PEDS FINAL

A nurse is assessing a child who has rhabdomyosarcoma of the nasopharynx. Which of the following are manifestations of rhabdomyosarcoma? (Select all that apply.) A. Enlarged neck lymph nodes B. Pain C. Vomiting D. Epistaxis E. Diplopia

. A. CORRECT: Palpable neck lymph nodes are a manifestation of rhabdomyosarcoma of the nasopharynx. B. CORRECT: Pain is a manifestation of rhabdomyosarcoma of the nasopharynx. D. CORRECT: Epistaxis is a manifestation of rhabdomyosarcoma of the nasopharynx.

The nurse is performing an assessment on a child admitted to the hospital with probably diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? Select all that apply 1. Pallor 2. Edema 3. Anorexia 4. Proteinuria 5. Weight loss 6. Decreased serum lipids

1, 2, 3, 4 Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated lipids, anorexia, pallor. The child gains weight.

The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all the apply. 1. Time the seizure 2. Restrain the child 3. Stay with the child 4. Place the child in prone position 5. Move furniture away from the child 6. Insert a padded tongue blade in the child's mouth

1, 3, 5 During a seizure, the child is placed on their side in lateral position to prevent aspiration because saliva drains out the corner of the child's mouth. The nurse would loosen restrictive clothing and ensure patent airway. Nothing is placed in the child's mouth during a seizure to prevent injury. The nurse would stay with the child to reduce risk of injury and allow for observation and timing of the seizure

The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. Which assessment findings are specifically characteristic of this disease? Select all that apply 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area

1, 5 Specific clinical manifestations associated with Hodgkin's disease include painless firm movable adenopathy in the cervical and supraclavicular area and abdominal pain as a result of enlarged retroperitoneal nodes. Hepatosplenomegaly is also noted. Although fever, malaise, anorexia and weight loss are associated with this disease, these manifestations are also seen in many disorders.

The nurse provides home care instructions to the parents of a child with celiac disease. The nurse should teach the parents to include which food item in the child's diet? 1. Rice 2. Oatmeal 3. Rye toast 4. Wheat bread

1. All wheat, rye, barley, and oats should be eliminated from the child's diet and replaced with corn, rice, and millet. Vitamin supplements (fat-soluble) may be needed to correct deficiencies. Dietary restrictions are lifelong.

A 1 month old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition? 1. Limited ROM in the affected hip 2. An apparent lengthened femur on the affected side 3. Asymmetrical adduction of the affected hup when the infant is placed supine with the knees and hips flexed 4. Symmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

1. Asymmetrical and restricted abduction of the affected hip when the child is placed supine with the knees and hips flexed would be an assessment finding in DDH in infants beyond newborn age. Other findings include short femur on affected side, asymmetry of gluteal skinfolds, and limited ROM in the affected extremity

The nurse is monitoring a child for bleeding after surgery for removal of brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which action should the nurse perform immediately? 1. Notify the surgeon 2. Reinforce the dressing 3. Document the findings and continue to monitor 4. Circle the are of drainage and continue to monitor

1. Colorless drainage on dressing indicates presence of CSF and should be reported to the surgeon immediately

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy . The nurse notes that the platelet count is 19, 500/ul. Based on the lab result, which intervention will the nurse document in the plan of care? 1. Initiate bleeding precautions 2. Monitor closely for sings of infection 3. Monitor temperature every 4 hours 4. Initiate protective isolation precautions

1. Leukemia is a malignant increase in leukocytes in the bone marrow. It affects the bone marrow and causes anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). Platelet count <50,000 requires initiation of bleeding precautions d/t increased risk of bleeding or hemorrhage. Precautions include limiting activity, using soft toothbrushes, administering stool softeners to reduce straining, avoid suppositories, rectal temps.

The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect? 1. Meningitis 2. Spinal cord injury 3. Intracranial bleeding 4. Decreased cerebral blood flow

1. Meningitis is infectious process of nervous system caused by bacteria and viruses. Kernigs sign is the inability to flex the leg when the thigh is flexed anteriorly at the hip

The nurse is monitoring a 3-year-old for s/s of increased ICP after a craniotomy. The nurse plans to monitor for which early s/s of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache

1. The brain is highly susceptible to increased pressure that may accumulate within the enclosure and volume and pressure must remain constant within the brain. A change in the size of the brain occurs with edema or increased volume of intracranial blood or CSF. Without compensatory change, this leads to ICP which may be life-threatening. Vomiting is an early sign of increased ICP and may become excessive as pressure builds up and stimulates the medulla in the brainstem which houses the vomiting center. Children 2-3months compensate with skull expansion and bulging fontanels. Headaches become more prevalent in older children

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all the apply 1. Maintain the child in a semiprivate room 2. Reduce exposure to environmental organisms 3. Use strict aseptic technique for all procedures 4. Ensure that anyone entering the child's room wears a mask 5. Apply firm pressure to a needle stick area for at least 10 minutes

2, 3, 4 A common complication of treatment of leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include use of private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand washing, ensure that anyone entering the child's room wears a mask, reducing exposure to environmental organisms by eliminating raw fruits and veggies from the diet and fresh flowers from the child's room and not leaving standing water in the child's room.

The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list. Select all that apply 1. Use the fingertips to lift the cast while it is drying 2. Keep small toys and sharp objects away from the cast 3. Use padded ruler or another padded object to scratch the skin under the cast if it itches 4. Place a heating pad on the lower end of the cast and over fingers if the fingers feel cold 5. Elevated the extremity on pillows for the first 24-48 hours after casting to prevent swelling 6. Contact PCP if child complains of numbness and tingling in the extremity

2, 5, 6 While the cast is drying, the palms of the hands are used to lift the cast. Fingertips could cause indentations and cause constant pressure on the underlying skin. Small toys and sharp objects are kept away from the cast, and no objects should be placed inside the cast d/t risk of altered skin integrity. The extremity is elevated to prevent swelling and PCP is notified immediately if signs of neurovascular impairment develop. Cold fingers should be notified to provider as indication of neurovascular impairment

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the childs parent should the nurse expect that is associated with this diagnosis? 1. His pediatrician said his kidneys are working well 2. I noticed his urine was the color of cola lately 3. I'm so glad they didn't find any protein in his urine 4. The nurse who admitted my child said his blood pressure was low

2. Gross hematuria, resulting in smoky cola colored urine is classic symptom of glomerulonephritis, BUN and creatinine may be elevated indicated compromised kidney function, mild elevation of protein in urine and hypertension d/t fluid volume overload secondary to the kidneys not working properly

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? 1. Test the urine for protein 2. Reposition the child frequently 3. Provide a stimulating environment 4. Assess blood pressure every 15 minutes

2. Hydrocephalus occurs as a result of an imbalance of CSF absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased ICP. The head grows at an abnormal rate and if the infant is not repositioned frequently, pressure ulcers can occur on the back and side of the head. An egg crate mattress under the head is also a nursing intervention that can help prevent skin breakdown. Proteinuria is not specific to hydrocephalus. Stimulus should be kept to a minimum because of increased ICP. It is not necessary to check the bp every 15 minutes

The nurse is performing an admission assessment on a 2-year-old who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. hypertension 2. generalized edema 3. increased urinary output 4. frank bright red blood in the urine

2. Nephrotic syndrome is massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Other s/s are weight gain, periorbital and facial edema, decreased urine output and dark frothy urine, abdominal swelling, slightly decreased or normal BP

The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. The femur is the most common site of this sarcoma 2. The child does not experience pain at the primary tumor site 3. Limping, if a weight-bearing limb is affected, is a clinical manifestation 4. The symptoms of the disease in the early stage are almost always attributed to normal growing pains

2. Osteosarcoma is the most common bone cancer in children. It is usually found in the metaphysis of long bones, especially the lower extremities, most commonly in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention they may be in considerable pain for the tumor.

A 4-year-old is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tire and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostics studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which lab result confirms the diagnosis? 1. Lumbar puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 4. White blood count of 4500

2. The confirmatory test of leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy, which is considered positive if blast cells are present. An altered platelet count occurs as a result of the disease but may occur as a result of chemotherapy and does not confirm the diagnosis. The white blood cell count may be normal, high or low in leukemia. A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate CNS disease.

A 4 year old sustains a fall at home. After an x-ray exam, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the childs cast. Which statement by the parents indicates a need for further instruction? 1. The cast may feel warm as the cast dries 2. I can use lotion or powder around the cast edges to relieve itching 3. A small amount of white shoe polish can touch up a soiled cast 4. If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast

2. The parents should be instructed not to use lotion or powders on skin around edges of cast or inside the cast, they can become sticky or caked and cause skin irriation

The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has blood glucose level of 60mg? Select all that apply 1. Administer regular insulin 2. Encourage child to ambulate 3. Give the child a teaspoon of honey 4. Provide electrolyte replacement therapy IV 5. Wait 30 minutes and confirm the blood glucose reading 6. Prepare to administer glucagon subcut in unconsciousness occurs.

3, 6 If possible, the nurse should confirm hypoglycemia with blood glucose reading. Glucose is administered orally immediately, rapid releasing glucose is followed by complex carb and protein, such as a slice of bread or peanut butter cracker. An extra snack is given if the next meal is not planned for more than 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose past is squeezed onto the gums, and blood glucose is tested in 15 minutes. If the child remains unconscious, admin of glucagon may be necessary. Encouraging the child to ambulate would result in lowered blood glucose. Providing electrolyte therapy IV is indicated for DKA. Waiting 30 minutes to confirm the blood glucose delays necessary intervention.

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1. Prone 2. On the Stomach 3. Left Lateral position 4. Right lateral position

3. After cleft lip repair, nurse avoids positioning an infant on the side of the repair or in the prone position because the positions can cause rubbing of the surgical site on the mattress. The nurse should position in the side lateral to the repair or on the back upright position to prevent airway obstruction by secretions, blood or the tongue.

The parents of a child recently diagnosed with cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitation occur as a result of which pathophysiological process? 1. An infectious disease of CNS 2. An inflammation of the brain as a result of a viral illness 3. A chronic disability characterized by impaired muscle movement and posture 4. A congenital condition that results in moderate to severe intellectual disabilities

3. CP is a chronic disability characterized by impaired movement and posture resulting from abnormality in the extrapyramidal or pyramidal motor system

Parents bring their 2 week old infant to the clinic for treatment after diagnosis of clubfoot made at birth. Which statement by the parents indicate a need for further teaching regarding this disorder? 1. Treatment needs to be started as soon as possible 2. I realize my infant will require follow up care until fully grown 3. I need to bring my infant back to the clinic in 1 month for a new cast 4. I need to come the the clinic every week with my infant for casting

3. Clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot carus, and ankle equinus. Treatment for clubfoot is started as soon as possible, serial manipulation and casting are performed at least weekly. If sufficient correction is not achieved in 3-6 months, surgery is indicated. Because clubfoot can recur, all children with this deformity will require long term interval follow up until they reach skeletal maturity to ensure optimal outcome

The nurse is reviewing the record of a child with increased ICP and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristics of this type of posturing? 1. Flaccid paralysis of all extremities 2. Adduction of the arms at the shoulders 3. Rigid extension and pronation of the arms and legs 4. Abnormal flexion of the upper extremities and extension and adduction of the lower extremities

3. Decerebrate (extension) posturing is characterized by the rigid extension and pronation of the arms and legs

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Lab results indicate that the child is neutropenic and protective isolation is initiated. The grandmother of the child visits and brings fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. I have a vase in the utility room, and I will get it for you 2. I will get the vase and wash it well before you put the flowers in it 3. The flowers from your garden are beautiful, but should not be placed in the child's room at this time 4. When you bring flowers into the room, place them on the bedside stand as far away from the child as possible

3. For a hospitalized neutropenic child, flowers or plants should not be kept in the room because the standing water and damp soil harbor aspergillus and pseudomonas aeruginosa to which the child is susceptible. In addition, fresh fruits and veggies harbor molds and should be avoided until WBC increases

The nurse is assisting a PCP examine a 3 week old infant with developmental dysplasia of the hip. What test or sign should the nurse expect the PCP to assess? 1. Babinski's sign 2. The moro reflex 3. Ortolani's maneuver 4. The palmar-plantar grasp

3. In DDH, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Ortolani's manuever is a test to assess for hip instability and can be done only before 4 weeks of age. The examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. A "clicking" sensation indicates a dislocated femoral head moving into the acetabulum.

The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform ROM at this time. The nurse should make which response? 1. Avoid all exercise during painful periods 2. ROM exercises must be performed every day 3. Have the child perform isometric exercises during this time 4. Administer additional pain medication before performing ROM exercises

3. JIA is an autoimmune inflammatory disease affecting joint an other tissues such as articular cartilage. During painful episodes, hot/cold pack and splinting, positioning the affected extremity in neutral position, and isometric or tensing exercises as soon as the child is able is important, Isometric exercises do not involve joint movement

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and CSF is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? 1. Clear CSF, decreased pressure, elevated protein level 2. Clear CSF, elevated protein, decreased glucose levels 3. Cloudy CSF, elevated protein, and decreased glucose levels 4. Cloudy CSF, decreased protein, and decreased glucose levels

3. Meningitis is an infectious process of the CNS caused by bacteria and viruses. IT may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. Meningitis is diagnosed by testing the CSF obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include elevated pressure, turbid or cloudy CSF, and elevated leukocyte, elevated protein, and decreased glucose levels.

The nurse is assigned to care for an 8 year old child with a diagnosis of basilar skull fracture. The nurse reviews the pediatricians prescriptions and should contact the pediatrician to question which prescription? 1. obtain daily weight 2. Provide clear liquid diet 3. Nasotracheal suction as needed 4. Maintain patent IV line

3. Nasotracheal suction is contraindicated in a child with a basilar skull fracture d/t the possibility that the catheter will enter the brain through the fracture and cause a high risk for secondary infection. Fluid balance is monitored closely by daily weights, intake and output measurement and serum osmolality determination to detect early signs of water rentention, excessive dehydration, and states of hypertonicity or hypotonicity. The child is NPO or clear liquids until it is determined the vomiting will not occur. An IV line is maintained to administer fluids or medications if necessary

The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? 1. Hold the next dose of insulin 2. Come to the clinic immediately 3. Encourage the child to drink liquids 4. Administer an additional dose of regular insulin

3. When the child is sick, parent should test urinary ketones with each voiding. If ketones are present, liquids are essential to aid in clearing the ketones. The child should be encourage to drink liquids. Bringing the child to the clinic immediately is unnecessary, insulin doses should not be adjusted or changed

A mother arrives at the emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected, and a nurse is monitoring the child continuously for signs of increased intracranial pressure (ICP). Which of the following is a late sign of increased ICP in this child? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia

4. A head injury can cause bleeding in the brain and result in increased ICP. In a child, early signs include slight change in LOC, headache, NV, visual disturbance (diplopia), and seizures. Late signs of increased ICP include significant decrease in LOC, bradycardia, decreased motor and sensory responses, alterations in pupil size and reactivity, posturing, cheyne stokes respirations and coma

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care? 1. Maintain enteric precautions 2. Maintain neutropenic precautions 3. No precautions are required as long as antibiotics have been started 4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics

4. A major priority of nursing care for a child suspected to have bacterial meningitis is to administer prescribed antibiotics as soon as a culture is obtained. The child will be placed on respiratory isolation precautions for at least 24 hours while culture results are obtained and the antibiotics is having an effect. Enteric precautions and neutropenic precautions are not associated with meningitis. Enteric precautions are initiated when the mode of transmission is through the GI tract. Neutropenic precautions are instituted when a child has a low neutrophil count.

The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which items need to be placed at bedside? 1. emergency cart 2. tracheotomy set 3. padded tongue blade 4. suctioning equipment and oxygen

4. A seizure results from excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. A tonic clonic seizure causes rigidity of all body muscles followed by intense jerking movements. Because increased oral secretions and apnea can occur during and after the seizure, oxygen and suctioning equipment are placed at the bedside. No object, including a padded tongue blade, should be placed in the child's mouth.

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. Administer an analgesic 2. Release the skin traction 3. Apply ice to the extremity 4. Notify HCP

4. An absent pulse to an extremity of the affected limb after a bone fracture could mean that the child is developing or experience compartment syndrome. This is an emergency situation and the HCP must be notified immediately! Administering analgesics would not improve circulation. The skin traction should be NOT be released without a prescription. Applying ice to an extremity with absent perfusion will worsen the problem

An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? 1. sweating and tremors 2. hunger and hypertension 3. cold, clammy skin and irritability 4. fruity breath and decreasing level of consciousness

4. DKA is a complication of DM that develops when severe insulin deficiency occurs. Hyperglycemia occurs with DKA. Signs of hyperglycemia include fruity breath odor and decrease LOC. Hunger can be a sign of hypoglycemia or hyperglycemia, but HTN is not a sign of DKA. Hypotension occurs because of decrease in blood volume related to dehydration in DKA. Cold clammy skin, irritability, sweating and tremors are signs of hypoglycemia.

Which question should the nurse ask the parents of a child suspected of having glomerulonephritis? 1. Did you child fall of a bike onto the handlebars? 2. Has the child had persistent nausea and vomiting? 3. Has the child been itching or had a rash anytime in the last week? 4. Has the child had a sore throat or throat infection in the last few weeks?

4. Group A b hemolytic streptococcal infection is the cause of glomerulonephritis. Often the child becomes ill with the respiratory infection and then develops the symptoms of acute glomerulonephritis in 1-2 weeks

A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? 1. Elevated vanillylmandelic acid urinary levels 2. The presence of blast cells in the bone marrow 3. The presence of epstein-barr virus in the blood 4. The presence of reed-sternberg cells in the lymph nodes

4. Hodgkin's disease is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (reed-sternberg cells is the classic characteristic of this disease. Elevated levels of vanillylandelic acid in the urine may be found in children with neuroblastoma. The presence of blast cells in the bone marrow indicates leukemia. Epstein-barr virus is associated with infectious mononucleosis.

A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? 1. Eat twice the amount normally eaten at lunchtime 2. Take half the amount of prescribed insulin on practice days 3. Take the prescribed insulin at noontime rather than in the morning 4. Eat a small box of raisins or drink a cup of orange juice before soccer practice

4. Hypoglycemia is a blood glucose <70mg and results from too much insulin, not enough food, or excessive activity. An extra snack of 15-30 g of carbs eaten before activities would prevent hypoglycemia. The parents should not be instructed to adjust the amount or time of insulin administration. Meal amounts should not be doubled

A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse is monitoring the child and notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? 1. Place the child in supine position 2. Place the child in trendelenburg's position 3. Increase the flow rate of the IV fluids 4. Notify the HCP

4. In the event of shock HCP is notified immediately before changing IVF. After craniotomy, child is NEVER place in supine or trendelenburg's position because it increased ICP and risk for bleeding. HOB should be elevated. Increased IVF can cause increase in ICP.

A child with type 1 diabetes mellitus is brought to the emergency department by the mother who states the child has been complaining of abdominal pain and has been lethargic. DKA is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of IV infusion? 1. Potassium infusion 2. NPH insulin infusion 3. 5% dextrose infusion 4. Normal saline infusion

4. Rehydration is the initial step in resolving DKA. Normal saline is the initial IV rehydration fluid. NPH is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level decreased to an acceptable level. IV potassium may be required depending on potassium level, but would not be part of the initial treatment.

A child is diagnosed with Reye's syndrome. The nurse creates a nursing care plan for the child and should include which intervention in the plan? 1. Assessing hearing loss 2. Monitoring urine output 3. Changing body position every 2 hours 4. Providing a quiet environment and dimmed lighting

4. Reye's syndrome is an acute encephalopathy that follows a viral illness and is characterized by cerebral edema and fatty changes in the liver. Supportive care is directed toward monitoring and managing cerebral edema. Decreased environmental stimuli would decrease the stress on the cerebral tissue and neuron responses. Hearing loss and urine output are not affected. Changing the body position every 2 hours would not affect cerebral edema directly. The child should be positioned with the head elevated to decrease the progression of cerebral edema and promote drainage of CSF

A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention? 1. Ensure that all ropes are outside the pulleys 2. Ensure that the weights are resting lightly on the floor 3. Restrict diversional and play activities until the child is out of traction 4. Check the HCP prescriptions for the amount of weight to be applied

4. While in traction, the nurse should check the HCP prescription for amount of traction weight. The nurse would maintain the correct amount of weight prescribed, ensure that the weights hang freely, check the ropes for fraying and ensure that they are on the pulleys appropriately, monitor neurovascular status of the involved extremity, monitor for s/s of immobilization. The nurse would provide therapeutic and diversional play activities for the child

A nurse is caring for a child who has short stature. Which of the following diagnostic tests should be completed to confirm growth hormone (GH) deficiency? (Select all that apply.) A. CT scan of the head B. Skeletal x-rays C. GH stimulation test D. Blood IGF-1 E. DNA testing

A. CORRECT: A CT scan of the head is conducted to determine whether there is a structural component to the short stature. B. CORRECT: Skeletal x-rays are conducted to determine the development of the bones. C. CORRECT: A GH stimulation test is conducted to confirm diagnosis of GH deficiency. D. CORRECT: A blood IGF-1 is obtained as a preliminary test to determine GH deficiency.

A nurse is reviewing sick-day management with a parent of a child who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Monitor blood glucose levels every 3 hr. B. Discontinue taking insulin until feeling better. C. Drink 8 oz of fruit juice every hour. D. Test urine for ketones. E. Call the provider if blood glucose is greater than 240 mg/dL.

A. CORRECT: A child who is experiencing illness can have waning blood glucose levels. Frequent monitoring of blood glucose levels is done to identify hyperglycemic or hypoglycemic episodes D. CORRECT: A child who is experiencing an illness should test her urine for ketones to assist in early detection of ketoacidosis. E. CORRECT: A child who is experiencing illness should notify the provider of blood glucose levels greater than 240 mg/dL to obtain further instructions in caring for the hyperglycemia.

A nurse is assessing a child who has nephrotic syndrome. Which of the following findings should the nurse expect? (Select all that apply.) A. Urine dipstick +2 protein B. Edema in the ankles C. Hyperlipidemia D. Polyuria E. Anorexia

A. CORRECT: A client who has nephrotic syndrome will exhibit proteinuria of due to the kidneys' inability to filter urine. B. CORRECT: A client who has nephrotic syndrome will exhibit edema in the ankles due to the decreasing colloidal osmotic pressure in the capillaries. C. CORRECT: A client who has nephrotic syndrome will exhibit hyperlipidemia due to the increased hepatic synthesis of proteins and lipids. E. CORRECT: A client who has nephrotic syndrome will exhibit anorexia due to the edema of the intestinal mucosa.

A nurse is teaching the parent of a child who has a growth hormone deficiency. Which of the following are complications of untreated growth hormone deficiency? (Select all that apply.) A. Delayed sexual development B. Premature aging C. Advanced bone age D. Short stature E. Increased epiphyseal closure

A. CORRECT: A complication of untreated growth hormone deficiency includes delayed sexual development. B. CORRECT: A complication of untreated growth hormone deficiency includes premature aging. D. CORRECT: A complication of untreated growth hormone deficiency includes short stature.

A nurse is caring for a child who has a fracture. Which of the following are manifestations of a fracture? (Select all that apply.) A. Crepitus B. Edema C. Pain D. Fever E. Ecchymosis

A. CORRECT: A fracture can leave bone fragments that will exhibit a grating sound. Crepitus is a manifestation of a fracture. B. CORRECT: Swelling at the site occur related to the trauma. Edema is a manifestation of a fracture. C. CORRECT: A child who has a fracture will experience pain from the trauma. E. CORRECT: Bleeding under the skin can occur related to the trauma. Ecchymosis is a manifestation of a fracture.

A nurse is caring for a child who has cerebral palsy. Which of the following medications should the nurse expect to administer to treat painful muscle spasms? (Select all that apply.) A. Baclofen B. Diazepam C. Oxybutynin D. Methotrexate E. Prednisone

A. CORRECT: Baclofen is a centrally acting skeletal muscle relaxant that decreases muscle spasm and severe spasticity. B. CORRECT: Diazepam is a skeletal muscle relaxant that decreases muscle spasms and severe spasticity. Oxybutin is an antispasmodic anticholinergic medication that decreases bladder spasms. Methotrexate is used to slow joint degeneration and progression of RA and JIA. Prednisone increases muscle strength in children with muscular dystrophy and decreases inflammation in JIA

A nurse is caring for a preschooler who has nephrotic syndrome. Which of the following findings should the nurse report to the provider? A. Blood protein 5.0 g/dL B. Hgb 14.5 g/dL C. Hct 40% D. Platelet 200,000 mm3

A. CORRECT: Blood protein 5.0 g/dL is out of the expected reference range for a preschooler and should be reported to the provider.

A nurse is providing teaching to the parent of a child who has a neuroblastoma. Which of the following statements should the nurse include in the teaching? (Select all that apply.) A. "Chemotherapy and radiotherapy may be necessary for treatment." B. "Your child will need a bone marrow biopsy." C. "Your child will be paralyzed because of this tumor." D. "Most children are diagnosed around age 12." E. "Your child will need surgery for resection of the tumor."

A. CORRECT: Chemotherapy and radiotherapy may be necessary for treatment. B. CORRECT: Diagnostic testing for neuroblastoma includes a bone marrow biopsy. E. CORRECT: Resection of the tumor is the treatment of choice.

A nurse is providing home care instructions to a parent of a child who is receiving chemotherapy. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Manifestations of infection B. Bleeding precautions C. Hand hygiene D. Homeschooling E. Airborne precautions

A. CORRECT: Chemotherapy destroys healthy WBCs, which increases the risk of infection. Manifestations of infection should be included in the teaching. B. CORRECT: Chemotherapy destroys healthy platelets, which increases the risk of bleeding. Bleeding precautions should be included in the teaching. C. CORRECT: Chemotherapy destroys healthy WBCs, which increases the risk of infection. Hand hygiene should be included in the teaching

A nurse is caring for a child who is experiencing neuropathy due to chemotherapy. Which of the following are manifestations of neuropathy? (Select all that apply.) A. Constipation B. Skin breakdown C. Foot drop D. Jaw pain E. Hemorrhage cystitis

A. CORRECT: Constipation is a manifestation of neuropathy. C. CORRECT: Foot drop is a manifestation of neuropathy. D. CORRECT: Jaw pain is a manifestation of neuropathy.

A nurse is assessing a child who has rhabdomyosarcoma of the upper arm. Which of the following findings should the nurse expect? (Select all that apply.) A. Pain B. Discoloration of the skin C. Lymph node enlargement D. Easy bruising E. Palpable mass

A. CORRECT: Pain is an expected finding in a child who has rhabdomyosarcoma. C. CORRECT: Lymph node enlargement is an expected finding of rhabdomyosarcoma of an extremity E. CORRECT: Palpable mass is an expected finding of rhabdomyosarcoma of an extremity.

A nurse is caring for a school-age child who has juvenile idiopathic arthritis. Which of the following home care instructions should the nurse include in the teaching? (Select all that apply.) A. Provide extra time for completion of ADLs. B. Use cold compresses for joint pain. C. Take ibuprofen on an empty stomach. D. Remain home during periods of exacerbation E. Perform range-of-motion exercises.

A. CORRECT: Providing extra time for the completion of ADLs promotes independence in the client and provides a means to maintain mobility E. CORRECT: Range of motion will assist in maintaining function of the joints. Using warm compresses or moist packs can relieve stiffness, child should be encouraged to attend school

A nurse is caring for a child who has thrombocytopenia. Which of the following actions should the nurse take? (Select all that apply.) A. Monitor for manifestations of bleeding. B. Administer routine immunizations. C. Obtain rectal temperatures. D. Avoid peripheral venipunctures. E. Limit visitors

A. CORRECT: The child who has thrombocytopenia is at risk for hemorrhage. Monitoring for findings of bleeding is an appropriate action for the nurse to take. D. CORRECT: The child who has thrombocytopenia is at risk for bleeding. Avoiding venipunctures is an appropriate action for the nurse to take

A nurse is caring for an infant and notices an audible click in their left hip. Which of the following diagnostic test should the nurse expect the provider to perform? (Select all that apply.) A. Barlow test B. Babinski sign C. Manipulation of foot and ankle D. Ortolani test E. Ponseti method

A. CORRECT: Use a Barlow test to assess developmental dysplasia of the hip for infants. The provider will flex the infants hip and knees to a right angle position. D. CORRECT: The Ortolani test assesses developmental dysplasia of the hip for infants. The provider will flex the infants hip and knees to a right angle position.

A nurse is assessing a child who has neuroblastoma of the adrenal gland. Which of the following are manifestations of metastasis from the primary site? (Select all that apply.) A. Weight gain B. Bone pain C. Periorbital ecchymoses D. Proptosis E. Weight loss

B. CORRECT: A child who has metastatic neuroblastoma will report bone pain. C. CORRECT: A child who has metastatic neuroblastoma will have periorbital ecchymoses. D. CORRECT: A child who has metastatic neuroblastoma will have proptosis. E. CORRECT: A child who has metastatis will have weight loss

A nurse is assessing a child who has leukemia. Which of the following are early manifestations of leukemia? (Select all that apply.) A. Hematuria B. Anorexia C. Petechiae D. Ulcerations in the mouth E. Unsteady gait

B. CORRECT: Anorexia is an early manifestation of leukemia. C. CORRECT: Petechiae is an early manifestation of leukemia E. CORRECT: Unsteady gait is an early manifestation of leukemia.

A nurse is caring for a child who is in skeletal traction. Which of the following actions should the nurse take? (Select all that apply.) A. Remove the weights to reposition the client. B. Assess the child's position frequently. C. Assess pin sites every 4 hr. D. Ensure the weights are hanging freely. E. Ensure the rope's knot is in contact with the pulley.

B. CORRECT: Assess the child's position frequently to ensure proper alignment is present. This avoids putting stress on the pinned areas and other areas of the body causing pain. C. CORRECT: Pin sites should be assessed frequently to monitor for the development of infection or loosening of the pins. Pin site care should be administered per facility policy. D. CORRECT: Ensure that the weights are hanging freely to allow for traction. The weights should only be removed by the provider in an emergency situation, the knot in the rope should not touch the pulley as this will alter the weight of the traction

A nurse is caring for a school-age child who has acute glomerulonephritis. Which of the following findings should the nurse report to the provider? A. BUN 8 mg/dL B. Blood creatinine 1.3 mg/dL C. Blood pressure 100/74 mm Hg D. Urine output 550 mL in 24 hr

B. CORRECT: Blood creatinine 1.3 mg/dL is above the expected reference range for school-age child, and should be reported to the provider.

A nurse is teaching a group of caregivers about fractures. Which of the following information should the nurse include in the teaching? A. "Children need a longer time to heal from a fracture than an adult." B. "Epiphyseal plate injuries can result in altered bone growth." C. "A greenstick fracture is a complete break in the bone." D. "Bones are unable to bend, so they break."

B. CORRECT: Detection and early treatment are crucial for an epiphyseal plate injury to prevent altered bone growth. A child heals quicker from a fracture than an adults d/t thicker periosteum and good blood supply, a greenstick fracture is a partial break in the bone. Childrens bones are soft and pliable and can bend up to 45 degrees before breaking

. A nurse is teaching a parent of a child who has a urinary tract infection. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Wear nylon underpants. B. Avoid bubble baths. C. Empty bladder completely with each void. D. Watch for manifestations of infection. E. Wipe perineal area back to front.

B. CORRECT: Discuss avoiding bubble baths. C. CORRECT: Discuss the need to completely empty the bladder with each void. D. CORRECT: Review the manifestations of infection

A nurse is caring for a child who sustained a fracture. Which of the following actions should the nurse take? (Select all that apply.) A. Place a heat pack on the site of injury. B. Elevate the affected limb. C. Assess neurovascular status frequently. D. Encourage ROM of the affected limb. E. Stabilize the injury.

B. CORRECT: Elevating the affected limb can decrease swelling at the injury site. C. CORRECT: Assessing neurovascular status assists the nurse in determining if the affected limp has adequate blood supply E. CORRECT: Stabilizing the injury will prevent further injury and damage. Place a cold pack at site of injury to decrease swelling, encourage ROM on non-affected limb

A nurse is teaching an adolescent who has diabetes mellitus about manifestations of hypoglycemia. Which of the following findings should the nurse include in the teaching? (Select all that apply.) A. Increased urination B. Hunger C. Poor skin turgor D. Irritability E. Sweating and pallor F. Kussmaul respirations

B. CORRECT: Hunger is a manifestation of hypoglycemia because of the increased adrenergic nervous system activity. D. CORRECT: Irritability is a manifestation of hypoglycemia because of the depleted glucose in the CNS. E. CORRECT: Sweating and pallor are manifestations of hypoglycemia because of the increased adrenergic nervous system activity.

A nurse is assessing an infant who has a suspected urinary tract infection. Which of the following are expected findings? (Select all that apply.) A. Increase in hunger B. Irritability C. Decrease in urination D. Vomiting E. Fever

B. CORRECT: Irritability is a manifestation in an infant who has a urinary tract infection. D. CORRECT: Vomiting is a manifestation in an infant who has a urinary tract infection. E. CORRECT: Fever is a manifestation in an infant who has a urinary tract infection.

A nurse is caring for an infant who has just returned from PACU following cleft lip and palate repair. Which of the following actions should the nurse take? A. Remove the packing in the mouth. B. Place the infant in an upright position. C. Offer a pacifier with sucrose. D. Assess the mouth with a tongue blade.

B. CORRECT: Placing the infant in an upright position will facilitate drainage and prevent aspiration

A nurse is developing a plan of care for a toddler who has cerebral palsy. Which of the following actions should the nurse include? A. Structure interventions according to the toddler's chronological age. B. Evaluate the toddler's need for an evaluation of hearing ability. C. Monitor the toddler's pain level routinely using a numeric rating scale. D. Provide total care for daily hygiene activities.

B. CORRECT: Recognize that the toddler who has CP has an increased risk for hearing impairment; therefore, evaluate the toddler's need for an evaluation of hearing ability. Interventions should be structured on childs developmental age, pain should be monitored using the FACES pain rating scale, promote as much independence as possible

A nurse is assessing a child who has a urinary tract infection. Which of the following are manifestations of a urinary tract infection? (Select all that apply.) A. Night sweats B. Swelling of the face C. Pallor D. Pale-colored urine E. Fatigue

B. CORRECT: Swelling of the face is a manifestation in child who has a urinary tract infection. C. CORRECT: Pallor is a manifestation in child who has a urinary tract infection. E. CORRECT: Fatigue is a manifestation in child who has a urinary tract infection.

A nurse is caring for a child who has muscular dystrophy. For which of the following findings should the nurse assess? (Select all that apply.) A. Purposeless, involuntary, abnormal movements B. Spinal defect and saclike protrusion C. Muscular weakness in lower extremities D. Unsteady, wide-based or waddling gait E. Upward slant to the eyes

C. CORRECT: A child who has MD will exhibit muscular weakness in the lower extremities as one of the first manifestations. D. CORRECT: A child who has MD will exhibit an unsteady, wide-based, or waddling gait due to the progressive muscle weakness.

A nurse is teaching a child who has type 1 diabetes mellitus about self-care. Which of the following statements by the child indicates understanding of the teaching? A. "I should skip breakfast when I am not hungry." B. "I should increase my insulin with exercise." C. "I should drink a glass of milk when I am feeling irritable." D. "I should draw up the NPH insulin into the syringe before the regular insulin."

C. CORRECT: An early manifestation of hypoglycemia is irritability. Drinking a glass of milk, which is approximately 15 g of carbohydrates, indicates understanding of the teaching.

A nurse is caring for an adolescent who has a new diagnosis of osteosarcoma. Which of the following actions should the nurse take first? A. Ensure that the adolescent has a referral for a psychiatrist visit. B. Prepare a teaching plan to educate the adolescent in detail about the diagnosis and treatment. C. Spend time with the adolescent to answer any questions. D. Perform a mental status examination to assess the adolescent's thought patterns.

C. CORRECT: Be available to answer the client's questions and to listen to any concerns.

A nurse is caring for a child who has type 1 diabetes mellitus. Which of the following are manifestations of diabetic ketoacidosis? (Select all that apply.) A. Blood glucose 58 mg/dL B. Weight gain C. Dehydration D. Mental confusion E. Fruity breath

C. CORRECT: Children who have diabetic ketoacidosis experience osmotic diuresis because of the electrolyte shift. D. CORRECT: Children who have diabetic ketoacidosis experience mental confusion because of the electrolyte shift. E. CORRECT: Children who have diabetic ketoacidosis experience fruity breath because of the body's attempt to eliminate ketones.

A nurse is planning care for an infant who is scheduled to have a lumbar puncture. Which of the following actions should the nurse include in the plan of care? A. Cleanse the thoracic area of the infant's back with an antiseptic solution. B. Apply a eutectic mixture of local anesthetic cream just before the procedure begins. C. Restrain the infant during the procedure to prevent movement. D. Position the infant with his head extended and chin raised.

C. CORRECT: Restraining the infant during the procedure to prevent movement will decrease the potential for injury. It is an appropriate action for the nurse to take.

A nurse is caring for a child following an above-the-knee amputation. Which of the following actions should the nurse take? A. Avoid discussing the amputation. B. Administer aspirin for phantom pain. C. Prepare the child for a prosthesis fitting. D. Maintain the affected limb in the dependent position.

C. CORRECT: Temporary prostheses are fitted soon after surgery. Preparing the child for a prosthesis will help the child cope with the transition.

A nurse is assessing a child who has short stature. Which of the following findings would indicate a growth hormone deficiency? A. Proportional height to weight B. Height proportionally greater than weight C. Oversized jaw D. Early-onset puberty

C. CORRECT: Treatment usually stops when the child grows less than 1 inch per year and has reached required bone maturity

A parent of a school-age child who has GH deficiency asks the nurse how long the child will need to take injections for growth delay. Which of the following responses should the nurse make? A. "Injections are usually continued until age 10 for girls and age 12 for boys." B. "Injections continue until your child reaches the fifth percentile on the growth chart." C. "Injections might be stopped once your child grows less than 1 inch/year." D. "The injections will need to be administered throughout your child's entire life."

C. CORRECT: Treatment usually stops when the child grows less than 1 inch per year and has reached required bone maturity

Separation anxiety is something that affects children when they are hospitalized. Each developmental stage has a somewhat different reaction as they deal with this difficulty. Which stage corresponds to the adolescent stage? a. May demonstrate separation anxiety by refusing to eat, experiencing difficulty in sleeping, crying quietly for their parents, continually asking when the parents will visit, or withdrawing from others. b. Separation anxiety comes in stages: protest, despair, and detachment. c. Loss of peer group contact may pose a severe emotional threat because of loss of group status, inability to exert group control or leadership, and loss of group acceptance. d. May need and desire parental guidance or support from other adult figures but may be unable or unwilling to ask for it.

C. Loss of peer group contact may pose a severe emotional threat because of loss of group status, inability to exert group control or leadership, and loss of group acceptance.

A nurse is caring for an infant who has a myelomeningocele. Which of the following actions should the nurse include in the preoperative plan of care? A. Assist the caregiver with cuddling the infant. B. Assess the infant's temperature rectally. C. Place the infant in a supine position. D. Apply a sterile, moist dressing on the sac.

CORRECT: A sterile, moist, nonadhering dressing is placed on the sac to keep it moist until surgery. This should be in the preoperative plan of care.

A nurse is caring for a child who is in a plaster spica cast. Which of the following actions should the nurse take? A. Use a heat lamp to facilitate drying. B. Avoid turning the child until the cast is dry. C. Assist the client with crutch walking after the cast is dry. D. Apply moleskin to the edges of the cast.

D. CORRECT: Apply moleskin to the edges of the cast to prevent the cast from rubbing on the client's skin. A cool fan can be used to facilitate drying of the cast. Child should be turned every 2 hrs to expose all areas of the cast, a child with a spica cast is non weight bearing until the cast is removed

A nurse is teaching a school-age child who has diabetes mellitus about insulin administration. Which of the following should the nurse include in the teaching? A. "You should inject the needle at a 30-degree angle." B. "You should combine your glargine and regular insulin in the same syringe." C. "You should aspirate for blood before injecting the insulin." D. "You should give four to six injections in one area before switching sites."

D. CORRECT: Instruct the child to administer four to six injections about 2.5 cm (1 in) apart before switching to another site

A nurse is planning care of a child who has a urinary tract infection. Which of the following interventions should the nurse include? A. Administer an antidiuretic. B. Restrict fluids. C. Evaluate the child's self-esteem. D. Encourage frequent voiding.

D. CORRECT: It's important to encourage frequent voiding. This assists in flushing the bacteria through the urinary system.

A nurse is caring for a toddler who has hip dysplasia and has been placed in a hip spica cast. The child's guardian asks the nurse why a Pavlik harness is not being used. Which of the following responses should the nurse make? A. "The Pavlik harness is used for children with scoliosis, not hip dysplasia." B. "The Pavlik harness is used for school-age children." C. "The Pavlik harness cannot be used for your child because her condition is too severe." D. "The Pavlik harness is used for infants less than 6 months of age."

D. CORRECT: The Pavlik harness is a soft brace designed for infants less than 6 months of age. A toddler is too large to fit into the brace.

You are working with a new graduate and explaining prevention of infection for a child with acute lymphocytic leukemia. Which statement by this new nurse indicates understanding? a. "Prophylaxis against Pneumocystis pneumonia is routinely given to most children during treatment for cancer." b. "If blood is drawn, firm pressure should be applied to the area for a minimum of 10 minutes." c. "Having a roommate with a routine surgery would be acceptable for this child." d. "The child should be vaccinated completely to avoid childhood diseases."

a. "Prophylaxis against Pneumocystis pneumonia is routinely given to most children during treatment for cancer."

A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerular nephritis. Which of the following nursing measures should be considered? Select all that apply. a. On examination, there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. b. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity, c. The primary objective is to reduce the excretion of urinary protein and maintain protein-free urine. d. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable. e. Because these children are particularly vulnerable to upper respiratory tract infection, protect them from contact with infected roommates, family, or visitors.

a. On examination, there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. b. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity, d. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable.

The potential physiologic and psychological effects of prolonged immobilization on a 9-year-old child who has experienced significant trauma in a motor vehicle crash include which of the following? Select all that apply. a. Orthostatic intolerance b. Deep vein thrombosis (DVT) c. Pressure ulcer formation d. Pneumonia e. Diarrhea f. Kidney stones g. Sense of euphoria and elation h. Constipation

a. Orthostatic intolerance b. Deep vein thrombosis (DVT) c. Pressure ulcer formation d. Pneumonia f. Kidney stones h. Constipation

When caring for a child with acute renal failure, which nursing measure requires immediate attention? a. Serum potassium concentrations in excess of 7 mEq/L b. Sodium level of 135 c. Transfusion for hemoglobin of 8 d. Mannitol and furosemide for a urine output of 2 ml/kg/hr

a. Serum potassium concentrations in excess of 7 mEq/L

Which of these statements accurately describes Duchenne muscular dystrophy (DMD)? Select all that apply. a. The absence of dystrophin leads to muscle fiber degeneration. b. DMD is inherited as an X-linked recessive trait. c. Cognitive and intellectual impairment are rare in children with DMD. d. Affected children have a waddling gait and lordosis and fall frequently. e. Ambulation usually becomes impossible by 12 years old, and affected children are confined to a wheelchair. f. Affected children must be hospitalized when ambulation becomes impossible.

a. The absence of dystrophin leads to muscle fiber degeneration. b. DMD is inherited as an X-linked recessive trait. d. Affected children have a waddling gait and lordosis and fall frequently. e. Ambulation usually becomes impossible by 12 years old, and affected children are confined to a wheelchair.

The parents of a child with Hodgkin disease ask how the physician will know what type of cancer their child has. Which of the following definitive signs and symptoms should the nurse describe? Select all that apply. a. The most common finding is enlarged, firm, nontender, movable nodes in the supraclavicular or cervical area. b. Tests include complete blood count, prothrombin time and glucose-6-phosphate dehydrogenase (G6PD), erythropoietin, and sedimentation rate. c. Generally a bone marrow biopsy is done to look for the presence of blast cells. d. The presence of Sternberg-Reed cells is considered diagnostic of Hodgkin disease. e. The presence of a white reflection as opposed to the normal red pupillary reflex in the pupil of a child's eye is a classic sign.

a. The most common finding is enlarged, firm, nontender, movable nodes in the supraclavicular or cervical area. d. The presence of Sternberg-Reed cells is considered diagnostic of Hodgkin disease.

You are working with a family that brought their child into the pediatric clinic. The mother describes what may be a type of seizure. What subjective data will help you determine the type? Select all that apply. a. The presence or absence of an aura b. If the child appeared disoriented after the seizure c. Presence of vomiting after the seizure d. The duration of the seizure e. If the seizure was related to certain foods or occurred after a certain activity

a. The presence or absence of an aura b. If the child appeared disoriented after the seizure d. The duration of the seizure

The nurse is caring for a 4-year-old girl with a history of frequent urinary tract infections (UTIs). What should the nurse be aware of before obtaining a urine sample? Select all that apply. a. To obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank. b. Because children who have a UTI will have painful urination, have the child drink a large amount of fluid before obtaining the sample. c. The specimen must be fresh—less than 1 hour after voiding with storage at room temperature or less than 4 hours after voiding with refrigeration. d. If a urinalysis obtained by a bag specimen is negative, a specimen still needs to be obtained by catheterization or suprapubic aspiration. e. The key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria. f. Because the child is febrile, the nurse should immediately start an antimicrobial and then obtain a urine culture.

a. To obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank. c. The specimen must be fresh—less than 1 hour after voiding with storage at room temperature or less than 4 hours after voiding with refrigeration. e. The key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria.

A father calls the pediatrician's office concerned about his 5-year-old type 1 diabetic child who has been ill. He reports that upon checking the child's urine, it was positive for ketones. What is the nurse's best response to this father? a. "Come to the office immediately." b. "Encourage the child to drink calorie-free liquids." c. "Hold the next dose of insulin." d. "Administer an extra dose of insulin now."

b. "Encourage the child to drink calorie-free liquids."

You are working with a pediatric nurse who has just transferred to the pediatric clinic. You are role-playing phone triage related to a child with a head injury. You ascertain that the nurse needs more teaching based on what response? a. "After initial physical exam, if there was no loss of consciousness with the head injury, the child can be observed at home." b. "If there is a language barrier, written instructions can be given, followed by discharge." c. "Another physical exam should take place in 1 or 2 days." d. "Parents should call the doctor if their child has any of these signs: blurred vision, walking unsteadily, or is hard to awaken."

b. "If there is a language barrier, written instructions can be given, followed by discharge."

While orienting a new nurse to the ICU, she asks, "How do these children sleep and not become frightened with all the lights and noises?" How should you respond? Select all that apply. a. "These children are sicker than those on the pediatric unit, so the noises and lights are necessary." b. "We try to organize care into clusters so that infants and children can sleep and we can turn down lights." c. "We silence alarms to allow for periods of sleep, especially at night." d. "When possible, we allow for uninterrupted sleep cycles—for infants 90 minutes and for older children 60 minutes." e. "We encourage parents to sit with and touch their child as often as possible.

b. "We try to organize care into clusters so that infants and children can sleep and we can turn down lights." e. "We encourage parents to sit with and touch their child as often as possible.

Urinary system distress (neurogenic bladder) in children with spina bifida (SB) is managed by: a. DDAVP (1-deamino-8-D-arginine vasopressin) b. Clean intermittent catheterization (CIC) c. Continuous urinary catheterization d. Mitrofanoff procedure

b. Clean intermittent catheterization (CIC)

At a visit to the pediatric clinic, a mother is concerned by her 4-year-old's symptoms over the last few weeks. Which of the following symptoms described by the mother would lead the nurse to be concerned about an oncologic disorder? Select all that apply. a. Bruising in various stages, mainly on the legs b. Frequent complaints of respiratory infections, while siblings remain healthy c. Enlarged, firm lymph nodes d. Asthma symptoms with increase in wheezing e. Fever for more than 1 week

b. Frequent complaints of respiratory infections, while siblings remain healthy c. Enlarged, firm lymph nodes e. Fever for more than 1 week

You are working in the emergency department, and a 10-year-old child with type 1 diabetes mellitus (DM) has just been admitted. He has been diagnosed with diabetic ketoacidosis (DKA). Which assessment data will you expect to note in this child? a. Shallow or normal respirations, hypertension, and tachycardia b. Fruity breath odor and decreasing level of consciousness c. Headache, hunger, and excessive irritability d. Normal urine output with specific gravity less than 1.020 and a trace of ketones

b. Fruity breath odor and decreasing level of consciousness

Discharge teaching for parents of a school-age patient with diabetes insipidus (DI) should include which of the following? Select all that apply. a. Education and support regarding the rationale for fluid restrictions b. Information for school personnel regarding the diagnosis so that they can grant children unrestricted use of the lavatory c. A thorough explanation regarding the condition with specific clarification that DI is a different condition from diabetes mellitus (DM) d. Understanding that treatment will only be needed until the child reaches puberty e. Knowing that school-age children may assume full responsibility for their care

b. Information for school personnel regarding the diagnosis so that they can grant children unrestricted use of the lavatory c. A thorough explanation regarding the condition with specific clarification that DI is a different condition from diabetes mellitus (DM) e. Knowing that school-age children may assume full responsibility for their care

The primary risk factor for the development of cerebral palsy (CP) is: a. Maternal chorioamnionitis b. Premature birth c. Birth asphyxia d. Intraventricular hemorrhage

b. Premature birth

The most common complication that should be anticipated and observed for in an infant with myelomeningocele after surgical repair of the defect is: a. Urinary stress b. Chiari malformation c. Hydrocephalus d. Latex allergy

c. Hydrocephalus

A 2-day-old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip (DDH), and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include: a. Return to the orthopedist's office in 2 weeks to remove the hip spica cast. b. The infant's bilateral foot casts should be elevated on pillows as much as possible. c. Remove the Pavlik harness once a day for no more than 2 hours and inspect skin. d. Remove the Pavlik harness while the infant is awake to allow "tummy time."

c. Remove the Pavlik harness once a day for no more than 2 hours and inspect skin.

As the nurse assigned to a child diagnosed with bacterial meningitis, you know that: a. The child will not need to be placed in isolation because antibiotics have been started. b. Enteric precautions will remain in place for up to 48 hours. c. Respiratory isolation will remain in place for 24 hours after antibiotics are started. d. Due to headache, the child will want the head of the bed elevated with two pillows.

c. Respiratory isolation will remain in place for 24 hours after antibiotics are started.

You are the nurse assigned to care for a child with a basilar skull fracture. Your most important nursing observation is change in level of consciousness (LOC). You will be highly alert for: a. Alterations in vital signs that often appear before alterations in consciousness or focal neurologic signs b. Bleeding from the ear, which is indicative of an anterior basal skull fracture c. Seizures, which are relatively uncommon in children at the time of head injury d. Changes in posturing, such as any signs of extension or flexion posturing, unusual response to stimuli, and random versus purposeful movement

d. Changes in posturing, such as any signs of extension or flexion posturing, unusual response to stimuli, and random versus purposeful movement

You are caring for a child with hydrocephalus who is postoperative from a shunt revision. Which assessment finding is your priority for increased intracranial pressure (ICP)? a. Nausea and refusal to eat postoperatively b. Complaint of a headache c. Irritability and wanting to sleep d. Decrease in heart rate over the last hour

d. Decrease in heart rate over the last hour

You are caring for a child on the pediatric unit with a suspected abdominal tumor. Which criteria would lead you to determine this tumor is a neuroblastoma rather than a Wilms tumor? a. Most children present with neuroblastoma around age 4. b. Neuroblastoma is a firm, nontender, irregular mass confined to one side, generally deep in the flank. c. Hypertension is often noted due to secretion of excess amounts of rennin by the tumor. d. Most tumors develop in the adrenal gland or the retroperitoneal sympathetic chain.

d. Most tumors develop in the adrenal gland or the retroperitoneal sympathetic chain.

A 12-year-old who was in an all-terrain vehicle (ATV) accident has a long-leg fiberglass cast on his left leg for a tibia-fibula fracture. He requests pain medication at 2:00 AM for pain he rates at a 10/10 on the Numeric Scale. The nurse brings the pain medication and notes that he has removed the pillows that kept his leg elevated. He complains of pain in the left foot, and she notes that there is 3+ edema in the exposed leg and foot, and she is unable to slip a finger under the cast. The nurse's priority interventions in this situation should include: a. Administer the pain medication and elevate the child's leg on the pillows. b. Elevate the leg on the pillows and follow up within 2 to 3 hours to see if the edema has decreased. c. Let the child know that he cannot have any additional pain medication until 6:00 AM. d. Notify the surgeon of the findings immediately.

d. Notify the surgeon of the findings immediately.