: absent

pH: 4 The expected pH is 4.8 to 7.8. This is within the normal specific gravity range of 1.016 to 1.022. Protein should not be present in the urine. If present, it would indicate an abnormality in glomerular filtration. Glucose should not be present. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

Major goals of the therapeutic management of juvenile idiopathic arthritis are to: prevent joint discomfort and regain proper alignment. prevent loss of joint function and achieve cure. prevent physical deformity and preserve joint function. prevent skin breakdown and relieve symptoms.

prevent physical deformity and preserve joint function. Once the joint is damaged, it may not be possible to regain proper alignment. It may not be possible to achieve a cure. These are the goals of treatment. A third goal is to control pain. Skin breakdown is usually not an issue in juvenile rheumatoid arthritis.

Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. The nurse should recognize that in clinical practice this system is: helpful because it explains the hemodynamics involved. helpful because children with cyanotic defects are easily identified. problematic because cyanosis is rarely present in children. problematic because children with acyanotic heart defects may develop cyanosis.

problematic because children with acyanotic heart defects may develop cyanosis. The classification does not reflect the path of blood flow within the heart. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Cyanosis is present when children have defects in which oxygenated blood and unoxygenated blood are mixed. This classification is problematic. Children with traditionally named acyanotic defects may be cyanotic, and children with traditionally classified cyanotic defects may appear pink.

External defects of the genitourinary tract such as hypospadias are usually repaired as early as possible to: prevent urinary complications. prevent separation anxiety. promote acceptance of hospitalization. promote development of normal body image.

promote development of normal body image. Preventing urinary complications is important for defects that affect function, but all external defects should be repaired as soon as possible. Proper preprocedure preparation can facilitate coping with these issues. Proper preprocedure preparation can facilitate coping with these issues. This is extremely important. Surgery involving sexual organs can be very upsetting to children, especially preschoolers who fear mutilation and castration.

The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. The MOST appropriate nursing assessment in this case is: reactivity of pupils. doll's head maneuver. oculovestibular response. funduscopic examination to identify papilledema.

reactivity of pupils. Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity. Doll's head maneuver should not be performed if there is a cervical spine injury. This is a painful test that should not be done on a child who is having variable levels of consciousness. Papilledema does not develop until 24 to 48 hours into the course of unconsciousness

An adolescent who had a lower leg amputated after a motorcycle accident complains of pain in the missing extremity. The nurse's MOST appropriate action is to: withhold pain medications because of narcotic addiction. refer the patient for psychologic counseling. teach the parents and adolescent child about nerve damage. reassure the child that it is normal and is called phantom limb sensation.

reassure the child that it is normal and is called phantom limb sensation. Phantom limb sensation is an expected phenomena following amputation of an extremity. The other choices are not relevant. Phantom limb sensation is an expected experience because the nerve-brain connections are still present. They gradually fade. This should be discussed before surgery with the child.

After a patient returns from cardiac catheterization, the nurse assesses that the pulse distal to the catheter insertion site is weaker. The nurse should: elevate the affected extremity. record the data on the nurse's notes. notify the physician of the observation. apply warm compresses to the insertion site.

record the data on the nurse's notes. - Elevation is not necessary; the extremity is kept straight. - The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. It should gradually increase in strength. Because a weaker pulse is an expected finding, the nurse should document this and continue to monitor. The insertion site is kept dry.

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually is associated with: incontinence. urinary obstruction. recurrent kidney infections. infarction of renal vessels.

recurrent kidney infections. Incontinence may be associated with urinary tract infections. When reflux is associated with vesicoureteral reflux, it can cause renal scarring but not obstruction. Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to kidney infections. Infarction of renal vessels does not occur.

The nurse is caring for a child with multiple injuries who is comatose. The nurse should recognize that pain: cannot occur if the child is comatose. may occur if the child regains consciousness. requires astute nursing assessment and management. is best assessed by family members who are familiar with the child.

requires astute nursing assessment and management. Pain can occur in the comatose child. The child can be in pain while comatose. Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must be focused on physiologic and behavioral manifestations. The family can provide insight into different responses, but the nurse should be monitoring physiologic and behavioral manifestations.

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. In the discussion the nurse should include that: parental protection is essential until the child reaches adulthood. cognitive impairment is to be expected with hydrocephalus. shunt malfunction or infection requires immediate treatment. most usual childhood activities must be restricted.

shunt malfunction or infection requires immediate treatment. Limits should be appropriate to the developmental age of the child. Except for contact sports, the child will have few restrictions. Cognitive impairment depends on the extent of damage before the shunt was placed. Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present. Limits should be appropriate to the developmental age of the child. Except for contact sports, the child will have few restrictions.

A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. The nurse should recognize that this is: absence seizure. generalized seizure. status epilepticus. simple partial seizure.

status epilepticus. Absence seizures are brief losses of consciousness. Generalized seizures are the most common of seizures. They have a tonic phase of approximately 10 to 20 seconds. They involve both hemispheres of the brain. Status epilepticus is a generalized seizure that lasts more than 30 minutes. Simple partial seizures are characterized by varying sensations.

The nurse is caring for an immobilized preschool child. During this period of immobilization, the nurse's BEST action is to: encourage wearing pajamas. let the child have few behavioral limitations. keep child away from other immobilized children if possible. take child for a "walk" by wagon outside the room.

take child for a "walk" by wagon outside the room. The child should be encouraged to wear street clothes during the daytime. Limit setting is necessary with all children. There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed. It is important for children to have activities outside of the room if possible. This increases environmental stimuli and provides social contact with others.

A 17-year-old boy with diabetes mellitus tells the school nurse that he has recently started drinking alcohol with his friends on weekends. The nurse should: -tell him not to do this. -ask him why he is drinking alcohol. -teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake. -provide an immediate referral for counseling so he understands the serious consequences of alcohol consumption.

teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake. - Admonishing him will not help the adolescent if he chooses to continue drinking. Asking him why will provide information to the nurse but will not address the information that the adolescent needs to have about managing his disease. The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the management of his illness. A recommendation for counseling can be included in the teaching plan but providing an immediate referral for counseling may be viewed as adversarial.

The primary therapy for secondary hypertension in children is: weight reduction. low-salt diet. increased exercise and fitness. treatment of underlying cause.

treatment of underlying cause. These therapies are usually effective for essential hypertension. These therapies are usually effective for essential hypertension. These therapies are usually effective for essential hypertension. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved.

In a non-potty-trained child with nephrotic syndrome, the best way to detect fluid retention is to: weigh the child daily. test the urine for hematuria. measure the abdominal girth weekly. count the number of wet diapers.

weigh the child daily. Measuring weight at the same time each day is the most accurate way to determine fluid gains and losses. The presence or absence of blood in the urine will not help with the determination of fluid retention. Abdominal girth is reflective of edema, but weekly is too infrequent a measure. The number of wet diapers reflects how often they have been changed. The diapers should be weighed to reflect fluid balance.