PEDS EXAM 3 QUESTIONS
Which comment should the parent of a 21⁄2-year-old expect from the toddler about a new baby brother? 1. "When the baby takes a nap, will you play with me?" 2. "Can I play with the baby?" 3. "The baby is so cute. I love him." 4. "It is time to put him away so we can play."
ANS: 4
A pediatric client with Chronic Nephrotic Syndrome is admitted to the hospital with a diagnosis of chronic kidney failure. For which signs of what electrolyte imbalance should the nurse monitor the client? 1 Hypokalemia 2 Hypocalcemia 3 Hypernatremia 4 Hyperglycemia
ANS: 2 Hypocalcemia, decreased calcium in the blood, occurs because of the reciprocal relationship with phosphorus, which is increased by the decreased glomerular filtration rate.
After surgery to correct pyloric stenosis, the nurse instructs the parents about the postoperative feeding schedule for their infant. The parents exhibit understanding of these instructions when they state that they can start feeding the child within which of the following time frames? 1. 6 hours. 2. 8 hours. 3. 10 hours. 4. 12 hours.
ANS: 1 Clear liquids containing glucose and electrolytes are usually prescribed 4 to 6 hours after surgery. If vomiting does not occur, formula or breast milk then can be gradually substituted for clear liquids until the infant is taking normal feedings.
A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous lineis inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which would the nurse expect to do immediately? 1. Administer a bolus of normal saline. 2. Administer a bolus of D10W. 3. Administer a bolus of normal saline with 5% dextrose added to the solution. 4. Offer the child an oral rehydrating solution such as Pedialyte.
ANS: 1 Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution.
When taking a diet history from the mother of a 7-year-old child with phenylketonuria, a report of an intake of which of the following foods should cause the nurse to gather additional information? 1. Cola. 2. Carrots. 3. Orange juice. 4. Bananas.
ANS: 1 Foods with low phenylalanine levels include vegetables, fruits, and juices. Foods high in phenylalanine include meats and dairy products, which must be restricted or eliminated. Colas contain more phenylalanine than the fruits listed.
The nurse is reviewing the health care provider's prescriptions for a child hospitalized with nephrotic syndrome. Which food should the nurse tell the unlicensed assistive personnel to remove from the child's food tray? 1.Pickle 2.Wheat toast 3.Baked chicken 4.Steamed vegetables
ANS: 1 Rationale: A no-added-salt diet is indicated. High-sodium foods such as pickles, chips, and cured meats should be avoided. The items in the remaining options can be consumed.
Which statement by the mother would lead the nurse to suspect sexual abuse in a 4-year-old? 1. "She has just started masturbating." 2. "She has lots more temper tantrums." 3. "She now has an invisible friend." 4. "She wants to spend time with her sister."
ANS: 2 Increased temper tantrums, increased sleep disorders, and depression may indicate sexual abuse.
The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1.Watery diarrhea 2.Ribbon-like stools 3.Profuse projectile vomiting 4.Bright red blood and mucus in the stools
ANS: 4 Rationale: Intussusception is a telescoping of 1 portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. A child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but is not projectile. Bright red blood and mucus are passed through the rectum and commonly are described as currant jelly-like stools. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.
An infant who was born yesterday is scheduled for surgery tomorrow. Which of the following interventions in the preoperative period will be the most helpful in assessing postoperative pain in this neonate? a. Assess neonate's behavior. b. Assess neonate's response after inducing pain. c. Interview mother about neonate's behavior. d. Ask mother what measures comfort neonate.
ANS: A
A nurse has completed a teaching session for parents about baby-proofing the home. Which statements made by the parents indicate an understanding of the teaching? Select all that apply. a. We will put plastic fillers in all electrical plugs. b. We will place poisonous substances in a high cupboard. c. We will place a gate at the top and bottom of stairways. d. We will keep our household hot water heater at 130 degrees. e. We will remove front knobs from the stove.
ANS: A, C, E By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs form the stove can prevent burns. Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less.
The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include which of the following? a. Arm restraints, postural drainage, mouth irrigations b. Cleansing suture line, supine and side-lying position, arm restraints c. Mouth irrigations, prone position, cleansing suture line d. Supine and side-lying positions, postural drainage, arm restraints
ANS: B
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which of the following? a. Protein b. Fruit juice c. Several glasses of water d. Complex carbohydrate and protein
ANS: D
A nurse is caring for a 12-month-old infant with a diagnosis of failure to thrive. The infant's weight is below the third percentile, and development is delayed. Which behaviors of the child suggest to the nurse the possibility of parental neglect? Select all that apply. 1 Stiff 2 Withdrawn 3 Easily satisfied 4 Minimal smiling 5 Responsive to touch 6 Little interest in the environment
ANS: 1, 2, 4, 6
Which statement is true of shaken baby syndrome? Select all that apply. 1. There may be absence of external signs of injury. 2. Multiple reports of the baby crying for long periods of time. 3. Shaken babies usually do not have retinal hemorrhage. 4. Shaken babies usually have signs of a subdural hematoma. 5. Shaken babies have signs of external head injury.
ANS: 1, 3, 4
A nurse is assessing a male newborn. Which characteristics should alert the nurse to conclude that the newborn is a preterm infant? Select all that apply. 1 Wrinkled, thin skin 2 Multiple sole creases 3 Small breast bud size 4 Presence of scrotal rugae 5 Pinna remaining flat when folded
ANS: 1, 3, 5
A newborn nursery nurse notes that a 36-hour-old baby's body is jaundiced. Which of the following nursing interventions will be most therapeutic? 1. Maintain a warm ambient environment. 2. Have the mother feed the baby frequently. 3. Have the mother hold the baby skin to skin. 4. Place the baby naked by a closed sunlit window.
ANS: 2
A client at 16 weeks' gestation calls the nurse at the prenatal clinic and states that her partner just told her he has genital herpes. What should the nurse include when teaching the client about sexual activity? 1 Condoms must be used when having intercourse. 2 Sexual abstinence should be practiced during the last six weeks. 3 It will be necessary to refrain from sexual contact during pregnancy. 4 Meticulous cleaning of the vaginal area after intercourse is essential.
ANS: 2 Abstinence 4 to 6 weeks before term is the best way to avoid contracting the virus and having an outbreak before the birth.
The nurse notes that an infant stares at an object placed in his/her hand and takes it to his/her mouth, coos and gurgles when talked to, and sustains part of his/her own weight when held in a standing position. The nurse correctly interprets these findings as characteristic of an infant at which of the following ages? 1. 2 months. 2. 4 months. 3. 7 months. 4. 9 months.
ANS: 2 Holding the head erect when sitting, staring at an object placed in the hand, taking the object to the mouth, cooing and gurgling, and sustaining part of her body weight when in a standing position are behaviors characteristic of a 4-month-old infant. A 2-month-old typically vocalizes, follows objects to the midline, and smiles. A 7-month-old typically is able to sit without support, turns toward the voice, and transfers objects from hand to hand. Usually, a 9-month-old can crawl, stand while holding on, and initiate speech sounds.
The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What should the nurse expect to note as the most likely finding in this infant? 1.Metabolic acidosis 2.Metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis
ANS: 2 Rationale: Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis as a result of the vomiting that occurs in this disorder. Additional findings include decreased serum potassium and sodium levels, increased pH and bicarbonate levels, and decreased chloride level. The remaining options are incorrect.
Which should the nurse teach the parents is one of the most common causes of injury and death for a 9-month-old infant? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.
ANS: 3
When developing the discharge plan for a school-age child diagnosed with acute poststreptococcal glomerulonephritis, which instruction should the nurse plan to discuss? 1. Restricting dietary protein. 2. Monitoring pulse rate and rhythm. 3. Preventing respiratory infections. 4. Restricting foods high in potassium.
ANS: 3 Children recovering from glomerulonephritis need to avoid exposure to all types of infections. Glomerulonephritis is caused by group A beta-hemolytic streptococcus, a common cause of sore throat. As the child recovers, he or she may be susceptible to a recurrence if exposed to the organism again. During convalescence from glomerulonephritis, fluid and dietary restrictions are no longer indicated because the kidneys are now functioning normally. There is no need for the parents to assess the child's vital signs.
An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse's best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize sexual functioning when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."
ANS: 3 Releasing the chordee surgically is necessary for future sexual function.
A 1-year-old child is diagnosed with intussusception, and the mother of the child asks the student nurse to describe the disorder. Which statement by the student nurse indicates correct understanding of this disorder? 1."It is an acute bowel obstruction." 2."It is a condition that causes an acute inflammatory process in the bowel." 3."It is a condition in which a distal segment of the bowel prolapses into a proximal segment of the bowel." 4."It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."
ANS: 4 Rationale: Intussusception occurs when a proximal segment of the bowel prolapses into a distal segment of the bowel. It is not an acute bowel obstruction, but it is a common cause of bowel obstruction in infants and young children. It is not an inflammatory process.
After hydrostatic reduction for intussusception, the nurse should expect to observe which client response? 1.Abdominal distension 2.Currant jelly-like stools 3.Severe colicky-type pain with vomiting 4.Passage of barium or water-soluble contrast with stools
ANS: 4 Rationale:Intussusception is the telescoping of one portion of the bowel into another. Hydrostatic reduction may be necessary to resolve the condition. After hydrostatic reduction, the nurse observes for the passage of barium or water-soluble contrast material with stools. Abdominal distension and currant jelly-like stools are clinical indicators of intussusception. Colicky pain and vomiting are signs of an unresolved gastrointestinal disorder
Which prescribed formula should the nurse plan to provide for an infant with lactose intolerance? a. Isomil b. Enfamil c. Similac d. Good Start
ANS: A
In acute glomerulonephritis, the nurse is aware that an early warning sign of encephalopathy is which of the following? a. Psychosis b. Dizziness c. Seizures d. Transient loss of vision
ANS: B
On the second postoperative day after repair of a cleft palate, which of the following should the nurse use to feed a toddler? 1. Cup. 2. Straw. 3. Rubber-tipped syringe. 4. Large-holed nipple.
ANS: 1 A cup is the preferred drinking or eating utensil after repair of a cleft palate. At the age when repair is done, the child is ordinarily able to drink from a cup. Use of a cup avoids having to place a utensil in the mouth, which would increase the potential for injury to the suture lines.
The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis? 1. "The baby is a very fussy eater and just does not want to eat." 2. "The baby tends to have a very forceful vomiting episode about 30 minutes after most feedings." 3. "The baby is always hungry after vomiting, so I feed her again." 4. "The baby is happy in spite of getting really upset after spitting up."
ANS: 3 Infants with pyloric stenosis are always hungry and often appear malnourished.
What gross motor skills should the nurse expect a developmentally appropriate 3-year-old child to perform? Select all that apply. 1 Skipping on alternate feet 2 Riding alone on a small bicycle 3 Standing on one foot for a few seconds 4 Alternating the feet when walking up stairs 5 Jumping rope by lifting both feet simultaneously
ANS: 3, 4
Which of the following measures would be most effective in helping the infant with a cleft lip and palate to retain oral feedings? 1. Burp the infant at frequent intervals. 2. Feed the infant small amounts at one time. 3. Place the end of the nipple far to the back of the infant's tongue. 4. Maintain the infant in a lying position while feeding.
ANS: 1 An infant with a cleft lip and palate typically swallows large amounts of air while being fed and therefore should be burped frequently. The soft palate defect allows air to be drawn into the pharynx with each swallow of formula. The stomach becomes distended with air, and regurgitation, possibly with aspiration, is likely if the infant is not burped frequently. Feeding frequently, even in small amounts, would not prevent swallowing of large amounts of air. A nipple placed in the back of the mouth is likely to cause the infant to gag and aspirate. Holding the infant in a lying position during feedings can also lead to regurgitation and aspiration of formula. The infant should be fed in an upright position.
An infant is to be discharged after surgery for intussusception. In developing the discharge teaching plan, the nurse should tell the mother: 1. The infant will experience a change in the normal home routine. 2. The infant can return to the prehospital routine immediately. 3. The infant needs to ingest more calories at home than what was consumed in the hospital. 4. The infant will continue to experience abdominal cramping for a few days.
ANS: 1 Infants who have had an interruption in their normal routine and experiences, such as hospitalization and surgery, typically manifest behavior changes when discharged. The infant's normal routine has been significantly altered, so it will take time to reestablish another routine. Calorie requirements at home will continue to be the same as those in the hospital. The infant does not need more calories at home. The surgical procedure corrected the problems, so the infant should not continue to have abdominal cramping.
When developing the plan of care for a child diagnosed with phenylketonuria (PKU), the nurse should establish which of the following goals? 1. Meeting the child's nutritional needs for optimal growth. 2. Ensuring that the special diet is started at age 3 weeks. 3. Maintaining serum phenylalanine level higher than 12 mg/100 mL (720 μmol/L). 4. Maintaining serum phenylalanine level lower than 2 mg/100 mL (120 μmol/L).
ANS: 1 The goal of care is to prevent mental retardation by adjusting the diet to meet the infant's nutritional needs for optimal growth. The diet needs to be started upon diagnosed, ideally within a few days of birth. Serum phenylalanine level should be maintained between 3 and 7 mg/100 mL (180 to 420 μmol/L). Significant brain damage usually occurs if the level exceeds 10 to 15 mg/100 mL (600 to 900 μmol/L). If the level drops below 2 mg/100 mL (120 μmol/L), the body begins to catabolize its protein stores, causing growth retardation.
Which of the following would be the best activity for the nurse to include in the plan of care for an infant experiencing severe diarrhea? 1. Monitoring the total 8-hour formula intake. 2. Weighing the infant each day. 3. Checking the anterior fontanel every shift. 4. Monitoring abdominal skin turgor every shift.
ANS: 2 Because an infant experiencing severe diarrhea is at high risk for a fluid volume deficiency, the nurse needs to evaluate the infant's fluid balance status by weighing the infant at least every day. Body weight is the best indicator of hydration status because a higher proportion of an infant's body weight is water, compared with an adult. Initially, the infant with severe diarrhea is not allowed liquids but is given fluids intravenously. Therefore, monitoring the oral intake of formula is inappropriate. Although checking the anterior fontanel for depression or bulging provides information about hydration status, this method is not considered the best indicator of the infant's fluid balance. Monitoring skin turgor can provide information about fluid volume status. The abdomen is commonly used to assess skin turgor in an infant because it is a large surface area and can be accessed quickly. However, weight is the best indicator of fluid balance.
The mother of an 18-month-old child tells the clinic nurse that the child has been having some mild diarrhea and describes the child's stools as "mushy." The mother tells the nurse that the child is tolerating fluids and solid foods. The most appropriate suggestion regarding the child's diet would be to give the child which items? 1.Applesauce, bananas, wheat toast 2.Mashed potatoes with baked chicken 3.Gelatin, strained cabbage, and custard 4.Fluids only until the "mushy" stools stop
ANS: 2 Rationale: The continued feeding of a normal diet can prevent dehydration, reduce stool frequency and volume, and hasten recovery. Common foods that are especially well tolerated during diarrhea are bland but nutritional foods, including complex carbohydrates (rice, wheat, potatoes, cereals), yogurt containing live cultures, cooked vegetables, and lean meats. The foods in options 1 and 3 may worsen the diarrhea. Fluids only will affect nutritional status.
After performing an assessment of an infant with bladder extrophy, the nurse prepares a plan of care. The nurse identifies which problem as the priority for the infant? 1.Urinary incontinence 2.Impaired tissue integrity 3.Inability to suck and swallow 4.Lack of knowledge about the disease (parents)
ANS: 2 Rationale:In bladder extrophy, the bladder is exposed and external to the body. The highest priority is impaired tissue integrity related to the exposed bladder mucosa. Although the infant needs to be monitored for elimination patterns and kidney function, urinary incontinence is not a concern for this condition, as the infant is not yet toilet trained. Inability to suck and swallow is unrelated to the disorder. Lack of knowledge about the diagnosis and treatment of the condition will need to be addressed but again is not the priority.
A nurse observes that an infant has head control and can roll over but can neither sit up without support nor transfer an object from one hand to the other. What developmental age should the nurse estimate based on these observations? 1 1 to 2 months 2 3 to 4 months 3 5 to 6 months 4 8 to 9 months
ANS: 3
A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine if this child is experiencing a long-term effect of cleft palate, which question should the nurse ask? 1. "Was the child recently treated for pneumonia?" 2. "Does the child play with an imaginary friend?" 3. "Is the child unresponsive when given directions?" 4. "Has the child had any difficulty swallowing food?"
ANS: 3 Rationale: Unresponsiveness may be an indication of hearing loss. A child who has a history of cleft palate should be routinely checked for hearing loss. Pneumonia and dysphagia are unrelated to cleft palate after repair. Having an imaginary friend is normal behavior for a preschool child. Many preschoolers with vivid imaginations have imaginary friends.
A nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. When should the nurse explain that insulin needs will decrease? 1 Puberty is reached. 2 Infection is present. 3 Emotional stress occurs. 4 Active exercise is performed.
ANS: 4 Exercise reduces the body's need for insulin. Increased muscle activity accelerates transport of glucose into muscle cells, thus producing an insulin-like effect.
Using Piaget's theory of cognitive development, what should the nurse expect a 6- month-old infant to demonstrate? 1 Early traces of memory 2 Beginning sense of time 3 Repetitious reflex responses 4 Beginning of object permanence
ANS: 4 1, 2 - This occurs between 13 and 24 months. 3 - This occurs during the first several months of life. These diminish as the newborn grows.
Immediately after the first oral feeding after corrective surgery for pyloric stenosis, a 4- week-old infant is fussy and restless. Which of the following actions would be most appropriate at this time? 1. Encourage the parents to hold the infant. 2. Hang a mobile over the infant's crib. 3. Give the infant more to eat. 4. Give the infant a pacifier to suck on.
ANS: 4 Giving the infant a pacifier would help meet nonnutritive sucking needs and ensure oral gratification. Additionally, sucking aids in calming the infant. Holding the infant to decrease fussiness and restlessness is more effective in an older infant. Also, the reason for the infant's fussiness needs to be explored. Hanging a mobile over the crib frequently does not decrease fussiness. After surgery to correct pyloric stenosis, feeding the infant more formula would lead to vomiting, putting additional stress on the operative site.
The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about casts in the urine. The nurses response is based on the knowledge that the presence of casts in the urine indicates: a. glomerular injury. b. glomerular healing. c. recent streptococcal infection. d. excessive amounts of protein in the urine.
ANS: A The presence of red blood cell casts in the urine indicates glomerular injury. Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. A urinalysis positive for casts does not confirm a recent streptococcal infection. Casts in the urine are unrelated to proteinuria.
A mother has just given birth to an infant with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" The most appropriate nursing action is: a. Encourage mother to express her feelings. b. Explain in simple language that the baby has a cleft lip. c. Provide emotional support until practitioner can talk to mother. d. Tell mother a pediatrician will talk to her as soon as the baby is examined.
ANS: B
The nurse provides anticipatory guidance to parents of a 3-year-old child. Instructions should include: a. To restrain the child in the car seat facing rear in the back seat of the car. b. The use of syrup of ipecac for accidental poisonings. c. Drug and alcohol education. d. The proper use of sports equipment.
ANS: B - The use of syrup of ipecac for accidental poisonings. Rationale: Nurses are instrumental in teaching parents how to make the toddler's environment safe by providing instructions about keeping syrup of ipecac available, having the Poison Control Center number close to the phone, using child-resistant containers and cupboard safety closures, and keeping medicines and other poisonous materials locked away. Infants are to be restrained in rear-facing car seat, school-age children should be taught the proper use of sports equipment, and adolescents should be provided education regarding drug and alcohol abuse.