Pediatric Question
what is ortolani sign?
Ortolani's sign is the abnormal clicking sound whenthe hips are abducted hip dysplasia
Because of the risks associated withadministration of factor VIIIconcentrate, the nurse would report whichof the following? a)yellowing of the skin b) constipation c) abdominal distention d) puffiness around the eyes
Answer A Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present.
The nurse teaches the mother of a young child with Duchenne's muscular dystrophy about the disease and its management. Which of the following statements by the mother indicates successful teaching? a)my son will probably be unable to walking dependently by the time he is 9 to 11 years old b) muscle relaxants are effective for some children;I hope they can help my son c) when my son is a little bit older, he can have surgery to improve his ability to walk d) I need to help my son be as active as possible to prevent progression of the disease
Answer A Muscular dystrophy is an X-linked recessive disorder.The gene is transmitted through female carriers to affected sons 50% of the time. Daughters have a 50%chance of being carriers. It is a progressive disease. Children who are affected by this disease usually are unable to walk independently by age 9-11 years. There is no effective treatment for the disease. A characteristic manifestation is Gower's sign -- the child walks the hands up the legs in an attempt to rise from sitting to standing position.
13. Which of the following should the nurse expect to note as a frequent complication for a child with congenital heart disease? a.Susceptibility to respiratory infection b. Bleeding tendencies c. Frequent vomiting and diarrhea d. Seizure disorder
Answer A Children with congenital heart disease aremore prone to respiratory infections
Which of the following signs and symptoms would observe in a child diagnosed of laryngotracheobronchitis? a)predominant stridor on inspiration b) predominant expiratory wheeze c) high fever d) slow respiratory rate
Answer A Because croup cause upper airway obstruction, inspiratory stridor is predominant symptom
A previously healthy 5-year-old girl presents to the ED with her parents with a temperature of 100.8°F (38.2°C) and a 2-day history of decreased appetite and persistent vague abdominal pain with tenderness in the mid-abdomen and right lower quadrant. Her parents report that she has had no appetite and felt nauseous but has not vomited. Laboratory results are unremarkable except for a white blood cell count of 16,000 cells/mL (normal, 4500- 11,000 cells/mL).Ultrasound of the abdomen and pelvis is inconclusive, and the patient is admitted to the hospital for observation. Eighteen hours into her hospital stay, she passes copious amounts of bloody stool. She remains hemodynamically stable with normal vital signs and no change in her abdominal pain. What is this patient's most likely diagnosis? (A)Appendicitis (B) Colonic arteriovenous malformation (C) Colonic diverticulitis (D) Gastric stress ulcer (E) Meckel's diverticulitis
Answer (E) Meckel's diverticulitis. Hemorrhage is the most common complication of Meckel's diverticulitis in children; therefore, this condition should be considered in any child with abdominal pain of unclear etiology associated with GI hemorrhage. Intestina obstruction is another possible diagnosis but is more common in adults. The diagnosis of Meckel's diverticulitis can be confirmed by 99mTc-pertechnetates can, which detects heterotopic gastric mucosa orpancreatic tissue within the diverticulum. Meckel'sdiverticula are usually completely asymptomatic, but resection is necessary when complications develop.Colonic arteriovenous malformations can cause GI hemorrhage in children but are much less common than Meckel's diverticula. Appendicitis is common in children but very rarely causes hemorrhage. Colonic diverticulitis and gastric stress ulcers are exceedingly rare in children and are unlikely in this case.
Which of the following statements is LEAST accurate concerning urinary tractinfections (UTI) in children? A)A negative urinalysis rules out UTI in children < 2 years of age. B) Children with multiple UTIs should be evaluated for abuse. C) Infants younger than 3 months of age with a UTI should be admitted for intravenous antibiotics. D) Neonatal boys are more prone to UTIs than girls .E) Well appearing children > 3 months old with pyelonephritis may be treated as outpatients.
Answer A A negative urinalysis rules out UTI in children < 2 years of age.In children younger than 2-years-old, a negative urinalysis does not rule out a urinary tract infection. Up to 50% ofchildren with UTIs can have a false negative urinalysis. Nitriteand leukocyte esterase presence in urine dipstick have thehighest combined sensitivity for UTI. In addition, if both are positive, the false positive rate is less than 4%. Most consider young girls to be at the highest risk for UTI. This is in fact true except for the neonatal period, when neonatal boys actually have a higher risk than girls. Children with UTIs are managed differently based on the age of the child. The very young are treated conservatively, and those under 3 months of age are generally admitted to the hospital for IV antibiotics. Pyelonephritis used to be commonly managed as an inpatient,but in well appearing children, this infection can be treated as an outpatient with oral antibiotics.
A 5-year old with congestive heart failure has been receiving Digoxin (Lanoxin).Which finding indicated that the medicationis having a desired effect. a.Increased urinary output b.Stabilized weigh c.Improved appetite d.Increased pedal edema
Answer A Lanoxin slows and strenghtens the contractions ofthe heart. An increase in urinary output shows thatthe medication is having a desired effect.
The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which of the following interventions would be most appropriate? a)fitting the diaper under the straps b) leaving the harness off while the infant sleeps c) checking for the skin redness under straps every other day d) putting powder on the skin under the straps every day
Answer A The Pavlik harness is worn over a diaper. Knee socks are also worn to prevent the straps and foot and leg pieces from rubbing directly on the skin. For maximum results, the infant needs to wear the harness continuously. The skin should be inspected several times a day, not every other day, for signs of redness or irritation. Lotions and powders are to be avoided because they can cake and irritate the skin. (Hip dysplasia is a condition in which the head of the femur is improperly rested in the acetabulum, or hip socket of the pelvis. The characteristic manifestations are as follows: asymmetry of the gluteal and thigh folds; limited hip abduction in the affected hip; apparent shortening of the femur on the affected side(Galeazzi sign and Allis sign); weight bearing causes titling of the pelvis downward on the unaffected side (Trendelenbergsign); Ortolani click (in infant under 4 weeks of age).
After talking with the parents of a child with Down Syndrome, which of the following would the nurse identify as an appropriate goal of care of the child? a)encouraging self-care skills in the child b) teaching the child something new each day c) encouraging more lenient behavior limits for the child d) achieving age-appropriate social skills
Answer A The goal in working with mentally challenged children is to train them to be as independent as possible,focusing on the developmental skills. The child may not be capable of learning something new every day but needs to repeat what has been taught previously.Rather than encouraging more lenient behavior limits,the parents need to be strict and consistent when setting limits for the child. Most children with Down syndrome are unable to achieve age-appropriate social skills due to their mental retardation. Rather, they taught socially appropriate behaviors.
Which of the following parameters would the nurse monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)? a.Vomiting b. Stools c. Uterine d. Weight
Answer A Thickened feedings are used with GER to stop the vomiting. Therefore, the nurse would monitor the child's vomiting to evaluate the effectiveness of using the thickened feedings.No relationship exists between feedings and characteristics of stools and uterine. If feedings are ineffective, this should be noted before there is any change in the child's weight.
Which of the following statements by the mother of an 18 month old would indicate to the nurse that the child needs laboratory testing for lead levels? a)my child does not always wash after playing outside b) my child drinks 2 cups of milk everyday c) my child has more temper tantrums than other kids d) my child is smaller than other kids of the same age
Answer A eating with dirty hands, especially after playing outside, can lead to lead poisoning because lead is often present in soil surrounding homes. When blood levels of lead reaches 15-19 mg/dL.., an investigation of the child's environment will be initiated. Oral chelation therapy is started when blood lead levels reached 45 mg/dL. When they reach 70 mg/dL, the child usually is hospitalized for intravenous chelation therapy.
What would cause the closure of the Foramen ovale after the baby had been delivered? a.Decreased blood flow b. Shifting of pressures from right side to the left side of the heart c. Increased PO2 d. Increased in oxygen saturation
Answer B During feto-placental circulation, the pressure in the heart is much higher in the right side, but once breathing/crying is established, the pressure will shift from the R to the L side, and will facilitate the closure of Foramen Ovale.(Note: that is why you should position the NB in R side lying position to increase pressure in the L side of the heart.)
The nurse is assessing an infant with hirschspung's disease. The nurse can expect the infant to: a.Weight less than expected for height and age b. Have infrequent bowel movements c. Exhibit clubbing of fingers and toes d. Have hyperactive deep tendon reflexes
Answer B The infant with hirschsprung's disease will have infrequent bowel movements.
A nurse is caring for an infant that hasrecently been diagnosed with a congenitalheart defect. Which of the followingclinical signs would most likely be present? A: Slow pulse rate B: Weight gain C: Decreased systolic pressure D: Irregular WBC lab values
Answer B Weight gain is associated with CHF andcongenital heart deficits .
When providing postoperative care for the child with a cleft palate, the nurse should position the child in which of the following positions? a.Supine b. Prone c. In an infant seat d. On the side
Answer B. Postoperatively children with cleft palate shouldbe placed on their abdomens to facilitate drainage.If the child is placed in the supine position, he orshe may aspirate. Using an infant seat does not facilitate drainage. Side-lying does not facilitatedrainage as well as the prone position
A mother has recently been informed that her child has Down's syndrome. You willbe assigned to care for the child at shiftchange. Which of the following characteristics is not associated with Down'ssyndrome? A: Simian crease B: Brachycephaly C: Oily skin D: Hypotonicity
Answer C The skin would be dry and not oily.
Who among the following pediatric clientshould be assessed first by the nurse? a)the child with 2 episodes of soft stools during the shift b) the child who had cough for the past three days, with clear nasal discharge and is irritable c) the child with 2 episodes of inconsolable crying while the knees are drawn over the abdomen and plays between the episodes d) the child with skin rashes on his face and trunk
Answer C - this indicates appendicitis. The pattern of abdominal pain in appendicitis is as follows: pain occurs for 2 to 3 hours, pain is relieved in 2 to 3 hours, the n pain recurs and persists. During the time that pain subsides, it is when rupture of appendicitis may occur unnoticed.
5. A 16 month old child diagnosed withKawasaki Disease (KD) is very irritable,refuses to eat, and exhibits peeling skinon the hands and feet. Which of thefollowing would the nurse interpret asthe priority? a)applying lotions to the hands and fee tb) offering foods the toddler likes c) placing the toddler in a quiet environment d) encouraging the parents to get some rest
Answer C One of the characteristics of children with KDis irritability. They are often inconsolable.Placing the child in a quiet environment may help quiet the child and reduce the workload of the heart. The child's irritability takes priority over peeling of the skin.
A school-aged client admitted to thehospital because of decreased urine outputand periorbital edema is diagnosed withglomerulonephritis. Which of the followinginterventions would receive the highestpriority? a)assessing vital signs every four hours b) monitoring intake and output every 12 hours c) obtaining daily weight measurements d) obtaining serum electrolyte levels daily
Answer C The child will glomerulonephritis experiences a problem with renal function that ultimately affects fluid balance. Because weight is the best indicator of fluid balance, obtaining daily weights would be the highest priority.
When the infant returns to the unit after imperforate anus repair, the nurse places the infant in which of the following position? a)on the abdomen, with legs pulled up under the body b) on the back, with legs extended straight out c) lying on the side with hips elevated d) lying on the back in a position of comfort
Answer C after surgical repair for an imperforate anus, the infant should be positioned either supine with the legs suspended at 90-degree angle or on either side with the hips elevated to prevent pressure on the perineum. A neonate who is placed on the abdomen pulls the legs up under the body, which puts tension on the perineum, as does positioning the neonate with the legs extended straight out
A child presents to the emergency room with the history of ingesting a large amount of acetaminophen. For which of the following would the nurse assess? a)hypertension b) frequent urination c) Right upper quadrant pain d) headache
Answer C after ingesting a large amount of acetaminohen,the child would complain of right upper quadrant pain due to hepatic damage from glutathione combining with the metabolite of acetaminophen being broken down.
While assessing a child with pyloric stenosis, the nurse is likely to note which of the following? a.Regurgitation b. Steatorrhea c. Projectile vomiting d. "Currant jelly" stools
Answer C. Projectile vomiting is a key symptom of pyloric stenosis. Regurgitation is seen more commonly with GER. Steatorrhea occurs in malabsorption disorders such as celiac disease. "Currant jelly"stools are characteristic of intussusception.
The mother of a 3 year old with esophageal reflux asks the nurse what she can do to lessen the baby's reflux. The nurse should tell the mother to: a.Feed the baby only when he is hungry b. Burp the baby after feeding is completed c. Place the baby in supine with head elevated d. Burp the baby frequently throughout thefeeding
Answer D Burping the baby throughout the feeding willhelp prevent gastric distention that contributesto esophageal reflux
29. When assessing the development of a 15 month old child with cerebral palsy, which of the following milestones would the nurse expect a toddler of this age to have achieved? a)walking up steps b) using a spoon c) copying a circle d) putting a block in cup
Answer D Delay in achieving developmental milestones is a Delay in achieving developmental milestones is a characteristic of children with cerebral palsy. A 15 characteristic of children with cerebral palsy.Walking up month old child can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months.steps typically is accomplished at 18 to 24 months.A child usually is able to use a spoon at 18 months.A child usually is able to use a spoon at 18 months.The ability to copy a circle is achieved at The ability to copy a circle is achieved at approximately 3 to 4 years of age.approximately 3 to 4 years of age.
Which of the following nursing diagnoses would be inappropriate for the infant with gastroesophageal reflux(GER)? a.Fluid volume deficit b. Risk for aspiration c. Altered nutrition: less than body requirements d. Altered oral mucous membranes
Answer D GER is the back flow of gastric contents into the esophagus resulting from relaxation or incompetence of the lower esophageal (cardiac)sphincter. No alteration in the oral mucous membranes occurs with this disorder. Fluid volume deficit, risk for aspiration, and altered nutrition are appropriate nursing diagnoses
nurse has just started her rounds delivering medication. A new patient on her rounds is a 4 year-old boy who is non-verbal. This child does not have on any identification. What should the nurse do? A: Contact the provider B: Ask the child to write their name onpaper. C: Ask a co-worker about the identification of the child. D: Ask the father who is in the room the child's name.
Answer D In this case you are able to determine the name of the child by the father's statement. You should not withhold the medication from the child following identification.
When teaching the mother of an infant who has undergone surgical repair of a cleft lip how to care for the suture line, the nurse demonstrates how to remove formula and drainage. Which of the following solutions would the nurse use? a)mouthwash b) providone - iodine (betadine) solution c) a mild antiseptic solution d) half-strength hydrogen peroxide
Answer D half-strength hydrogen peroxide is recommended for cleansing the suture line after cleft lip repair.The bubbling action of the hydrogen peroxide is effective for removing debris. Normal saline also maybe used. Mouthwashes frequently contain alcohol which can be irritating. Povidone-iodine solution is not used because iodine contained in the solution can be absorbed through the skin, leading to toxicity. A mild antiseptic solution has some antibacterial properties but is ineffective in removing suture-line debris.
A 4 year old with hydrocephalus is scheduled to have a ventroperitoneal shunt in the right side of the head. When developing the child's postoperative plan of care, the nurse would expect to place the preschooler in which of the following positions immediately after surgery? a)on the right side, with the foot of the bed elevated b) on the left side, with the head of the bed elevated c) prone with the head of the bed elevated d) supine, with the head of the bed flat
Answer D For at least the first 24 hours after insertion of a ventriculo peritoneal shunt, the child is positioned supine with the head of the bed flat to prevent too rapid decrease in CSF pressure. A rapid reduction in the size of the ventricles can cause subdural hematoma. Positioning on the operative site is to be avoided because it places pressure on the shunt valve, possibly blocking desired drainage of CSF. With continued increased ICP, the child would be positioned with the head of bed elevated to allow gravity to aid drainage.
11. Which of the following would the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? a)maintaining the joints in an extended position b) applying gentle traction to the child's affected joints c) supporting proper alignment with rolled pillows d) using a bed cradle to avoid the weight of bed lines on the joints
Answer D for a child with arthritis associated with rheumatic fever, the joints are usually so tender that even the weight of bed linens can cause pain. Use of the bed cradle is recommended to help remove the weight of the linens on painful joints. Joints need to be maintained in good alignment, not positioned in extension, to ensure that they remain functional.Applying gentle traction to the joints is not recommended because traction is usually used to relieve muscle spasms, not typically associated with rheumatic fever. Supporting the body in good alignment and changing the client's position are recommended, but these measures are not likely to relieve pain.