uworld-Pediatric

29. A nurse is caring for a 1-month-old client who is being evaluated for congenital hypothyroidism. The nurse should recognize which of the following as clinical manifestations of hypothyroidism in infants? sata 1. difficult to awaken 2.dry skin 3. frequent, loose stools 4. hoarse cry 5. tachycardia

1 . 2. 4 Congenital hypothyroidism occurs when abnormal development of the thyroid gland causes complete or decreased secretion of thyroid hormone (TH). Untreated hypothyroidism can cause severe intellectual disability in infants if undetected. Screening occurs after birth for all infants in the United States and Canada to prevent disability and encourage early treatment (ie, levothyroxine). TH plays an important role in growth, development, and regulation of many bodily functions (eg, heat production, muscle tone, skin function, cardiac function, metabolism). Clinical manifestations in affected infants reflect the pathophysiology of decreased TH and may include: Difficulty awakening, lethargy, or hyporeflexia due to alterations in central nervous system function (Option 1) Dry skin due to alterations in skin function (Option 2) Hoarse cry caused by swelling of the vocal cords due to fluid retention (Option 4) Constipation due to slowed metabolism Bradycardia due to the effect of TH on cardiac function (Options 3 and 5) Hyperthyroidism (Graves disease) is an autoimmune condition related to increased production of TH. Neonatal Graves disease is uncommon and usually occurs secondary to maternal hyperthyroidism. Tachycardia and increased bowel motility (frequent or loose stools) are features of hyperthyroidism and are related to an increase in metabolic processes.

9.. The nurse is educating the parent of an adolescent client who is newly diagnosed with infectious mononucleosis. Which statement by the parent indicates the need for additional instruction? 1. "I need to go to the pharmacy to pick up an antibiotic prescription." 2. " It is acceptable for my child to have ibuprofen for discomfort." 3. " My child will be on bed rest with few activities for several days." 4. "Participation in soccer practice will not be allowed for the next month."

1. "I need to go to the pharmacy to pick up an antibiotic prescription." Mononucleosis, a viral infection caused by Epstein-Barr virus, is commonly seen in adolescents, resulting from direct exposure to the saliva of infected individuals (eg, sharing drinks, kissing). Treatment for mononucleosis includes hydration, rest, control of pain, and reducing fever as necessary. Antibiotic treatment is inappropriate for a viral infection and can cause a rash.

2The nurse is reviewing discharge instructions with the parents of a child who just had a tracheostomy. Which statement made by the parents indicates teaching has been effective? 1. "I will always travel with two tracheostomy tubes, one of the same size and one a size smaller." 2. "I will immediately change the tracheostomy tube if my child has difficulty breathing." 3. "I will provide deep suctioning frequently to prevent any airway obstruction." 4. "I will remove the humidifier if my child starts developing more secretions. "

1. "I will always travel with two tracheostomy tubes, one of the same size and one a size smaller. " in the event of an accidental decannulation or another urgent need to change a tracheostomy tube, the most important action is to quickly replace the tube as it is the client's only means to ventilate. Clients should always carry two spare tracheostomy tubes, one the same size and one a size smaller. If the tube is not easily replaced or is meeting resistance, the smaller tube should be used. (Option 2) Changing a tracheostomy tube is a high-risk procedure that should be done only if respiratory distress is noted and other interventions (eg, suctioning) have failed. Mucus plugs (ie, thickening and buildup of mucus due to dehydration) are one of the most common causes of respiratory distress. (Option 3) A tracheostomy should be suctioned frequently to maintain airway patency. However, deep suctioning should be reserved for clients in respiratory distress due to the risk of injury. Tracheostomy tubes should be suctioned to the specified depth using a measurement marked on the tube, to provide safe, effective suctioning. (Option 4) Humidification is crucial for clients with a tracheostomy as the upper airway, which provides natural humidity for inhaled air, is bypassed. Humidification helps keep secretions thin and reduces formation of mucus plugs. The humidifier should not be removed if the child develops more secretions as this is the intended effect. Educational objective:Clients with a tracheostomy should always carry two spare tubes, one the same size and one a size smaller, to ensure that the tube can be replaced quickly and effectively.

6. The nurse is reviewing recommended dietary modifications with the parents of a 6-month-old client with phenylketonuria. Which of the following information should the nurse include? Select all that apply. 1. " a low-phenylalanine diet is required. " 2. " Meat and dairy products should not be introduced into the diet." 3. " Phenylketonuria is self-limiting and dietary modifications are temporary." 4. "Specially prepared infant formula is necessary." 5. "Tyrosine should be removed from the diet."

1. 2. 4 Phenylketonuria (PKU) is one of a few genetic inborn errors of metabolism. Individuals with PKU have a phenylalanine hydroxylase (PAH) enzyme deficiency. PAH enzyme is required for converting the amino acid phenylalanine into the amino acid tyrosine. As unconverted phenylalanine accumulates; irreversible neurologic damage can occur. A low-phenylalanine diet is essential in the treatment of PKU (Option 1). Phenylalanine cannot be entirely eliminated from the diet because it is an essential amino acid and necessary for normal development. The diet must meet nutritional needs while maintaining safe phenylalanine levels (2-6 mg/dL [120-360 µmol/L] for clients age <12). Other management strategies for clients with PKU include: Eliminating high-phenylalanine foods (eg, meats, eggs, milk) from the diet (Option 2) Feeding infants specially prepared formulas that are low in phenylalanine (Option 4) Encouraging consumption of natural foods low in phenylalanine (ie, most fruits and vegetables) (Option 3) There is no known age at which the low-phenylalanine diet can be discontinued safely. Lifetime dietary restrictions are recommended for optimal health. (Option 5) Restriction of dietary tyrosine is not necessary. Tyrosine levels in clients with PKU may be normal or slightly decreased. Educational objective:Phenylketonuria (PKU) is an inherited metabolic disease that results from a deficiency or absence of an enzyme needed to metabolize phenylalanine, an amino acid that is present in proteins. To prevent neurological damage caused by elevated serum phenylalanine levels, infants need to consume formulas low in phenylalanine and maintain a lifetime dietary restriction of high-phenylalanine foods (eg, meat, eggs, milk).

21. A nurse is reinforcing education given to the parents of a child diagnosed with chronic allergic rhinitis that is triggered by household and environmental allergens. Which statements by the parents indicate that the teaching has been effective? Select all that apply. 1. "My wife plans to wipe down our child's furniture with a damp rag every other day." 2 ."Our child needs plastic covers for the mattress and pillow." 3. "We must give away the family dog." 4. "We will keep the windows open during warm weather to air out the house." 5. "We will replace the carpet with hardwood floors throughout the house. "

1. 2. 5 Symptoms of allergic rhinitis include sneezing, nasal drainage, nasal congestion, and pruritus of the eyes or nose. Clients and their families can help prevent these symptoms by identifying individual triggers (eg, dust, mold, pollen, dander) and implementing strategies to reduce or avoid exposure to known allergens. Key measures to reduce exposure to household and environmental allergens include the following: Installing high-efficiency particulate air filters in the home air conditioning system Keeping windows closed and staying indoors, particularly during times of heavy pollen Using hypoallergenic pillow and mattress covers to prevent exposure to dust mites (Option 2) Reducing or eliminating carpet and area rugs from the home (Option 5) Regularly mopping hard floors and damp-dusting furniture (at least weekly) (Option 1) (Option 3) If the client is not allergic to animal dander, keeping a household pet may be acceptable. However, to prevent pets from bringing environmental allergens into the home, further precautions may need to be implemented, such as more frequent baths or placement of additional doormats. (Option 4) Open windows allow environmental allergens, such as pollen, to enter the home. To prevent exposure to these particles, susceptible clients should keep exterior windows closed and avoid spending long periods of time outdoors.

27. A home health nurse is managing care for an adolescent client with cystic fibrosis. Which of the following potential complications should the nurse consider when developing a nurse care plan? sata 1. chronic hypoxemia 2.diabetes insipidus 3. frequent respiratory infections 4. obesity 5. vitamin deficiencies

1. 3. 5 Cystic fibrosis (CF) is an inherited disorder (autosomal recessive) characterized by thickened secretions due to impaired chloride and sodium channel regulation that causes exocrine gland dysfunction. Management of a client with CF should primarily address potential complications related to the following body systems: Pulmonary: Alterations in respiratory secretions (ie, thick sputum) make it difficult to clear the airway and can result in frequent respiratory infections and sinusitis (Option 3). Frequent infections and inflammation damage lung tissue and may lead to chronic hypoxemia (Option 1). Gastrointestinal: Thickened secretions obstruct the release of pancreatic enzymes, causing malabsorption of fat-soluble vitamins (eg, A, E, D, K) and other nutritional deficiencies (Option 5). High-protein, high-calorie foods and supplemental enzymes with meals are necessary. Reproductive: Thickened reproductive secretions (eg, seminal fluid, cervical mucus) or the absence of the vas deferens in men contributes to CF-related infertility. (Option 2) Diabetes mellitus, not diabetes insipidus, is a potential complication for clients with CF due to pathologic pancreatic changes (eg, fibrosis). (Option 4) Due to impaired gastrointestinal absorption, weight loss and failure to thrive are more common and a greater concern than obesity. Educational objective:Cystic fibrosis is an inherited disorder that results in impaired exocrine gland function and is characterized by thickened secretions that affect the pulmonary, gastrointestinal, and reproductive systems. When planning care, the nurse should monitor for priority concerns, including development of respiratory infections, chronic hypoxemia, nutritional deficiencies, and abnormal growth (failure to thrive).

25. The nurse is assisting with an education conference for graduate nurses about infant CPR. Which of the following statements are appropriate to include in the teaching? Select all that apply. 1. " A single rescuer responding to an unwitnessed infant arrest should perform 2 minutes of CPR before retrieving a defibrillator." 2. "Depth of chest compressions for infants should be half the depth of anterior-posterior chest diameter." 3. "Rescuers should place the heel of one hand on the lower sternum when delivering chest compressions to infants." 4. "The ratio of chest compressions to breaths during CPR by a single rescuer is 15:2 for infants." 5." You should assess the infant's brachial pulse for no longer than 10 seconds."

1. 5 Although rare, cardiac arrest in infants can occur and usually stems from a respiratory etiology. The American Heart Association provides guidelines for basic life support of infants (<12 months), including certain CPR modifications (eg, the location of pulse check) and the timing of emergency services notification and retrieval of the automatic external defibrillator (AED). The rescuer should check the infant's brachial pulse for no longer than 10 seconds (Option 5). During an unwitnessed collapse, a single rescuer should shout for nearby help, activate the emergency response system (eg, call emergency services via mobile device if located outside a health care setting), and then provide approximately 2 minutes of CPR at a rate of at least 100 compressions/min before retrieving the AED (Option 1). (Option 2) The rescuer should deliver chest compressions to an infant at a depth equal to one-third of the chest's anterior-posterior diameter (ie, ~1.5 in [4 cm]) and allow for recoil between compressions. (Option 3) The rescuer should perform infant chest compressions using either two fingers or two thumbs on the sternum just below the nipple line. (Option 4) Single rescuers performing infant CPR should use a 30:2 compression-to-breath ratio. A compression-to-breath ratio of 15:2 is used when two rescuers are involved. Educational objective:The American Heart Association provides guidelines for basic life support of infants, including initial client evaluation (eg, assess brachial pulse) and retrieval of automatic external defibrillator (ie, after 2 min of CPR during an unwitnessed collapse with a single rescuer).

17. The nurse assesses a child with intussusception. Which assessment findings require priority intervention? 1. abdominal rigidity with guarding 2. absence of tears in crying child with IV start 3. blood-streaked mucous stool in diaper 4. sausage-shaped right-sided mass on palpation

1. abdominal rigidity with guarding Intussusception occurs when part of the intestine telescopes into another adjacent part and causes a blockage. This leads to swelling and decreased blood supply to the intestine. Tissue death as well as perforation to the bowel may result. If perforation occurs, the client could develop peritonitis in which the peritoneum in the abdomen becomes inflamed due to infection. This can quickly lead to sepsis and multiple organ failure. Peritonitis is characterized by fever, abdominal rigidity, guarding, and rebound tenderness. This condition can be fatal if it is not treated quickly.

32. The nurse is assessing a 4-week-old infant during a routine office visit. Which assessment finding is most likely to alert the nurse to the pressure of right hip development dysplasia ? 1. decreased right hip adduction 2.presence of extra gluteal folds on right side 3. right leg longer than the left leg 4. right pelvic tilt with lordosis

2 . presence of extra gluteal folds on right side. Screening for developmental dysplasia of the hip is a standard part of infant assessment. Manifestations in infants age <2-3 months include the presence of extra inguinal or thigh folds and laxity of the hip joint on the affected side. After age 3 months, limited hip abduction and limb shortening on the affected side are evident. A pelvic tilt is noted once the child learns to walk.

1. A child received the varicella immunization. The day after the injection, the parent calls the nurse to say that the child has discomfort, slight redness, and 2 vesicles at the injection site. Which instruction should the nurse reinforce? 1. administer aspirin to decrease discomfort 2. cover the vesicles with a small bandage until they are dry 3. isolate the child from the other children for 21 days to avoid exposure 4. make an appointment with the health care provider (HCP) as soon as possible

2 cover the vesicles with a small bandage until they are dry. The varicella immunization is administered to prevent infection of varicella zoster, commonly known as chickenpox. Side effects of the immunization include discomfort, redness, and a few vesicles at the injection site. Covering the vesicles with clothing or a small bandage will reduce the risk of transmission from any exudate. Once the vesicles have dried, or crusted, a dressing is no longer necessary. (Option 1) Acetaminophen is the appropriate medication to reduce the discomfort of the injection. Aspirin should be avoided in children due to the risk of Reye syndrome. (Option 3) Unless the rash becomes widespread, isolation of the child is unnecessary. It is unlikely that the infection will be transmitted by the 2 vesicles, but covering them with clothing or a small bandage will decrease the risk of transmission. (Option 4) Discomfort, redness, and a few vesicles at the injection site are common side effects of the varicella immunization and do not require the attention of a healthcare provider. Educational objective:Discomfort, redness, and vesicles at the injection site are common side effects of the varicella immunization. Covering the vesicles with clothing or a small bandage will reduce the risk of transmission from any exudate.

20. A 30-month-old child with developmental dysplasia of the hip (DDH) is being fitted for a Pavlik harness . Which statement made by the parent indicates a need for further instruction? 1. " I should leave the harness on during diaper changes." 2. " I will adjust the harness straps every 3-5 days." 3. "I will inspect the skin under the straps 2-3 times daily." 4. " The harness should keep my baby's legs bent and spread apart."

2. The Pavlik harness is used in the treatment of DDH; it maintains the infant's hips in a slightly flexed and abducted position to allow for proper joint development. Strap adjustments should be performed by the HCP to allow for proper positioning and avoid nerve or vascular damage.

28. The nurse is caring for a 7-year-old client diagnosed with nephrotic syndrome who will be discharged soon. Which statement by the parent indicates the need for further teaching? 1. " I"ll provide a healthy diet without added salt for my child." 2. "I'll organize playdates to keep my child's spirits up during relapses." 3." I'll restrict my child's fluids if I notice swelling or rapid weight gain." 4. " I'll test for protein in my child's urine every day."

2. The loss of immunoglobulins causes increased susceptibility to infection. Caregivers should minimize the risk of infection during relapses (eg, limiting visitors) (Option 2). Treatment typically includes: Corticosteroids and other immunosuppressants (eg, cyclosporine) Loss of appetite management (eg, making foods fun and attractive) Infection prevention (eg, limiting social interaction until the child is in remission) (Option 1) A regular diet without added salt is prescribed to prevent edema while in remission. More stringent sodium restrictions are necessary when symptoms are present. (Option 3) Fluid restriction is needed in cases of edema or rapid weight gain. (Option 4) There is a high risk for recurrence after recovery, and relapses may occur several times per year. The parent/caregiver should test daily for proteinuria, weigh the child weekly, and keep a diary of results. Educational objective:Nephrotic syndrome is characterized by massive proteinuria, edema, and hypoalbuminemia. Home management includes a low-sodium diet with attractive foods; infection prevention; fluid restriction for severe edema; and monitoring of weight gain and proteinuria to detect relapse.

11.The nurse is reinforcing education about home care to the parent of a 10-year-old with cystic fibrosis. Which of the following statements by the parent indicates that teaching has been effective? Select all that apply. 1. " chest physiotherapy is administered only if respiratory symptoms worsen." 2. " I will give my child pancreatic enzymes with all meals and snacks." 3. " I will increase my child's salt intake during hot weather. " 4." Our child will need a high-carbohydrate, high-protein diet." 5. " We will limit our child's participation in sports activities."

2. 3. 4 (Option 1) Regardless of symptoms, clients should incorporate chest physiotherapy (eg, percussion, vibration, postural drainage) into their daily routine to improve mucus clearance and lung function. (Option 5) The parents should encourage physical activity as tolerated because it helps to thin secretions and remove them from airways and improves muscle strength and lung capacity. Educational objective:Cystic fibrosis causes increased viscosity of exocrine gland secretions. Clients require pancreatic enzyme supplements with all meals and snacks; a diet high in carbohydrates, protein, and fat; and increased salt intake during times of significant perspiration. Clients should also incorporate chest physiotherapy and exercise into their daily routine.

24. A 2-month-old recently diagnosed with developmental dysplasia of the hip is beginning treatment with a Pavlik harness. Which instructions should the nurse reinforce to the parents? Select all that apply. 1. "Apply lotion under the straps to protect the skin." 2." dress the child in a shirt and knee socks under the straps." 3, " lightly massage the skin under the straps daily." 4. " Place the diaper under the straps." 5. "Remove the harness during diaper changes."

2. 3. 4 Instructions on care for the infant wearing a Pavlik harness are as follows: Regularly assess skin for redness or breakdown under the straps Dress the child in a shirt and knee socks under the harness to protect the skin (Option 2) Avoid lotions and powders to prevent irritation and excess moisture (Option 1) Lightly massage the skin under the straps every day to promote circulation (Option 3) Only apply 1 diaper at a time as wearing ≥2 diapers (previous treatment practice) increases risk of incorrect hip placement Apply diapers underneath the straps to keep harness clean and dry (Option 4) (Option 5) The Pavlik harness is usually worn all the time, particularly during the first few weeks of treatment. Some providers may allow the harness to be removed for a short bath once a day, but it should be left in place for all other care activities, including diaper changes.

30. The clinic nurse supervises a student nurse who is preparing to administer routine vaccinations to a child diagnosed with hemophilia. Which instructions should the clinic nurse provide to the student? sata 1. administer ibuprofen for pain relief 2. administer vaccines via the subcutaneous route 3. apply a warm compress to the injection site 4. hold firm pressure on the site for 5 minutes 5. massage the injection site to disperse the medication

2. 4. Hemophilia is a bleeding disorder caused by a deficiency in coagulation proteins, increasing the risk for bleeding. The nurse should avoid procedures that can cause bleeding (eg, intramuscular injections, rectal temperature measurement). Vaccinations are administered subcutaneously whenever possible to prevent intramuscular hematoma (Option 2). The smallest gauge needle is used, and firm, continuous pressure is applied at the site for 5 minutes (Option 4). (Option 1) Children with hemophilia should avoid aspirin and nonsteroidal anti-inflammatory drugs due to the risk of bleeding. Acetaminophen is recommended for pain relief. (Options 3 and 5) Firm pressure should be held on the site without rubbing or massaging due to the risk of bleeding and hematoma formation. Superficial bleeding can be controlled using ice packs, which promote vasoconstriction. Applying a warm compress would cause vasodilation and prolong bleeding. Educational objective:Procedures that can cause bleeding (eg, intramuscular injections) are avoided in children with hemophilia. Vaccinations are administered subcutaneously when possible, and the smallest gauge needle is used. Firm pressure is applied to the injection site for 5 minutes, often using ice. Nonsteroidal anti-inflammatory agents including aspirin are avoided due to the risk of bleeding.

4.A client diagnosed with acute glomerulonephritis has pitting edema in the lower extremities, a blood pressure of 170/80 mm Hg, and proteinuria. When the practical nurse is assisting in the development of a care plan for this client, which measurement is the most accurate indicator of fluid loss or gain and should therefore be included in the plan? 1. blood pressure measurements 2. daily weight measurements 3. severity of pitting edema 4. strict intake and output measurements

2. daily weight measurements The most accurate indicator of fluid loss or gain in an acutely ill client is weight as accurate measuring of intake and output and assessment of insensible losses may be difficult (Option 4). A 2.2-lb (1-kg) weight gain is equal to 1,000 mL of retained fluid. (Option 1) Blood pressure measures the amount of pressure exerted on the arterial walls due to factors such as peripheral artery constriction or dilation, not just fluid volume status. (Option 3) Pitting edema is not an accurate indicator as the fluid may shift from intravascular to interstitial spaces without an overall change in fluid gain or loss throughout the body. Educational objective:The most accurate indicator of fluid loss or gain in an acutely ill client is daily weight measurement.

31. A 7-month-old infant is admitted to the unit with suspected bacterial meningitis after receiving an initial dose of antibiotics in the emergency department. Frequent monitoring of which of the following is most important? 1. babinski reflex 2.fontanel assessment 3.pulse pressure 4. pupillary light response

2. fontanel assessment Bacterial meningitis is inflammation of the meninges of the brain and spinal cord caused by infection. General manifestations in infants and children age <2 include fever, restlessness, and a high-pitched cry. One common acute complication of bacterial meningitis is hydrocephalus, an increase in intracranial pressure (ICP) resulting from obstruction of cerebrospinal fluid flow. Increased ICP can progress to permanent hearing loss, learning disabilities, and brain damage. Bulging/tense fontanels and increasing head circumference are important early indicators of increased ICP in children. Frequent assessment for developing complications is vital for any client with suspected bacterial meningitis. (Option 1) The Babinski reflex can be present up to age 1-2 years and is a normal, expected finding; it does not indicate meningitis. (Option 3) Pulse pressure is the difference between systolic and diastolic blood pressures. Widening of pulse pressure is one of the signs of Cushing's triad (systolic hypertension with widened pulse pressure, bradycardia, respiratory depression). These signs occur very late if increased ICP is not treated. Fontanel assessment provides an earlier indication of increased ICP. (Option 4) Because meningitis clients are sensitive to light (photophobia), frequent assessment of pupillary light response will be uncomfortable. Severely increased ICP may alter pupillary response; however, this is a late complication of hydrocephalus. Fontanel assessment provides an earlier indication of a developing problem. Educational objective:Infants with bacterial meningitis can develop hydrocephalus. Bulging/tense fontanels and increasing head circumference are important early indicators of increased ICP in children and should be monitored to prevent long-term complications.

7. The nurse is caring for a newborn with patent ductus arteriosus. Which assessment finding should the nurse expect? 1. harsh systolic murmur 2. loud machine-like murmur 3. soft diastolic murmur 4. systolic ejection murmur

2. loud machine-like murmur Patent ductus arteriosus (PDA) is an acyanotic congenital defect more common in premature infants. When fetal circulation changes to pulmonary circulation outside the womb, the ductus arteriosus should close spontaneously. This closure is caused by increased oxygenation after birth. If a PDA is present, blood will shunt from the aorta back to the pulmonary arteries via the opened ductus arteriosus. Many newborns are asymptomatic except for a loud, machine-like systolic and diastolic murmur. The PDA will be treated with surgical ligation or IV indomethacin to stimulate duct closure. (Option 1) A harsh systolic murmur is heard in the setting of ventricular septal defect, an opening between the ventricles of the heart. Ventricular septal defect is an acyanotic defect. (Option 3) A diastolic murmur is heard in mitral stenosis and aortic regurgitation but not in PDA. (Option 4) A systolic ejection murmur is heard in pulmonic stenosis. Right ventricular hypertrophy will develop if this defect is not repaired. In adults, systolic ejection murmur is usually due to aortic stenosis. Educational objective:The ductus arteriosus of a newborn should close spontaneously when fetal circulation changes to pulmonary circulation. If the ductus arteriosus remains open, blood will shunt from the aorta to the pulmonary arteries. The child will be acyanotic but will have a machine-like murmur heard on both systole and diastole.

23. The nurse is observing the parent feed a 3-month-old diagnosed with gastroesophageal reflux. Which action by the parent indicates that further teaching is necessary? 1. The parent does not push the infant to finish the bottle 2. the parent engages the infant in active play after the feeding 3. the parent interrupts the feeding to burp the infant 4. The parent supports the infant upright during the feeding

2. the parent engages the infant in active play after the feeding. Gastroesophageal reflux (GER) is attributed to an immature lower esophageal sphincter. It is common in infants age ≤3 months and results in spitting up after feeds. If an infant is gaining weight and meeting developmental milestones, treatment is aimed at controlling the symptoms. Because infants with GER are at risk for aspiration and apnea, caregivers should be instructed in cardiopulmonary resuscitation. For at least 30 minutes after feeding, these infants should not be rocked or agitated by active play but should be kept calm and upright (Option 2). (Option 1) Infants with GER should be offered small frequent feedings and not be pushed to complete a feeding when demonstrating satiety. (Option 3) To minimize reflux, the feedings should be interrupted after every 1-2 ounces for burping the infant as waiting until the feeding is complete will increase the chance of regurgitation. (Option 4) Maintaining the infant in an upright position during and after feedings will minimize spitting up. Infants should not be placed in a car seat after feedings as this can increase intra-abdominal pressure, causing reflux. An infant's head should be elevated 30 degrees when placed in an infant seat. Educational objective:Infants with gastroesophageal reflux should be offered small frequent feeds, burped frequently during the feeding, and kept in an upright position during and after the feeding.

26. The nurse is evaluating a parent's understanding of home care management for a 2-week-old client after initial cast placement for treatment of congenital clubfoot. Which of the following statements by the parent indicate a correct understanding? Select all that apply. 1. " Cradling my baby in my arms may cause stress and damage to the cast. " 2" I will check my baby's toes several times a day to ensure that they are pink and warm." 3. " My baby should alternate between sleeping on the stomach and back. " 4. " My baby will need to have a new cast applied weekly for 5-8 weeks." 5. " When I bathe or diaper my baby, I will be sure to keep the cast dry. "

2.4. 5 Clubfoot (ie, talipes equinovarus) is a congenital bone deformity and soft tissue contracture manifested by one or both feet being turned inward. The health care provider typically begins management of the deformity soon after birth by manipulation and stretching of the affected foot and placing a long-leg cast. Weekly recasting over 5-8 weeks (ie, Ponseti method) is necessary to gradually reposition the foot (Option 4). To maintain the correction after successful casting, the client commonly wears custom shoes secured to a bar brace. To prevent recurrence, long-term follow-up continues until the child attains skeletal maturity. The nurse should teach parents about cast care, which includes monitoring the client's circulation (eg, toes pink and warm) and keeping the cast dry during diapering and bathing to prevent skin irritation or infection (Options 2 and 5). (Option 1) Parents should continue to cradle and hold their infants to encourage bonding and attachment. (Option 3) Parents should place infants to sleep in the supine position. Placing an infant on the stomach to sleep increases the risk for sudden infant death syndrome.

10. When monitoring an infant with a left-to-right-sided heart shunt, which finding would the nurse expect during the physical assessment ? sata 1. clubbing of fingertips 2. cyanosis when crying 3. diaphoresis during feedings 4.heart murmur 5. poor weight gain

3. 4. 5 Congenital heart defects that cause blood to shunt from the higher pressure left side of the heart to the lower pressure right side (eg, patent ductus arteriosus, atrial septal defect, ventricular septal defect) increase pulmonary blood flow. Left-to-right shunting results in pulmonary congestion, causing increased work of breathing and decreased lung compliance. Compensatory mechanisms (eg, tachycardia, diaphoresis) result from sympathetic stimulation. Clinical manifestations of acyanotic defects may include: Tachypnea Tachycardia, even at rest Diaphoresis during feeding or exertion (Option 3) Heart murmur or extra heart sounds (Option 4) Signs of congestive heart failure Increased metabolic rate with poor weight gain (Option 5) (Option 1) Clubbing of the fingertips is associated with chronic hypoxia caused by decreased pulmonary circulation as occurs with right-to-left heart defects. (Option 2) Right-to-left congenital heart defects (eg, cyanotic defects) impede pulmonary blood flow (eg, tetralogy of Fallot, transposition of the great vessels) and cause cyanosis, which is evident shortly after birth and during periods of physical exertion.

5. The practical nurse monitoring a 3-year-old finds dyspnea, high fever, irritability, and open-mouthed drooling with leaning forward. The parents report that the symptoms started rather abruptly. The client has not received age-appropriate vaccinations. Which set of actions should the practical nurse anticipate? 1. 20-gauge needle insertion at the mid-axillary line for pleural aspiration 2 . 4L oxygen at 100% per nasal cannula with bilevel positive airway pressure ventilation standing by 3. intubation in the operating room with a prepared tracheotomy kid standing by 4. nebulized racemic epinephrine with a pediatric anesthesiologist standing by

3. intubation in the operating room with a prepared tracheotomy kid standing by Epiglottitis should be considered first in a 3- to 7-year-old with acute respiratory distress, toxic appearance (eg, sitting up, leaning forward, drooling), stridor, and high-grade fever. Tachycardia and tachypnea are also present. The complications of epiglottitis are serious and include sudden airway obstruction. Epiglottitis is a pediatric emergency and should be managed with endotracheal intubation. However, intubating such clients is difficult, and as a result, preparation for possible tracheostomy is also standard. (Option 1) This is a recommended therapy for spontaneous tension pneumothorax, which is demonstrated by tracheal deviation, absent lung sounds, and severe abrupt hypotension and dyspnea. (Option 2) Neither oxygenation nor bilevel positive airway pressure is acceptable in acute epiglottitis as the trachea can close completely due to edema. (Option 4) This is the appropriate therapy for croup, not epiglottitis. Croup presents with a characteristic hacking cough, which is absent in epiglottitis. Educational objective:When assessing a client with symptoms suggestive of epiglottitis (eg, acutely ill, drooling, leaning forward, dyspnea), the nurse should prepare for an emergency airway.

15.The nurse is caring for an infant with osteogenesis imperfecta admitted with a new fracture. The client also has old fractures in multiple stages of healing but no bruising, abrasions, or redness of the skin. Which nursing intervention should be included in the plan of care? 1. during diaper changes, carefully lift the infant by the ankles 2. lift from under the arms when picking up the infant 3. obtain blood pressure manually to avoid cuff over-tightening 4. request a social work consultation to assess for child abuse

3. obtain blood pressure manually to aboid cuff over-tightening Osteogenesis imperfecta (brittle bone disease) is a rare genetic condition resulting in fragile bones and frequent fractures. The nurse should use careful handling (eg, checking blood pressure manually, distributing pressure when lifting the infant, using supportive devices) to minimize additional fractures and prevent molding of soft bones (eg, skull).

8. The parent of a newborn is concerned about the possibility of the child developing hip dysplasia. Which intervention should the nurse encourage to help reduce the risk in this newborn? 1. choose an infant carrier with a narrow seat 2. place 2 diapers on the infant at all times 3. swaddle the infant with hips flexed and abducted 4.use an infant swing that keeps both legs straight

3. swaddle the infant with with hips flexed and abducted Developmental dysplasia of the hip (DDH) is a range of various hip abnormalities that may be present at birth or develop during the first few years of life. There are many risk factors, including breech birth, large infant size, and family history. Although all cases cannot be prevented, several interventions have been shown to help reduce the risk of DDH development. Key measures include: Proper swaddling technique - infants should be swaddled with their hips bent up (flexion) and out (abduction), allowing room for hip movement (Option 3) Choosing infant carriers orcar seats with wide bases - infant seats should allow for proper hip positioning in an abducted manner Avoiding any positioning device, seat, or carrier that causes hip extension with the knees straight and together

3. The parent of a 15-month-old calls the nurse and says that the child developed a rash and mild fever after receiving a routine measles, mumps, rubella, and varicella (MMRV) vaccine in the pediatric clinic 5 days ago. What is the best response by the nurse? 1. " Apply over-the-counter hydrocortisone cream to the rash." 2." Bring your child to the clinic this afternoon." 3. "This is a common reaction to the MMRV vaccine." 4. "What is your child's temperature right now.?'

4 Some children have a mild reaction to the MMRV vaccine within 5-12 days after the first dose. Problems include low-grade fever, mild rash, swelling and erythema at the injection site, irritability, and restlessness. Although rare, fever after MMRV vaccination can lead to febrile seizures. Therefore, it is important for the nurse to determine the child's temperature to evaluate the risk for a febrile convulsion. It would also be important for the nurse to instruct the parent to monitor the child's temperature and administer acetaminophen for a fever above 102 F (38.9 C). Children with a history of seizures should be vaccinated with separate MMR and varicella vaccines instead of the combination MMRV vaccine. (Option 1) This is not an appropriate intervention. The rash should disappear in 2-3 days. (Option 2) The child seems to be experiencing a normal reaction to the vaccine; a clinic visit is not necessary. (Option 3) Although this is an appropriate response, it is most important for the nurse to first determine the child's temperature and the extent of the fever. Educational objective:The normal MMRV vaccine reactions that occur within 5-12 days after vaccination include mild fever and rash, irritability and restlessness, and swelling and erythema at the injection site. Febrile seizure is a rare but more serious reaction to the vaccine.

12. A nurse discovers a cyanotic newborn with excessive frothy mucus in the mouth. What should be the nurse's first action? 1. administer 100% oxygen 2. auscultate the lungs 3. place infant in knee-chest position 4. suction the infant's mouth

4. suction the infant's mouth

22.A 2-year-old in the emergency department is suspected of having intussusception. Which assessment finding should the nurse expect? 1 . black, sticky stools 2. greasy, foul-smelling stools 3. stools mixed with blood and mucus 4. thin, "ribbon-like" stools

Intussusception is an intestinal obstruction that occurs when a segment of the bowel folds (ie, telescopes) into another segment. Pressure gradually increases within the bowel, causing ischemia and leakage of blood and mucus into the lumen, which produces the characteristic stool mixed with blood and mucus (ie, red, "currant jelly"). Initially, some infants may have only general symptoms (eg, irritability, diarrhea, lethargy). Subsequently, episodes of sudden abdominal pain (cramping), drawing the knees up to the chest, and inconsolable crying are seen. After an episode, the infant may vomit and then appear otherwise normal. Assessment may show a sausage-shaped abdominal mass. (Option 1) Melena (dark red or black, sticky stool) is an indication of an upper gastrointestinal (UGI) bleed. Gastritis is a common cause of UGI bleeding in infants and toddlers. (Option 2) Oily or bulky, foul-smelling stool is an indication of excess fat in the stool (steatorrhea) from malabsorption. This is characteristic of pancreatic insufficiency, cystic fibrosis, or celiac disease. (Option 4) Thin, ribbon-like stool is characteristic of Hirschsprung disease (congenital aganglionic megacolon). Bowel obstruction is caused by failure of the internal sphincter to relax. Educational objective:The classic symptom triad of intussusception is abdominal pain, "currant jelly" stools, and a sausage-shaped abdominal mass. However, it is more common for clients to have episodes of sudden abdominal pain, inconsolable crying, and vomiting followed by periods of normal behavior.

14. acute appendicitis condition

Once the appendix ruptures, pain is relieved only temporarily and will return with full-blown peritonitis and sepsis.

18. Status epilepticus

a serious and life-threatening emergency in which a client has been seizing for 5 minutes or longer. Grunting and a dazed appearance are 2 common signs. A client with hydrocephalus (abnormal collection of cerebrospinal fluid in the head) and a ventriculoperitoneal (VP) shunt is at a higher risk for seizures. Stopping seizure activity is the first nursing priority. IV benzodiazepines (diazepam or lorazepam) are used acutely to control seizures. However, rectal diazepam is often prescribed when the IV form is unavailable or problematic. Parents often get prescriptions for rectal diazepam and are advised to administer a dose before bringing a child to the emergency department.

19. clostridium botulinum spores

clostridium botulinum spores in honey can colonize an infant's (age<12 months) immature gastrointestinal system and release a toxin that causes botulism, a rare but potential life-threatening illness.

16. Strabismus

patching of the unaffected eye

13. RSV ---Respiratory syncytial virus

use of saline drops and a bulb syringe to suctin nares