Peds Exam 2

Cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of respiratory tract infections because: a. They are safer. b. A more comfortable environment is produced. c. Respiratory secretions are dried. d. They are less expensive.

A Cool-mist vaporizers are safer than steam vaporizers, and limited evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but decreased risk for burns and growth of organisms exist in cool-mist vaporizers.

After the acute stage and during the healing process the primary complication from burn injury is: a. Infection. b. Asphyxia. c. Renal shutdown. d. Shock.

A During the healing phase local infection and sepsis are the primary complications. Respiratory problems, primarily airway compromise, are the primary complications during the acute stage of burn injury.

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 9 years; girls, 8 years b. Boys, 10 years; girls, 9.5 years c. Boys, 12 years; girls, 10 years d. Boys, 11 years; girls, 9 years

A Manifestations of sexual development before age 9 in boys and age 8 in girls is considered precocious and should be investigated. Boys older than 9 years of age and girls older than 8 years of age fall within the expected range of pubertal onset.

In addition to the application of a pediculicide, parents are instructed to: a. Comb the child's hair daily with a special comb to remove nits. b. Cut the child's hair to a length of 1 inch. c. Avoid sending the child to daycare of school until nits are no longer visible. d. Treat all family members with a pediculicide for 7 days.

A Nit removal is the key to prevent re-infestation of lice. Most pediculocides kill live lice, but not nits. Nits contain the lice eggs and when they hatch the child will develop a new lice infestations.

A child with extensive burns requires debridement. The nurse should anticipate that a priority goal related to this procedure is to: a. Reduce pain. b. Prevent bleeding. c. Restore fluid balance. d. Maintain airway.

A Partial-thickness burns require debridement of devitalized tissue to promote healing. The procedure is very painful and requires analgesia and sedation before the procedure. Preventing bleeding, maintaining the airway, and restoring fluid balance are not goals of debridement.

Several complications can occur when a child receives a blood transfusion. An immediate sign or symptom of an air embolus is: a. Sudden difficulty in breathing. b. Chills and shaking. c. Nausea and vomiting. d. Irregular heart rate.

A Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia.

The most appropriate nursing diagnosis for a child with anemia is: a. Activity Intolerance related to generalized weakness. b. Risk for Injury related to depressed sensorium. c. Risk for Injury related to dehydration and abnormal hemoglobin. d. Decreased Cardiac Output related to abnormal hemoglobin.

A The basic pathology in anemia is the decreased oxygen-carrying capacity of the blood. The nurse must assess the child"s activity level (response to the physiologic state). The nursing diagnosis would reflect the activity intolerance. In generalized anemia no abnormal hemoglobin may be present. Only at a level of very severe anemia does cardiac output become altered. No decreased sensorium exists until profound anemia occurs. Dehydration and abnormal hemoglobin are not usually part of anemia.

A high-protein diet for the child with major burns is ordered to: a. Avoid protein breakdown. b. Diminish risks of stress-induced hyperglycemia. c. Promote growth. d. Improve appetite.

A The diet must provide sufficient calories to meet the increased metabolic needs and enough protein to avoid protein breakdown. Healing, not growth, is the primary consideration. Many children have poor appetites, and supplementation will be necessary. Hypoglycemia, not hyperglycemia, can occur from the stress of burn injury because the liver glycogen stores are rapidly depleted.

The earliest recognizable clinical manifestation(s) of cystic fibrosis (CF) is: a. Meconium ileus. b. History of poor intestinal absorption. c. Foul-smelling, frothy, greasy stools. d. Recurrent pneumonia and lung infections.

A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools and recurrent respiratory infections are later manifestations of CF.

A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? Select all that apply. a. Dry, thick skin b. Weight loss c. Cold intolerance d. Fatigue e. Diarrhea

A C D

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests: a. Asthma. b. Pneumonia. c. Foreign body in the trachea. d. Bronchiolitis.

A. Children with asthma usually have these chronic symptoms. Pneumonia appears with an acute onset and fever and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea will occur with acute respiratory distress or failure and maybe stridor.

Respiratory syncytial virus (RSV) is: a. an uncommon virus that causes severe bronchiolitis in older children b. a common virus that often causes moderate-to-severe bronchiolitis in infants c. a common virus that rarely requires hsoptialization d. an uncommon virus that usually does not require hospitalization

B

What fluid is the best choice when a child with mucositis asks for something to drink? a. Hot chocolate b. Popsicle c. Orange juice d. Lemonade

B

An effective strategy to reduce the stress of burn dressing procedures is to: a. Encourage the child to master stress with controlled passivity. b. Give the child as many choices as possible. c. Explain to the child why analgesics cannot be used. d. Reassure the child that dressing changes are not painful.

B Children who have an understanding of the procedure and some perceived control demonstrate less maladaptive behavior. They respond well to participating in decisions and should be given as many choices as possible. The dressing-change procedure is very painful and stressful. The child should not be misinformed. Analgesia and sedation can and should be used. Encouraging the child to master stress with controlled passivity is not a positive coping strategy.

A toddler with hemophila is at risk for: a. all of the above b. Developmental delay related to activity restrictions c. Altered growth related to poor appetite d. infection related to decreased WBCs

B Children with Hemophila are restricted in activity d/t bleeding concerns. Since play is the 'work of childhood', lack of ability for free, unrestricted play can impact development.

The triage nurse is fielding a call about croup. The parent describe her child as having a barking cough, no fever and the child is drinking and eating well. The nurse's management advise to the parent is based on the knowledge that most children with croup: a. need to be hopsitalized b. can be cared for at home c. are over the age of 6 years d. may need to be intubated

B Children with mild croup who are eating and drinking well, and not showing any signs of respiratory distressed can be cared for at home. Croup generally affects children under the age of 5 years. Children with croup rarely need to be hospitalized or intubated - children with Epiglottitis will need to be hospitalized and often are intubated.

One of the first signs of overwhelming sepsis in a child with burn injuries is: a. Bradycardia. b. Disorientation. c. Decreased blood pressure. d. Seizures.

B Disorientation in the burn patient is one of the first signs of overwhelming sepsis and may indicate inadequate hydration. Seizures, bradycardia, and decreased blood pressure are not initial manifestations of overwhelming sepsis.

What is considered a cardinal sign of diabetes mellitus? a. Impaired vision b. Frequent urination c. Nausea d. Seizures

B Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.

A common fungal infection of the skin in pediatrics is: a. scabies b. tinea corporis c. herpes simplex type 1 d. warts

B Tinea is the only fungal infection listed. Herpes is a virus, scabies is an infestation, warts are viral.

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should he or she suggest? a. Iron-fortified commercial formula can be used by ages 4 to 6 months. b. Iron-fortified infant cereal can be used at approximately 6 months of age. c. Iron (ferrous sulfate) drops after age 1 month. d. Iron-fortified infant cereal can be used by age 2 months.

B Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated. Introducing iron-fortified infant cereal at 2 months should be done only if the mother is choosing to discontinue breastfeeding.

The nurse is talking to a parent of a 2-year old child with severe atopic dermatitis. What should the nurse reinforce with the parent? Select all that apply. a. 'You can use warm wet compresses to relieve discomfort.' b. 'You will need to keep your infant's skin well hydrated by only using a mild soap in the bath.' c. 'You can help prevent your baby from scratching the area by using a mild antihistamine.' d. 'You can try a fragranced fabric softener in the laundry to avoid rough cloth.' e. 'You should apply an emollient to the skin immediately after a bath.' f. 'You should bathe your baby in a bubble bath at least twice a day.'

B C & E The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection; an antihistamine can be used. Keeping the skin hydrated is a goal of treating atopic dermatitis. Applying an emollient immediately after a bath helps to trap moisture and prevent moisture loss. Using warm compresses to relieve discomfort, bathing the baby in a bubble bath, and using fabric softener are not appropriate suggestions for this condition.

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes (choose all that apply): Strict intake and output to avoid congestive heart failure. b. Administration of antibiotics. c. Cluster care to conserve energy. d. Round-the-clock administration of antitussive agents.

B&C Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Round-the-clock antitussive agents and strict intake and output are not included in the care of the child with pneumonia.

Which assessment finding after tonsillectomy should be reported to the physician? a. Pain at surgical site b. Pain on swallowing c. Vomiting bright red blood d. The ability to only take small sips of liquids

C

Which of the following questions would be most important for the nurse to ask the parents of a child admitted to the hospital with a diagnosis of reactive airway disease? a. "What brings you to the hospital today?" b. "What is your cultural background?" c. "Do you have a history of asthma or allergies in your family?" d. "Was your pregnancy uneventful?"

C

When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of a. Neurotoxicity b. Lower respiratory tract infections c. Asthma d. Nephrosis

C Atopy is correlated with asthma. So often children with asthma have atopic skin disorders such as eczema

A possible cause of acquired aplastic anemia in children is a. Congenital defect. b. Deficient diet. c. Drugs. d. Injury.

C Drugs such as chemotherapeutic agents and several antibiotics such as chloramphenicol can cause aplastic anemia. Fanconi syndrome is a primary form of the disorder, which is congenital/present-at-birth and not acquired after birth. Deficient diet and congenital defect are not causative agents in acquired aplastic anemia.

An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is: a. Disseminated intravascular coagulation. b. Thalassemia major. c. Idiopathic thrombocytopenic purpura. d. Aplastic anemia.

C Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and a normal bone marrow. Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse's response should be based on knowing that: a. Scratching the lesions will not cause a problem. b. Poison ivy does not itch and needs further investigation. c. Scratching the lesions may cause them to become secondarily infected. d. Scratching the lesions will cause the poison ivy to spread.

C Poison ivy is a contact dermatitis that results from exposure to the oil urushiol in the plant. Every effort is made to prevent the child from scratching because the lesions can become secondarily infected. The poison ivy produces localized, streaked or spotty, oozing, and painful impetiginous lesions. Itching is a common response. The lesions do not spread by contact with the blister serum or by scratching.

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Fluid overload b. Weight gain c. Poor wound healing d. Moist skin

C Recurrent urinary tract and vaginal infections, especially with Candida albicans, are often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.

The family of a 4-month-old infant will be vacationing at the beach. The best recommendation for preventing sunburn is to: a. Use sun block on the infant's nose and ear tips. b. Use a topical sunscreen product with a sun protective factor of 15. c. Keep the infant in total shade at all times. d. The infant can be exposed to the sun for 15-minute increments.

C The infant should be kept out of the sun or physically shaded from it. Fabric with a tight weave such as cotton, offers good protection. Infants should be covered with clothing or kept in the shade to prevent sun damage to the delicate skin at all times. The blocker can protect the nose and ear tips, but none of the infant"s skin should be exposed. Sunscreens should not be used extensively on infants younger than 6 months.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to: a. Encourage drinking large amounts of favorite fluids. b. Administer an antiemetic as soon as child has nausea. c. Administer an antiemetic before chemotherapy begins. d. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside.

C The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Encouraging the child to remain NPO will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic after the child has nausea does not avoid anticipatory nausea.

A nurse is caring for a child who has bonchiolitis. Which of the following actions should the nurse take? (select all that apply) a. Initiate chest percussion and postural drainage b. Administer oral penicillin c. Suction the nasopharynx as needed d. Administer oral predisone e. Administer humidified oxygen

C & E Corticosteroids are not recommended in the treatment of bronchiolitis - the nurse should question this order. This is a viral disease. Antibiotics are not used in the treatment of bronchiolitis - the nurse should question this order. Humidified oxygen is recommended in the treatment of bronchiolitis - it is an appropriate action for the nurse to take Suctioning the nasopharynx is an appropriate nursing action for a patient with bronchioltis. It will assist the patient in clearing secretions.

In the child who is suspected of having epiglottis the nurse should a. prepare to immunize the child for Haemophilus influenzae b. obtain a throat culture c. visually inspect the child's oropharynx with a tongue blade d. have intubation equipment readily available

D

What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease? a. Soft tissue swelling b. Soft to hard, nontender mass in pelvic area c. Protuberant, firm abdomen d. Enlarged, painless, firm cervical lymph nodes

D

Which of the foods listed is the most appropriate to offer FIRST to an alert child who is in the postoperative period following a tonsillectomy: a. strawberry ice cream b. red cherry-flavored gelatin c. cold diluted orange juice d. an apple-flavored popcicle

D

Chelation therapy is begun on a child with b-thalassemia major. The purpose of this therapy is to: a. Decrease the risk of hypoxia. b. Manage nausea and vomiting. c. Treat the disease. Correctd. Eliminate excess iron.

D A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine (an iron-chelating agent) is given with oral supplements of vitamin C to increase iron excretion. Chelation therapy treats the side effects of disease management. Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

An important nursing consideration when caring for a child with impetigo contagiosa is to: a. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. b. Examine child under a Wood lamp for possible spread of lesions. c. Apply topical corticosteroids to decrease inflammation. d. Carefully wash hands and maintain cleanliness when caring for an infected child.

D A major nursing consideration related to bacterial skin infections such as impetigo contagiosa is to prevent the spread of the infection and complications. This is done by thorough handwashing before and after contact with the affected child. Corticosteroids are not indicated in bacterial infections. Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states such as tinea capitis.

The nurse is providing dietary education to parents of a 3 year old child with cystic fibrosis (CF). The nurse includes which nutritional information? a. Avoid most fruits and vegetables since they are not well tolerated. b. You can allow your child to eat their favorite foods, management of CF does not require a specific diet c. Your child's diet should be low in protein, carbohydrates and fats. d. Your child's diet should be high in quality carbohydrates and protein.

D Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would he or she expect to observe? a. Nausea and vomiting b. Oliguria c. Glycosuria d. Polyuria and polydipsia

D Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone secretion.

Which statement best describes b-thalassemia major? a. The condition is usually not discovered until early in adolescence. b. Inadequate numbers of red blood cells are present. c. All formed elements of the blood are depressed. d. Symptoms include pallor, failure to thrive and severe anemia (hgb < 6).

D Individuals with Cooley's anemia are usually diagnosed when they are infants or toddlers. Their symptoms include pallor, failure to thrive and severe anemia (hgb < 6). An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable.

Manifestations of hypoglycemia include: a. Nausea and vomiting. b. Lethargy. c. Thirst. d. Shaky feeling and dizziness

D Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia.

A school-age child is admitted in vasoocclusive sickle cell crisis. The child's care should include: a. Correction of acidosis. b. Pain management and administration of heparin. c. Adequate oxygenation and replacement of factor VIII. d. Adequate hydration and pain management.

D The management of crises includes adequate hydration, minimizing energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII are not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.

A hospitalized child with insulin dependent diabetes mellitus suddenly becomes unresponsive and unconscious, and suffers from seizures. Which medication should the nurse administer immediately? a. Glucocorticoids b. Insulin c. Steroids d. Glucagon

D The nurse should immediately administer glucagon to the child to prevent the condition from getting worse. Insulin is not used in an emergency medication. Glucocorticoids are administered to a child with congenital adrenal hyperplasia. Steroids are administered to a child with panhypopituitarism.

Which of these is NOT an appropriate goal in the management of atopy? (select one) a. prevent secondary infections b. provide relief from pruritis c. skin hydration d. reduce inflammation e. avoid live virus vaccines

E Live virus vaccines have nothing to do with atopic skin disease. With atopic conditions such as ezcema, it is important to: keep the skin hydrated, control itching through topical and oral medications, reduce inflammation with steroid creams and prevent secondary infections by keeping nails short and controlling for itching.

The nurse is providing medication teaching to an adolescent with a new onset diagnosis of asthma. Which of the following medications should the nurse instruct the patient to use as needed prior to basketball practice. a. Inhaled albuterol b. Inhaled fluticasone/salmeterol c. Predinsone d. Montelukast

Inhaled albuterol is a bronchodilator. This is an appropriate medication to use prior to exercise to prevent bronchoconstriction and wheezing. Inhaled corticosteroids (fluticosone) is a controller medication and should not be used for rescue or pre-excercise. Montelukast is an immune modulator and best used to control allergic responses and wheezing Prednisone is a anti-inflammatory medication used to treat acute exacerbations of asthma