Peds Final
-A nurse is caring for a 6-year-old child who is to receive 60mg of phenytoin (Dilantin) over 15 minutes for treatment of seizures. The medication will be given with a syringe pump. The concentration of phenytoin (Dilantin) is 60mg in 100mls of normal saline. How many milliliters per hour will you set the pump to infuse?
You need to give 100mls (60mg phenytoin) over 15 minutes. Multiply 100mls by 4 to yield the rate to infuse the mediation over 15 minutes. The correct answer is: 400
A nurse is caring for a 14-year-old adolescent with type 1 diabetes mellitus who asks the nurse, "Why do I need to have this hemoglobin A1c test?" What response by the nurse is the most appropriate? a. "It determines how balanced your diet has been." b. "It is a test that tells us if you are anemic." c. "It determines how controlled your blood sugar has been." d. "It determines if your blood ketone level is normal."
The correct answer is: "It determines how controlled your blood sugar has been." Hemoglobin A1c, or glycosylated hemoglobin, reflects average blood glucose levels over 2-3 months. Frequent high blood glucose levels would result in a higher hemoglobin A1c, suggesting that blood glucose needs to be in better control. Balanced diet is not determined by the hemoglobin A1c. Anemia would be determined by checking a CBC. Presence of ketones in the blood is not determined by the hemoglobin A1c.
The nurse is incorporating different types of play into the treatment plan of a 4-year-old child. Which of the following toys would best promote imaginative play in a 4-year-old child? a. Large blocks b. Dress-up clothes c. Wooden puzzle d. Tricycle
The correct answer is: Dress-up clothes. Dress-up clothes enhance imaginative play and imagination, allowing preschoolers to engage in rich fantasy play. Building blocks and wooden puzzles are appropriate for encouraging fine motor development. Tricycles encourage gross motor development.
A nurse is caring for a 6-month-old child who is being seen in the clinic for a well infant check-up. The infant's mother asks, "I want to go back to work but I don't want my baby to suffer because I have less time with her." The most appropriate answer by the nurse is: a. "Why do you want to go back to work?" b. "You will need to stay home until your baby gets old enough to go to school." c. "You should go back to work so your baby will get used to being with others." d. "Let's talk about child care options that will be best for you and your baby."
The correct answer is: "Let's talk about child care options that will be best for you and your baby." "Let's talk about the child care options that will be best for you and your baby" is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and her baby. "Why do you want to go back to work?", "You will need to stay home until your baby gets old enough to go to school", and "You should go back to work so your baby will get used to being with others" are directive statements and do not address the effect of her working on her baby.
Which statement made by the nurse would indicate a correct understanding of palliative care? a. "Palliative care serves to hasten death and make the process easier for the family." b. "Palliative care provides pain and symptoms management for the child." c. "The goal of palliative care is to place the child in a hospice setting at the end of life." d. "The goal of palliative care is to act as the liaison between the family, child, and other health care professionals."
The correct answer is: "Palliative care provides pain and symptoms management for the child." The primary goal of palliative care is to provide pain and symptom management, not to hasten death or place the child in a hospice setting. Palliative care is provided by a multidisciplinary team whose goal it is to provide active total care for patients whose disease is no longer responding to curative treatment.
A nurse is caring for a 10-year-old child who is newly diagnosed with type 1 diabetes mellitus. He is an avid soccer player and his parents are concerned about his continued participation in soccer. Which of the following is the nurse's best response? a. "Children with type 1 diabetes mellitus should not participate in contact sports." b. "It is okay to play sports such as soccer unless the weather is too hot." c. "The child will need an extra 15 to 30 g of carbohydrate snack before soccer practice." d. "The child should only play for 30 minutes to avoid hypoglycemia."
The correct answer is: "The child will need an extra 15 to 30 g of carbohydrate snack before soccer practice." Exercise lowers blood glucose levels. A snack with 15 to 30 g of carbohydrates before exercise will decrease the risk of hypoglycemia. Limiting the amount of time the child plays soccer is not necessary unless the child is experiencing hypoglycemia. Soccer is an appropriate sport for a child with type 1 diabetes as long as the child prevents hypoglycemia by eating a snack. Participation in contact sports is not contraindicated for a child with type 1 diabetes. The child with type 1 diabetes may participate in sports activities regardless of climate.
A nurse is performing a visual acuity exam on an infant. By what age should an infant be able to fix on and follow an object? a. 1 month b. 1 to 2 months c. 3 to 4 months d. 6 months
The correct answer is: 3 to 4 months. Visual fixation and following a target should be present by ages 3 to 4 months. Ages 1 to 2 months are too young for this developmental milestone. If the infant is not able to fix and follow by 6 months of age, further ophthalmologic evaluation is needed.
A nurse is caring for a 9-year-old child with type 1 diabetes mellitus who received 8 units of regular insulin at 8:30am. What time would the nurse most likely see signs and symptoms of hypoglycemia? a. 9:30am to 2:30pm b. 8:30am to 9:00am c. 2:30pm to 10:30pm d. 8:00pm to 10:00pm
The correct answer is: 9:30am to 2:30pm. Regular insulin is a short-acting insulin with onset of 30 minutes to 1 hour, peaks in 1-5 hours, and duration of 6-10 hours. The greatest risk of developing hypoglycemia occurs when insulin is peaking so in this case, the child is at highest risk of developing hypoglycemia between 9:30am and 2:30pm.
A nurse is working in an emergency department and is caring for several children with asthma. Which child should the nurse see first? a. A 12-month-old child who has a weak cry, is pale in color, has diminished breath sounds throughout with no wheezing, and an oxygen saturation of 93%. b. A 5-year-old child who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%. c. A 9-year-old child who is quiet, is pale in color, is wheezing bilaterally, and has an oxygen saturation of 92%. d. A 16-year-old child who is speaking in 3-4 word sentences, is wheezing bilaterally, sitting upright, and has an oxygen saturation of 93%.
The correct answer is: A 12-month-old child who has a weak cry, is pale in color, has diminished breath sounds throughout with no wheezing, and an oxygen saturation of 93%. This 12-month-old child who has a weak cry, is pale in color, has diminished breath sounds throughout with no wheezing, and an oxygen saturation of 93% is exhibiting signs of severe asthma. This child should be seen first. The child no longer has wheezes, is no longer moving air, and has diminished breath signs. The 5-year-old child who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93% is exhibiting symptoms of mild asthma and should not be seen before the other children. The 9-year-old child who is quiet, is pale in color, is wheezing bilaterally, and has an oxygen saturation of 92% is exhibiting signs of moderate asthma and should be watched but is not the patient with the highest priority. The 16-year-old child who is speaking in 3-4 word sentences, is wheezing bilaterally, sitting upright, and has an oxygen saturation of 93% is exhibiting signs of moderate asthma and is not the patient of highest priority.
A nurse is speaking to the mother of a 3-week-old infant who states that the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the mother perform first? a. Administer pain medication. b. Reposition the infant in the crib. c. Check the neurovascular status of the foot. d. Administer diphenhydramine (Benadryl) for itching.
The correct answer is: Check the neurovascular status of the foot. Checking the neurovascular status of the foot is the highest priority. The cause of the crying needs to be determined prior to administering pain medication. Although repositioning the infant in the crib is appropriate, it is not the first intervention. Administering diphenhydramine (Benadryl) for itching is not appropriate.
A nurse is caring for a 2-year-old child with a chronic illness and disabilities. Which intervention will encourage a sense of autonomy in this child? a. Avoiding separation from family during hospitalization. b. Encourage age-appropriate independence in as many areas as possible. c. Expose the child to pleasurable experiences as much as possible. d. Help the parents learn special care needs of the child.
The correct answer is: Encourage age-appropriate independence in as many areas as possible. Encouraging the toddler to be independent encourages a sense of autonomy. The child can be given choices about feeding, dressing, and diversional activities, which will provide a sense of control. Avoiding separation from family during hospitalization and helping parents learn special care needs of their child should be practiced as part of family-centered care. They do not particularly foster autonomy. Exposing the child to pleasurable experiences, especially sensory ones, is a supportive intervention. It does not particularly support autonomy.
A nurse is caring for a 2-month-old infant. How can the nurse best facilitate the trust relationship between infant and parents while the infant is hospitalized? a. Encourage the parents to remain at their child's bedside at all times. b. Keep parents informed about all aspects of their child's condition. c. Encourage the parents to hold their child as much as possible. d. Encourage the parents to actively participate in their child's care.
The correct answer is: Encourage the parents to hold their child as much as possible. Encouraging parents to hold their child as much as possible best facilitates the trust relationship between infant and parents. Keeping parents informed about all aspects of their child's condition and encouraging parents to actively participate in the infant's care is important; however, it does not facilitate the trust relationship between the infant and parents. It is unrealistic to expect parents to remain at their child's bedside at all times.
A nurse is caring for an 8-year-old child in the clinic who is being seen for a well-child check. The child asks how the blood pressure cuff works. The most appropriate nursing action is to: a. Ask her why she wants to know. b. Determine why the child is so anxious. c. Explain in simple terms how the blood pressure cuff works. d. Tell the child she will see how the blood pressure cuff works when it is used.
The correct answer is: Explain in simple terms how the blood pressure cuff works. School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively to requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so the child can then observe during the procedure.
A nurse is providing education to a group of parents regarding the pediatric musculoskeletal system. Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's? a. Fractures in children younger than one year are not common. b. Muscle growth occurs in children as a result of an increase in the number of muscle fibers. c. The periosteum of the child's bone is much weaker than that of an adults. d. Fractures heal more slowly in children.
The correct answer is: Fractures in children younger than one year are not common. Fractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones. A child's growth occurs because of an increase in size rather than an increase in the number of the muscle fibers. Fractures heal quicker in children. The periosteum of the child's bone is much stronger than that of an adults.
A nurse is caring for a 7-year-old child who is being evaluated for possible type 1 diabetes mellitus. Which symptom is a cardinal symptom of diabetes mellitus? a. Nausea b. Impaired vision c. Frequent urination d. Seizures
The correct answer is: Frequent urination. 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 nurse is caring for an 8-year-old child with a chronic illness and disabilities. Which nursing intervention is the most appropriate to promote normalization for this child? a. Give the child as much control as possible. b. Ask the child's peers to help the child feel normal. c. Convince the child that nothing is wrong with him or her. d. Explain to the parents that family rules for the child do not need to be the same as for healthy siblings.
The correct answer is: Give the child as much control as possible. The school-age child who is ill may be forced into a period of dependency. To foster normalcy, the child should be given as much control as possible. It is unrealistic to expect one individual to make the child feel normal. The child has a chronic illness. It would be unacceptable to convince the child that nothing is wrong. The family rules should be similar for each of the children in a family. Resentment and hostility can arise if different standards are applied to each child.
A nurse is providing information about infant mortality at a conference. Which of the following statements is correct regarding infant mortality? a. Infant mortality for Caucasians is lower than all other races in the United States. b. The United States has the lowest infant mortality rate among the developed countries. c. The infant mortality rate in the United States has increased sharply over the past 10 years. d. The gap in mortality rates between Caucasians and non-Caucasians in the United States has widened in recent years.
The correct answer is: Infant mortality for Caucasians is lower than all other races in the United States. Infant mortality rates for Caucasians is considerably lower than for all other races in the United States. The infant mortality rate in the United States has decreased dramatically; however, the United States continues to lag behind other developed countries in reducing infant mortality. The gap in mortality rates between Caucasians and non-Caucasians in the United States has narrowed in recent years.
A nurse is providing teaching to parents of a 15-month-old child. Which is the priority concern the nurse should address? a. Guidelines for toilet training. b. Guidelines for weaning children from bottles. c. Information on preschool readiness. d. Instructions on home safety and "child proofing" the home.
The correct answer is: Instructions on home safety and "child proofing" the home. Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment. Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. Parents of a 15-month-old child should have been advised to begin weaning from the breast or bottle at 6 to 12 months of age. Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment.
A nurse is providing education to the parents of a 7-year-old child who has been diagnosed with type 1 diabetes mellitus. What information should the nurse provide about this condition? a. It is best managed through diet, exercise, and oral medication. b. It can be prevented by proper nutrition and monitoring blood glucose levels. c. It is primarily characterized by insulin resistance. d. It is primarily characterized by insulin deficiency.
The correct answer is: It is primarily characterized by insulin deficiency. Type 1 diabetes mellitus is primarily characterized by insulin deficiency. Though insulin resistance can be one of the factors in type 1 diabetes mellitus, it is not the primary factor. Type 1 diabetes mellitis cannot be prevented by proper nutrition because it is characterized by insulin deficiency. Monitoring blood glucose levels does not prevent type 1 diabetes mellitus. Type 2 diabetes mellitus is best managed by diet, exercise, and oral medication.
Which statement is most descriptive of pediatric family-centered care? a. It reduces the effect of cultural diversity on the family. b. It encourages family dependence on the health care system. c. It recognizes that the family is the constant in the child's life. d. It avoids expecting families to be part of the decision-making process.
The correct answer is: It recognizes that the family is the constant in the child's life. The key components of family-centered care are for the nurse to support, respect, encourage, and embrace the family's strength by developing a partnership with the child's parents. Family-centered care recognizes the family as the constant in the child's life. The nurse should support the cultural diversity of the family, not reduce its effect. The family should be enabled and empowered to work with the health care system and to be part of the decision-making process.
A nurse is caring for an 18-month-old child and observes abdominal breathing. What does this finding indicate? a. Imminent respiratory failure b. Hypoxia c. Normal respirations d. Airway obstruction
The correct answer is: Normal respirations. Young children normally exhibit abdominal breathing. When measuring respiratory rate, the nurse should observe the rise and fall of the abdomen. A very slow respiration rate is an indicator of respiratory failure. Nasal flaring with inspiration and grunting on expiration occurs when hypoxia is present. The child with an airway obstruction will use accessory muscles to breathe.
The father of a hospitalized child tells the nurse, "He can't have meat, we are Buddhist and vegetarians". Which of the following is the best action by the nurse? a. Order the child a vegetarian tray. b. Ask a Buddhist priest to visit. c. Explain that hospitalized patients are exempt from dietary rules. d. Help the parent understand that meat contains protein needed for healing.
The correct answer is: Order the child a vegetarian tray. It is essential for the nurse to respect the religious practices of the child and family. The nurse should arrange a dietary consultation to ensure that nutritionally complete vegetarian meals are prepared by the hospital kitchen. The nurse should be able to arrange for a vegetarian tray. The nurse should not encourage the child and parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian meals should be provided.
A nurse is performing a developmental screening on an 8-month-old infant. Which of the following gross motor skills should the nurse expect the infant to perform? a. Rolls from front to back b. Builds a tower of 6-7 blocks c. Runs clumsily but falls often d. Turns pages in a book, one page at a time
The correct answer is: Rolls from front to back. An 8-month-old infant should be able to roll from front to back. This gross motor skill is typically achieved by 5 months of age. A 2-year-old should be able to build a tower of 6-7 blocks. An 18-month-old is expected to run clumsily but fall often. Turning pages in a book, one page at a time, is a fine motor skill and should be able to be performed by a 2-year old.
A nurse is caring for an 11-year-old child who was recently diagnosed with type 1 diabetes mellitus. What should the nurse include in the teaching plan? a. The parents do not need to learn how to give insulin injections. b. The child is old enough to give most of his own injections. c. The child will not be able to give his own injections until he is an adolescent. d. The child will not be able to give himself injections until he can reach all the injection sites.
The correct answer is: The child is old enough to give most of his own injections. School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used.
Which initial assessment made by nurse suggests that a child requires immediate intervention? a. The child is restless and has nasal flaring. b. The child has a frequent non-productive cough. c. The child's oxygen saturation is 94%. d. The child has capillary refill of 2-3 seconds.
The correct answer is: The child is restless and has nasal flaring. One of the initial observations is respiratory rate and effort. Restlessness and nasal flaring are early indications of respiratory distress. A cough, normal oxygen saturation, and normal capillary refill do not need immediate intervention.
A nurse is assessing a 2-year-old child's growth and development during a well-child visit. Which statement best describes language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he or she can express. c. The toddler's vocabulary contains approximately 1000 words. d. Language is generally not understandable during toddler years.
The correct answer is: The toddler understands more than he or she can express. The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language). Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. By 2 years of age, 60% to 70% of the toddler's speech is understandable. The toddler's vocabulary contains approximately 300 or more words.
A nurse is caring for a 16-year-old adolescent with a chronic illness and disability that has recently become rebellious and has been purposefully skipping doses of his medication. What information should the nurse provide the parents to help explain their child's behavior? a. At this age, children require stricter discipline. b. At this age, children require more socialization with their peers. c. This behavior is seen as a normal part of adolescence. d. This is the child's way of asking for more parental involvement to manage stress.
The correct answer is: This behavior is seen as a normal part of adolescence. Risk taking, rebelliousness, and lack of cooperation are normal parts of adolescence. If the parents increase the amount of discipline, he will most likely be more rebellious. Socialization with peers should be encouraged as a part of adolescence. It is a normal part of adolescence during which the young adult is establishing independence.
A nurse is preparing to see a 2-year-old child in the clinic. Which of the following is an important consideration for the nurse when communicating with this child? a. Speak loudly, clearly, and directly. b. Use transition objects such as a doll. c. Disguise own attitudes, feelings, and anxiety. d. Initiate contact with the child when the parent is not present.
The correct answer is: Use transition objects such as a doll. Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child. Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.
A nurse is caring for a 4-year-old child who is being seen for a well-child visit. Which of the following immunizations should the nurse expect to administer at this visit? a. Varicella (VAR) b. Meningococcal conjugate c. Human papillomavirus (HPV) d. Rotavirus (RV)
The correct answer is: Varicella (VAR). The varicella (VAR) immunization is given between 12-15 months of age and between 4-6 months of age. Meningococcal conjugate immunization is given at 11-12 years with a booster dose at 16 years. Human papillomavirus (HPV) is administered at 11-12 years of age with subsequent doses 1-2 months after the first dose and 24 weeks after the first dose. Rotavirus (RV) is administered at 2 and 4 months if RV1 (Rotarix) and at 2, 4, and 6 months if RV5 (RotaTeq).
A nurse is caring for a 3-month-old infant with a urinary tract infection (UTI). Which assessment findings should the nurse expect? (Select all that apply) a. Malodorous urine b. Crying when voiding c. Feeding difficulties d. Enuresis e. Urgency with urination
The correct answers are: Malodorous urine, Crying when voiding, Feeding difficulties. The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Enuresis and voiding urgency should be assessed in an older child.
