peds exam 2

A nurse is providing teaching to an adolescent who has type 1 diabetes. Which of the following should the nurse include? a. administer glucagon for hyperglycemia b. obtain an influenza vaccine yearly c. inject insulin in the deltoid muscle d. take glyburide with breakfast

Answer: B Glyburide is contraindicated for clients who have type 1 diabetes mellitus.

A nurse is caring for a child who has Kawaski disease. Which of the following systems should the nurse monitor in response to this diagnosis? a. cardiovascular b. GI c. integumentary d. respiratory

answer: A

A nurse is providing teaching about self-administration of insulin to the parent of a school-age child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parents indicates a need for further teaching a. "I will be sure my child aspirates before injecting insulin" b. "the insulin can be injected anywhere where there is adipose tissue" c. "I will be sure by child rotates sites after 5 injections in one area" d. "the insulin should be injected at a 90 degree angle"

answer: A

A nurse is assessing a school age child whose blood glucose is 280. which of the following findings should be expected? a. lethargy b. pallor c. tremor d. shallow respirations

answer: A A blood glucose of 280 mg/dL is above the expected reference range indicating hyperglycemia. The nurse should expect the child to appear lethargic, leading to a decreased level of consciousness and confusion.

A nurse is caring for an infant who has a congenital heart defect. Which of the following is associated with increased pulmonary blood flow? a. coarctation of the aorta b. patent ductus arteriosus c. tetralogy of fallot d. tricuspid atresia

answer: B

A nurse is caring for a group of adolescents. Which of the following findings should be reported to the provider immediately? a. a client who is 1 day post-op and has a temperature of 99.5 b. a client who has a burn injury to an estimated 5% of his leg and is crying c. a client who's BP changes from 112/60 to 90/54 when standing d. client who has an ankle fracture reports pain level increase from 3 to 5 after ambulation

answer: C Vital sign ranges for adolescents are similar to those for adults. A drop in the systolic blood pressure of more than 20 mm Hg or a drop in the diastolic of more than 10 mm Hg after standing is considered to be orthostatic hypotension. One of the most common causes of orthostatic hypotension is hypovolemia. The client likely will feel lightheaded and dizzy. This finding should be reported to the provider.

A nurse is assessing a 3 year old child at a routine wellness checkup. Which of the following findings should be expected? a. skips and hops on one foot b. has a vocab of 1500 words c. walks backwards heel to toe d. stands on one foot for a few seconds

answer: D

A nurse is caring for a 7 year old child who has an upper respiratory infection and type 1 diabetes. Which of the following statements by the mother indicates a need for further teaching a. "I will encourage her to drink a half cup of water or sugar free fluids every 30 minutes" b. "I will report a change in her breathing or signs of confusion" c. "I will notify the doctor if her temperature is not controlled with acetaminophen" d. "I will continue to check his blood sugar 2 times per day:

answer: D A client who has type 1 diabetes mellitus and is ill is at risk of developing DKA. DKA results in the breakdown of body fat for energy and the presence of ketones in the blood and urine. Because acute illness increases glucose levels, the child's glucose levels and the urine ketones should be checked every 3 hr. Checking the child's blood glucose two times per day is not enough to adequately monitor glucose levels.

Alaric was diagnosed with minimal-change nephrotic syndrome; which of the following signs and symptoms are characteristics of the said disorder? a. HTN, edema, hematuria b. HTN, edema, proteinuria c. gross hematuria, fever, proteinuria d. poor appetite, edema, proteinuria

answer: D D: Clinical manifestations of nephrotic syndrome include loss of appetite due to edema of intestinal mucosa, proteinuria, and edema. A,B: Hypertension alone or accompanied by hematuria is associated with glomerulonephritis. C: Gross hematuria is not associated with nephrotic syndrome. Fever will occur only if infection also existed.

A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart from the identified symptoms of the disease, she may also likely develop which of the following? a. sepsis b. meningitis c. mitral valve disease d. aneurysm formation

answer: D Kawasaki disease is a rare childhood illness that affects the blood vessels. 20% to 25% of children can develop aneurysm formation if not intervened. Treatment depends on the degree of the disease, but is often immediate treatment with IV gamma globulin or aspirin. Corticosteroids can sometimes lessen impending complications. Children who experience the disease usually need lifelong follow-up appointments to keep an eye on heart health.

A nurse is obtaining a health history from a child who has suspected acute rheumatic fever. Which of the following questions should the nurse ask? a."has your son had a sore throat recently?" b. "was your son born with this cardiac defect?" c. "has your child had any injuries recently?" d. "have you given your child aspirin in the last 2 weeks?"

answer: A Rheumatic fever typically develops 2 to 6 weeks after an untreated or ineffectively treated streptococcal infection of the respiratory tract. It is appropriate to determine whether the child previously had a sore throat.

A nurse is assessing an adolescent who experienced blunt trauma to the abdomen. Which of the following findings is a priority? a. BP 92/50 mmHg b. HR 72 c. abdominal pain rates as 4/10 d. RR 20/min

answer: A The expected reference range for blood pressure in an adolescent is 110/65 to 120/80 mm Hg. A blood pressure 92/50 mm Hg indicates the adolescent is hypotensive and unstable. Therefore, this finding is the priority. Blunt abdominal trauma can cause internal hemorrhage that leads to hypotension.

A nurse is caring for an 8 year old child who has acute rheumatic fever. Which of the following assessments is the nurse's priority immediately after admission. a. auscultating the rate and characteristic of heart sounds b. using a pain rating tool to determine the severity of the joint pain c. identifying the degree of parental anxiety to the diagnosis d. assessing the client's erythematous rash

answer: A Using the airway, breathing, circulation approach to client care, the nurse should place priority on auscultating the client's heart rate and heart sounds. Rheumatic fever is an inflammatory disease that begins with a strep throat from a streptococcal infection and can progress to rheumatic heart disease, which is a condition in which the heart valves are damaged by rheumatic fever. Auscultating heart sounds is the priority assessment because tachycardia and cardiac murmur indicate cardiac involvement, which can result in serious, life-threatening, and life-long complications.

Mr. and Mrs. Baker's only daughter is diagnosed with heart failure. Which of the following interventions would be appropriate to promote optimal nutrition for the infant? a. replacing regular nipples with easy to suck ones b. allowing infant to feed for at least 1 hour c. providing large feeding evenly spaced every 4 hours d. offering formula that is high sodium and calories

answer: A The nurse should replace regular nipples with easy-to-suck-ones because the infant may tire instantly with regular nipples and thus would not be able to suck sufficiently.

A new nurse is assessing a 3 year old child who has aortic stenosis. Which of the following findings should the nurse expect? a. hypotension b. bradycardia c. clubbing of the nail beds d. weak pulses e. murmur

answer: A, D, E Hypotension with aortic stenosis is a result of decreased cardiac output. Weak pulses with aortic stenosis are a result of decreased cardiac output. Murmur is correct. A narrowing of the aortic valve cause a characteristic murmur in children who have aortic stenosis. A narrowing of the aortic valve cause a characteristic murmur in children who have aortic stenosis.

A nurse is preparing to measure an infant's vital signs. The nurse should use which of the following sites to assess a heart rate? a. carotid artery b.. apex of heart c. brachial artery d. radial artery

answer: B

A nurse is providing discharge teaching to the parents of a child who has a new diagnosis of diabetes. Which of the following statements by the parents indicates and understanding of the teaching? a. "the onset of low blood glucose usually occurs slowly" b. "my son may complain of feeling shaky when he has low blood glucose" c. "sweating can occur with hyperglycemia" d. "my son might have nausea and vomiting with hypoglycemia"

answer: B

Bryce is a child diagnosed with coarctation of aorta. While assessing him, Nurse Zach would expect to find which of the following? a. squatting posture b. absent or diminished femoral pulses c. severe cyanosis at birth d. cyanotic tet episodes

answer: B B: Absent or diminished femoral pulse is a classic characteristic of coarctation of aorta. C: Severe cyanosis at birth is seen in such defects as transposition of the great vessels. A,D: Tet episodes and squatting are characteristic of tetralogy of Fallot.

A nurse if providing teaching to a school-age child who has a new diagnosis of type 1 diabetes. Which of the following statements by the child indicates an understanding of the teaching? a. "my morning blood glucose should be between 90 and 130" b. "I should eat a snack half an hour before playing soccer" c. "I should not take my regular insulin when I am sick." d. "I can store unopened bottles of insulin in the freezer".

answer: B Exercise lowers blood glucose levels. The child should eat a snack half an hour prior to physical activity. If the exercise is prolonged, the child might require a snack during the activity. Insulin should be stored at room temperature or in a refrigerator. Freezing insulin causes it to become inactive.

A nurse is providing discharge teaching instructions to the parent of a 10 year old child following cardiac catheterization. Which of the following should be included? a. keep the child home for one week b. give the child acetaminophen for discomfort c. offer the child clear liquids for the first 24 hours d. assist the child to take a tub bath for the first 3 days

answer: B The child might have minor discomfort at the puncture site. The parent should offer either acetaminophen or ibuprofen due the risk of Reye syndrome associated with taking aspirin.

A nurse is obtaining vital signs from a 2 month old. The HR is 190/minute and temperature is 104. The father asks the nurse why the infant's heart is beating so fast. Which of the following responses is most appropriate. a. this is within the expected range for your baby b. the fever is causing an increase in the heart rate c. as your baby begins to fall asleep, the HR will decrease d. your baby's heart is beating fast in an attempt to cool down his body.

answer: B The expected reference range for the temperature of an infant from birth to 1 year is 36.5° C (97.7° F) to 37.2° C (98.9° F). This infant has a fever that is causing the infant's heart rate to increase. The expected reference range for heart rate in a 2 month-old infant is 121 to 179/min.

A school nurse is assessing an adolescent who reports feeling shaky and is having difficulty speaking and concentrating on the questions the nurse is asking. The nurse checks the blood glucose and it is 55. Which of the findings should the nurse expect? a. dry, flushed skin b. deep, rapid respirations c. tachycardia d. polyuria

answer: C

A nurse is teaching a school-age child who has type 1 diabetes mellitus and his parents about illness management. Which of the following instructions should the nurse include? a. withhold insulin dose if feeling nauseous b. notify the provider if blood glucose levels are over 350 c. test the urine for ketones d. limit fluid intake during meal time

answer: C The parent or child should test the urine for ketones and report the presence of them in the urine. Ketonuria can indicate that the child does not have enough glucose for energy and is breaking down fats to provide glucose to cells. The nurse should instruct the school-age child and his parent to notify the provider if his blood glucose levels are greater than 250 mg/dL in order to initiate treatment before injury can occur.