PEDS Week 5- Book/Online

3. 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

1. Which of the following is a clinical manifestation of increased intracranial pressure (ICP) in infants? A. Irritability B. Photophobia C. Vomiting and diarrhea D. Pulsating anterior fontanel

A Irritability is one of the changes that may indicate increased ICP. Photophobia is not indicative of increased ICP in infants. A pulsing anterior fontanel is normal. Vomiting is one of the signs of increased ICP in children, but when present with diarrhea, it is indicative of a gastrointestinal disturbance.(CH 32 pg 1428)

7. Therapeutic management of nephrotic syndrome includes which of the following? A. Corticosteroids B. Long-term diuretics C. Antihypertensive agents D. Fluid and salt restrictions

A Most children with nephrotic syndrome respond to corticosteroids, making this group the drug of choice. Corticosteroid therapy is begun as soon as the diagnosis has been determined. Children with nephrotic syndrome usually do not respond to diuretics. Furosemide, in combination with metolazone, is useful for severe edema. Antihypertensive agents are not indicated in the management. Fluids are rarely restricted. The child is placed on a no-added-salt diet.(CH 25 pg 1019)

8. Which of the following is the primary clinical manifestation of acute renal failure? A. Oliguria B. Hematuria C. Proteinuria D. Bacteriuria

A Oliguria is the primary clinical symptom of acute renal failure. Generally, urinary output is less than 1 ml/kg/hr. Hematuria, proteinuria, and bacteriuria may be present in renal disease, but they are not the primary manifestations of acute renal failure.(CH 25 pg 1023)

3. The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. Which of the following is the most essential in this assessment? A. Reactivity of pupils B. Doll's head maneuver C. Oculovestibular response D. Funduscopic examination to identify papilledema

A Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity. The doll's head maneuver should not be performed if there is a cervical spine injury. The oculovestibular response is a painful test that should not be done on a child who is having variable levels of consciousness. Papilledema does not develop until 24 to 48 hours into the course of unconsciousness.(pg 1433)

2. 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, B, D

5. 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, B, D

1. The nurse is caring for a 4-year-old girl with a history of frequent urinary tract infections. 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. Since 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, C, E

4. When giving discharge instructions to a parent post hypospadias repair, the nurse recognizes a need for more teaching when the mother says which of the following? Select all that apply. A. "I know I should never clamp off the catheter." B. "My child can take a tub bath when we arrive home because it will soothe the area." C. "An antibacterial ointment may be applied to the penis daily for infection control." D. "Fluids should be monitored and rationed to prevent fluid overload." E. "My child should avoid straddle toys, sandboxes, swimming, and rough activities until allowed by the surgeon."

A, C, E

3. 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

5. What is the 24-hour fluid requirement for a child weighing 32 kg? A. 1920 ml/day B. 1740 ml/day C. 1840 ml/day D. 1620 ml/day

B

4. Which of the following best describes the cause of most cases of acute glomerulonephritis? A. Renal vascular anomalies B. Antecedent streptococcal infection C. Results from a urinary tract infection D. Structural anomalies of genitourinary tract

B Most cases are postinfectious and have been associated with pneumococcal, streptococcal, or viral infections. Renal vascular anomalies are not associated with acute glomerulonephritis. Urinary tract infections and structural anomalies can result in progressive renal injury, not acute glomerulonephritis.(CH 25 pg 1013)

1. Which of the following urine tests of renal function is used to estimate glomerular filtration? A. pH B. Creatinine C. Osmolality D. Protein level

B The most useful clinical estimation of glomerular filtration is the clearance of creatinine. The production and secretion of creatinine remain relatively constant from day to day, and its appearance in the urine is determined by the serum level. The pH is a measure of alkalinity, not glomerular filtration. Osmolality is a measure of concentration. The presence of protein is indicative of abnormal glomerular permeability.(CH 25 pg 1000)

5. The nurse is caring for a 2-year-old girl who is unconscious but stable after a car accident. Her parents are staying at the bedside most of the time. Which of the following is an appropriate nursing intervention? A. Suggest that the parents go home until she is alert enough to know they are present. B. Encourage the parents to hold, talk, and sing to her as they usually would. C. Use ointment on her lips but do not attempt to cleanse her teeth until swallowing returns. D. Position her with proper body alignment and the head of the bed lowered 15 degrees.

B The parents should be encouraged to interact with their daughter. Senses of hearing and tactile perception may be intact, and stimulation of these senses is important. The daughter may be able to hear that they are present. Oral care is essential in an unconscious child. Mouth care should be done at least twice daily. The head of the bed should be elevated, not lowered.(CH 32 pg 1441)

2. Which of the following factors predisposes the urinary tract to infection? A. Increased fluid intake B. Short urethra in girls C. Ingestion of highly acidic juices D. Frequent emptying of the bladder

B The short urethra, which measures approximately 2 cm (0.8 in) in girls and 4 cm (1.6 in) in mature women, provides a ready pathway for invasion of organisms. Increased fluid intake results in frequent emptying of the bladder, preventing urinary stasis. Urine is bacteriostatic at pH of 5.0. This is not achievable by ingestion of juice. Frequent emptying of the bladder helps prevent urinary tract infections.(CH 25 pg 1005)

2. 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

10. Which of the following is an advantage of continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis for adolescents who require dialysis? A. Dietary restrictions are no longer necessary. B. Hospitalization is only required several nights per week. C. Adolescents can carry out procedures themselves. D. Insertion of a catheter does not require surgical placement.

C Continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis provide the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves. Dietary restrictions are still required but are less strict. The procedure can be done at home. The catheter is surgically implanted in the abdominal cavity.(CH 25 pg 1038)

10. A child is brought to the emergency department after experiencing a seizure at school. He has no history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is which of the following? A. "Epilepsy is easily treated." B. "Very few children have actual epilepsy." C. "The seizure may or may not mean that your child has epilepsy." D. "Your child has had only one convulsion; it probably won't happen again."

C A single seizure event is not classified as epilepsy and is generally not treated with long-term antiepileptic drugs. It can be the result of an acute medical or neurologic disease. True epilepsy is not easily treated, so saying that it is easily treated minimizes the father's concern. The statistics on epilepsy do not address the father's issues about his child. The seizure may or may not mean that a child has epilepsy, so it may not happen again. The nurse needs to provide the information to the parent that the diagnosis is not based on one seizure episode.(CH 32 pg 1464)

5. In acute glomerulonephritis, the nurse is aware that an early warning sign of encephalopathy is which of the following? A. Seizures B. Psychosis C. Dizziness D. Transient loss of vision

C Acute and severe hypertension can cause the protective autoregulation of cerebral blood flow to fail, leading to hyperperfusion of the brain and cerebral edema. The premonitory signs of encephalopathy are headache, dizziness, abdominal discomfort, and vomiting. Seizures and transient loss of vision are signs that the condition is progressing. Psychosis is not an early warning sign of hypertensive encephalopathy. Seizures and transient loss of vision are signs that the condition is progressing.(CH 25 pg 1014)

9. The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. Which of the following is a priority of nursing care? A. Initiate isolation precautions as soon as diagnosis is confirmed. B. Provide environmental stimulation to keep the child awake. C. Administer antibiotic therapy as soon as it is available. D. Administer sedatives and analgesics on a preventive schedule to manage pain

C Administering antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to avoid resultant disabilities and to prevent death. Isolation should be instituted as soon as diagnosis is anticipated. It is important to decrease the external stimuli. The nurse should keep the room as quiet as possible. Antibiotics are the priority function; pain should be managed if it occurs.(CH 32 pg 1458)

3. A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually results in A. incontinence. B. urinary obstruction. C. recurrent urinary tract infections. D. infarction of renal vessels.

C Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to urinary tract infections and pyelonephritis. Incontinence may be associated with urinary tract infections. Reflux, when associated with vesicoureteral reflux, can cause renal scarring but not obstruction. Infarction of renal vessels does not occur.(CH 25 pg 1005)

2. The Glasgow Coma Scale consists of an assessment of A. pupil reactivity and motor response. B. level of consciousness and verbal response. C. eye opening and verbal and motor response. D. intracranial pressure and level of consciousness.

C The scale is a three-part assessment that includes eye opening, verbal response, and motor response. It is an observational tool to detect a life-threatening complication such as cerebral edema. Pupil reactivity, level of consciousness, and intracranial pressure are not included in the scale.(CH 32 pg 1430)

4. The nurse is caring for a child with multiple injuries who is comatose. The nurse should recognize that pain A. cannot occur if the child is comatose. B. may occur if the child regains consciousness. C. requires astute nursing assessment and management. D. is best assessed by family members who are familiar with the child.

C. Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations. The child can be in pain while comatose. The family can provide insight into different responses, but the nurse should monitor physiologic and behavioral manifestations.(CH 32 pg 1437)

1. 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. 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 that 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

4. You are caring for a child with hydrocephalus who is postoperative from a shunt revision. Which assessment finding is your priority for increased intercranial pressure? 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

7. The nurse should recommend medical attention if a child with a slight head injury experiences which of the following? A. Vomiting B. Sleepiness C. Headache, even if slight D. Confusion or abnormal behavior

D Altered mental status is a clinical manifestation that the damage from the head injury is progressing. Medical evaluation is necessary. Vomiting may occur after a minor head injury. Observation is required for changes in behavior or vital signs that indicate progression. Sleepiness may occur after a minor head injury. Observation is required to ensure that the child is arousable. Headache is common after a head injury and does not require medical evaluation unless accompanied by other signs of progression.(CH 32 pg 1444)

8. A 3-year-old child is hospitalized after submersion injury. The child's mother complains to the nurse, "This seems unnecessary when he is perfectly fine." The nurse's best reply would be which of the following? A. "He still needs a little extra oxygen." B. "I'm sure he is fine, but the doctor wants to make sure." C. "It is important to observe for possible physical reasons for the accident." D. "The reason for hospitalization is that complications could still occur."

D Complications such as respiratory compromise and cerebral edema can occur 24 hours after the incident. If the child needed oxygen, the mother would not state the child is perfectly fine. Telling the mother that the doctor wants to make sure the child is fine minimizes the role of the nurse and the need for observation for potential life-threatening complications. Physiologic causes may need to be identified in the case of a submersion injury, but it is not the reason for hospitalization.(CH 32 pg 1453)

6. The clinical manifestations of nephrotic syndrome include which of the following? A. Hematuria, bacteriuria, and weight gain B. Gross hematuria, albuminuria, and fever C. Hypertension, weight loss, and proteinuria D. Proteinuria, hypoalbuminemia, and edema

D Edema, proteinuria, hypoalbuminemia, and hypercholesterolemia are the clinical manifestations of nephrotic syndrome in children. Bacteriuria is not a diagnostic criterion for nephrotic syndrome. Fever is not associated with nephrotic syndrome. Weight gain occurs secondary to the edema. (CH 25 pg 1017)

6. Why are infants particularly vulnerable to acceleration-deceleration head injuries? A. The anterior fontanel is not yet closed. B. The nervous tissue is not well developed. C. The scalp of the head has extensive vascularity. D. Musculoskeletal support of the head is insufficient.

D The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants. The anterior fontanel, nervous tissue, and scalp of the head do not have an effect on this type of injury.(CH 32 pg 1443)

9. Dialysis or transplantation becomes necessary for chronic renal failure when A. anemia develops. B. acidosis develops. C. glomerular filtration rate falls below 50% of normal. D. glomerular filtration rate falls below 10% to 15% of normal.

D Treatment with dialysis or transplantation is required when the glomerular filtration rate falls below 10% to 15% of normal. Anemia and acidosis may be present as part of the underlying disorder. The glomerular filtration rate determines the need for dialysis. The kidneys are able to maintain the chemical composition of fluids within normal limits until more than 50% of functional renal capacity is destroyed by disease or injury.(CH 25 pg 1029)