Pedi Exam 3

The nurse is teaching a pediatric electrocardiogram (EKG) class to nurses in a pediatric cardiac unit. Which anatomical structure does the nurse use to describe the initiation of cardiac electrical conduction? 1. The Purkinje fibers in the ventricles 2. The bundle branch in the left atrium 3. The sinoatrial node in the right atrium 4. The bundle of His in the ventricle walls

3. The sinoatrial node in the right atrium This is correct. When teaching the electrical conduction of the heart, the nurse starts with the sinoatrial (SA) node in the right ventricle, which is known as the pacemaker of the heart.

The nurse is admitting an adolescent who is 19 years of age with a diagnosis of acute renal infection. While obtaining medical and health history information, which finding does the nurse identify as supporting the diagnosis? 1. Hospitalization for removal of tonsils at 10 years of age 2. Prolonged use of acetaminophen for frequent headaches 3. A family history that is positive for renal calculi formation 4. Acknowledgment of being sexually active since 14 years of age

4. Acknowledgment of being sexually active since 14 years of age This is correct. Sexual activity is a risk factor, although the mechanism remains unclear. This the only finding that supports the patient's diagnosis.

The nurse is providing care for an infant at 3 months of age. The parent reports sudden flexor or extensor movements of the neck, trunk, and extremities occurring multiple times a day. The infant is diagnosed with infant spasms and is prescribed corticotropin (Acthar jell) therapy. Which instruction is most important for the nurse to provide for the parent? 1. Reason for weekly laboratory visits 2. Expected medication side effects 3. Signs and symptoms of infections 4. How to administer IM medication

4. How to administer IM medication This is correct. Corticotropin (Acthar jell) is administered IM, so the most important information for the nurse to provide to the parent is how to administer the medication.

What is Kawasaki Syndrome?

Acute febrile, systemic vascular inflammatory disorder that affects small and midsize arteries, including the coronary arteries Leading cause of acquired heart disease in children

What are the signs and symptoms and treatments for Tetraology of Fallot?

Audible Murmur Cyanosis Tachypnea Treatments: Need to focus on if oxygen is within safe range. If too low give: Prostaglandin Drip (PGE Gtt) (ductal dependent) to keep ductus open for increase pulmonary blood flow and oxygen level. And consider surgery as a neonatal if mild cyanosis or normal oxy then baby gets surgery at around 6 months.

What are the signs and symptoms and treatments of Obstructive Defects?

Restrict blood flow across a stenotic area of the heart Tx- PGE Gtt, Prostaglandin, or keep ductus arteriosus patent

What is Tricuspid Artesia?

When the triscupid valve between the right atrium and right ventricle doesn't open and result in a small or missing right ventricle that cant pump blood to the lungs. Usually accompanied by ASD and VSD allowing blood to mix

The nurse in a pediatric clinic is assessing an infant 2 months of age. The mother states, "He always spits up, but it has become so much worse. Vomit goes everywhere." Which additional assessment will help the nurse identify a possible diagnosis for the infant? 1. A hard mass is palpated in the mid-epigastrium. 2. Vomiting occurs both before and after eating. 3. Weight is normal even with frequent vomiting. 4. Normal skin turgor is noted over the sternum.

1. A hard mass is palpated in the mid-epigastrium. This is correct. Vomiting after eating that grows worse and evolves into projectile vomiting are signs of pyloric stenosis. If the nurse palpates the infant's mid-epigastrium and finds a pyloric mass, it is likely indicative of pyloric stenosis. This finding is called the olive sign.

The nurse is admitting an infant who is 3 months of age. The parents sought medical attention when the infant began passing pale-colored stools that are nearly white. The infant had been diagnosed with biliary atresia at birth and underwent corrective surgery. For which treatment will the nurse prepare the parents? 1. A liver transplant 2. A second corrective surgery 3. Initiating comfort care 4. Focusing on diet therapy

1. A liver transplant This is correct. If initial surgery for biliary atresia is not successful, then a liver transplant may be indicated. The occurrence of pale, gray, or white stools is an indication the condition is still present.

A third-grade teacher discusses behavioral problems with a student. The teacher states, "He walks around class making horrible sucking noises. He does not respond to me." Which information does the nurse seek from the student's parents? 1. Ask if the student has been tested by a physician for seizure disorder. 2. Inquire if the student is either diagnosed or medicated for ADHD. 3. Ascertain if the student has experienced recent illness or a fever. 4. Suggest the student be screened for possible developmental delays.

1. Ask if the student has been tested by a physician for seizure disorder. This is correct. The student's behavior is commonly seen with complex partial seizures; the nurse needs to ask if the student has been tested for seizure disorder. Manifestations include automatisms such as lip smacking, chewing, sucking, repetitive and involuntary movements, walking, and restlessness. Consciousness is altered, but the person remains awake.

An adolescent who is 15 years of age is brought to the pediatric clinic because of bloody urine. Which additional finding during assessment will cause the nurse to consider acute kidney injury (AKI)? 1. Bruising in the flank area 2. Tenderness in the lower back 3. Hesitation and pain with urination 4. Suprapubic swelling and pain

1. Bruising in the flank area This is correct. AKI is the result of poor renal perfusion or injury. In children, this is caused by ischemia, toxicity, nephropathy, or sepsis. Bruising in the flank area can be an indication of physical injury, which can cause bloody urine.

The nurse is providing care for a neonate diagnosed with tetralogy of Fallot. Prostaglandin E1 therapy is prescribed to keep the foramen ovale and the ductus arteriosus open. Which is the most important intervention for the nurse to include in the neonate's plan of care? 1. Maintain a separate IV access for continuous administration of the medication. 2. Watch for respiratory distress or apnea after adding medication to the breathing tube. 3. Monitor for and document evidence of flushing, bradycardia, and irritability as expected. 4. Monitor weight and adjust the dosage using a scale of 0.05 to 0.1 mcg/kg/min IV infusion.

1. Maintain a separate IV access for continuous administration of the medication. This is correct. During the administration of prostaglandin E1, the nurse starts and maintains a separate IV access for continuous administration of the medication.

The nurse is assisting with high school sports physicals. The nurse performs a physical assessment on a male student who is tall and thin, with disproportionately long arms. Which additional finding will prompt the nurse to recommend a cardiac evaluation? 1. Notable laxity of joints 2. Sparsity of body hair 3. Deep tone to the voice 4. Slow, rhythmic gait

1. Notable laxity of joints This is correct. Tall and thin with arms disproportionately long and with laxity of joints are physical manifestations of Marfan syndrome. The nurse may also notice dislocation of lenses, spinal problems, stretch marks, hernia, pectus abnormalities, and/or restrictive lung disease. Marfan syndrome is also associated with aortic aneurism as well as aortic and/or mitral regurgitation.

A 3-month-old infant is diagnosed with pulmonary stenosis. Which parent teaching does the nurse provide? 1. Options for treatment include a repair of the artery or the valve. 2. Balloon angioplasty is performed as an outpatient procedure. 3. Pulmonary stenosis repair can be delayed until 1 year of age. 4. After repair, the child is no longer at risk for cardiac problems.

1. Options for treatment include a repair of the artery or the valve. This is correct. Options are to repair the pulmonary artery and/or pulmonic valve as soon as possible to avoid worsening side effects of the condition.

The nurse is aware the neonate's blood circulation is different before birth than after birth. Which circulation pattern does the nurse recognize as occurring prior to birth? 1. Oxygenated blood flows from the right atrium to the left atrium through the foramen ovale. 2. Oxygenated blood flows from the right ventricle to the lungs and then to the left ventricle. 3. For a short time after birth, the neonate continues to depend on the mother for oxygen supply. 4. Once the neonate takes a first breath, the ductus venosus closes and blood goes to the lungs.

1. Oxygenated blood flows from the right atrium to the left atrium through the foramen ovale. This is correct. Prior to birth, oxygenated blood crosses from the right atrium to the left atrium via the patent foramen ovale (PFO) and is pumped by the left ventricle.

The school nurse is present at a school assembly when a student falls to the floor with a seizure. Which intervention does the nurse initiate when providing care to the student during the seizure? 1. Protect the student from injury related to seizure movement. 2. Remove or loosen any tight clothing around the neck or waist. 3. Provide comfort and promote resting in a quiet environment. 4. If incontinent, cover the student with a blanket or sheet

1. Protect the student from injury related to seizure movement. This is correct. During the seizure, the nurse needs to protect the student from injury caused by seizure movement.

The nurse is preparing teaching materials for an adolescent patient recently diagnosed with nonalcoholic fatty liver disease (NAFLD). The adolescent initially presented with right upper quadrant pain, obesity, and hepatomegaly. Which teaching will the nurse initially present? 1. Review lifestyle changes and diet modification with the adolescent. 2. Explain the care that is provided in the event acute liver failure occurs. 3. Discuss feelings the adolescent has related to the disease diagnosis. 4. Begin to introduce the probability for a liver transplant later in life.

1. Review lifestyle changes and diet modification with the adolescent. This is correct. Initially, the nurse will present information about the dietary and lifestyle changes necessary to prevent worsening of the condition. The nurse will emphasize the danger of rapid weight loss and the benefits of regular exercise.

The pediatric nurse in a clinic is mentoring a newly hired nurse who has no experience in pediatrics. The new nurse is performing a physical assessment on an infant who is 1 month of age. Which observation will prompt the nurse to discuss assessment skills with the new nurse? 1. The new nurse states, "How can I hear bowel sounds when he cries?" 2. The new nurse keeps the sleeping infant covered for parts of the assessment. 3. The new nurse performs all observations before physical assessment. 4. The new nurse informs the attending parent about the assessment actions.

1. The new nurse states, "How can I hear bowel sounds when he cries?" This is correct. The new nurse needs to know that auscultation of the abdomen of an infant is performed prior to percussion and palpation in order to keep the infant quiet for auscultation.

The nurse in a pediatric clinic is collecting information for the reason a parent has brought a toddler to the clinic. The parent states the toddler cries with urination and is sometimes incontinent. The nurse obtains an axillary temperature of 101.2°F (38.4°C). For which additional reason does the nurse suspect a urinary tract infection (UTI)? 1. The toddler is 3 years of age. 2. The toddler attends a preschool. 3. The toddler is a circumcised male. 4. The symptoms are comparable to an adult UTI.

1. The toddler is 3 years of age. This is correct. The nurse is aware that UTIs are more commonly seen in children between 2 and 6 years of age.

The nurse is assessing a 4-month-old infant during a routine well-baby visit. During the neurological assessment, which finding is a reason for concern? 1. When the cheek is brushed, the head is turned toward the stimuli. 2. Toes fan out when the sole of the food is stroked upward. 3. Placing a small object in the palm inconsistently elicits a grasp. 4. A light puff of air in the face causes the eyes to close.

1. When the cheek is brushed, the head is turned toward the stimuli. This is correct. The nurse is assessing for the presence of the rooting reflex, which disappears by the age of 3 to 4 months. The presence of this reflex at 4 months is a reason for concern.

The nurse is collecting information about a school-age patient brought to a pediatric clinic by a parent. The parent reports several incidences of syncope. Which assessment question helps the nurse to identify a possible diagnosis of vasovagal syncope? 1. "Has your daughter been diagnosed with diabetes mellitus?" 2. "Did your child feel strange and faint after standing up?" 3. "Was your child in a stressful situation before fainting?" 4. "Does your daughter have any cardiac conditions?"

2. "Did your child feel strange and faint after standing up?" This is correct. This question is appropriate for identifying vasovagal syncope, which is the most common type of syncope. Blood pressure drops quickly, reducing the blood flow to the brain. Standing results in a flow of blood in the lower extremities, and the autonomic nervous system needs to act in conjunction with the heart to normalize blood pressure.

The nurse is providing care for a neonate diagnosed with a cardiovascular disorder immediately after birth. When gathering assessment information from the mother, which comment will the nurse recognize as the most likely contributing factor for the defect? 1. "We live in the country, and we get all our water from a well." 2. "I quit my preschool job when a child was diagnosed with measles." 3. "The baby was born a week early; I hope that is not the cause." 4. "We were in a European country before pregnancy was confirmed."

2. "I quit my preschool job when a child was diagnosed with measles." This is correct. The nurse is most likely to contribute exposure to a child with measles as a causative factor for the neonate's heart defect. The nurse will assess further for timelines and manifestations.

The nurse is presenting a class to high school females about decreasing the developmental risks related to pregnancy. Which information does the nurse consider to be most important? 1. Young women should begin taking 600 mg of calcium twice a day. 2. All females of child-bearing age should take 0.4 mg of folic acid daily. 3. Early prenatal care is essential for a healthy pregnancy and baby. 4. Important fetal development occurs before pregnancy is suspected.

2. All females of child-bearing age should take 0.4 mg of folic acid daily. This is correct. Because neural tube closure occurs before most women even know they are pregnant, it is important to teach adolescent girls to begin taking folic acid supplements before pregnancy occurs. Teen pregnancies are usually unplanned, which makes folic acid intake very important.

The nurse in a pediatric clinic is obtaining a health history on a child who is 9 years of age. The nurse learns the child exhibits a chronic cough, midsternal discomfort, and frequent sore throats without infection. Physical assessment indicates the child is on the 50th percentile on the height chart and on the 85th percentile for weight. Which recommendation does the nurse make? 1. Serve citrus juices instead of carbonated beverages. 2. Begin an age-appropriate weight loss program. 3. Initiate a practice of no eating or drinking after dinner. 4. Encourage lying on the left side after eating a meal.

2. Begin an age-appropriate weight loss program. This is correct. When a child is on the 50th percentile in height and the 85th percentile for weight, the child is overweight. The nurse needs to recommend an age-appropriate weight loss program.

The nurse is admitting a 6-month-old infant for testing because of a second UTI and suprapubic pain with palpation. Diagnostic tests reveal a grade II vesicoureteral reflux (VUR). Which information does the nurse provide to the family? 1. Preparation necessary for surgery 2. Information about medication therapy 3. Importance of genetic counseling 4. Necessity of establishing dialysis

2. Information about medication therapy This is correct. The nurse will provide information about the medication prescribed for the existing UTI. The reason, route, length of therapy, and side effects will be covered.

5. A parent brings an 18-month-old toddler to the pediatric emergency department for abdominal pain and stool mixed with blood and mucus. The pain is recurring three to four times an hour. Which intervention will the nurse initiate first? 1. Assess laboratory results. 2. Initiate intravenous access. 3. Maintain strict intake and output. 4. Prepare for ultrasound studies.

2. Initiate intravenous access. This is correct. The nurse recognizes the existence of an emergency based on the toddler's presenting symptoms. The nurse will first initiate intravenous access in order to have a route established for medications and/or emergency interventions.

The parents are preparing to take their newborn, who was diagnosed with tetralogy of Fallot with pulmonary atresia, home. The nurse is developing a teaching sheet regarding care of the newborn for the parents. Which information does the nurse need to include in the teaching plan? 1. There is no need to limit activities. 2. It is important to maintain caloric intake. 3. No secondary complications are expected. 4. The neonate has natural immunity to infections.

2. It is important to maintain caloric intake. This is correct. Due to a clinical finding of failure to gain weight, the parents are instructed on the importance of maintaining caloric intake. Frequent small feedings are necessary to meet this need and not increase cardiac stress.

The pediatric nurse is examining the skin of a young child and notices eight café-au-lait spots between 1.5 and 3 inches in diameter on the body, along with axillary freckling. Which recommendation does the nurse make to the parent? 1. Refrain from having additional children without counseling. 2. Make an appointment with a physician for testing and evaluation. 3. Agree to blood testing of the child to identify a defect in the NF1 gene. 4. Arrange for psychological therapy to address self-esteem problems.

2. Make an appointment with a physician for testing and evaluation. This is correct. The nurse may recognize that the child's skin manifestations are related to a strong possibility of neurofibromatosis. The nurse needs to recommend seeing a physician for testing and evaluation.

The nurse is providing care for a 2-month-old infant admitted to the hospital for testing because of a persistent low-grade fever. Laboratory tests and ultrasound of the abdomen confirm the presence of gallstones. Which procedure does the nurse expect to be prescribed for this infant? 1. Immediate preparation for abdominal surgery 2. Monitoring without surgical interventions 3. Endoscopic removal of stones and gallbladder 4. Placing the infant on low-fat, soy-based formula

2. Monitoring without surgical interventions This is correct. Gallstones in infancy do not need removal unless symptomatic, because gallstones usually resolve spontaneously. The presence of a low-grade fever is indicative of inflammation. A symptomatic presentation would include jaundice and possibly vomiting.

The nurse is providing care for an adolescent diagnosed with Crohn's disease. The nurse provides patient teaching regarding which manifestation of the condition? 1. Urgency to defecate 2. Possibility of oral aphthous ulcers 3. Episodic epigastric pain 4. Nocturnal awakening events

2. Possibility of oral aphthous ulcers This is correct. Oral aphthous ulcers are canker sores, which are small, shallow lesions that develop on the soft tissues in the mouth or at the base of the gums. Unlike cold sores, canker sores do not occur on the surface of the lips and are not contagious. The condition is present in patients who have Crohn's disease, and information of the condition will be provided in patient teaching.

Shortly after the birth of a male neonate, the parents are informed about the diagnosis of hypospadias. The physician explains that the neonate's urethral opening is located midpenile, and surgery will occur between the ages of 6 and 12 months. Which additional explanation does the nurse provide to the parents? 1. The neonate should be circumcised immediately. 2. The diagnosis is usually an isolated anomaly. 3. A ventral curvature of the penis is likely. 4. A pediatric surgeon will perform the surgery.

2. The diagnosis is usually an isolated anomaly. This is correct. Hypospadias is usually an isolated anomaly; however, the neonate will be examined for other genitourinary anomalies, including undescended testicles or an inguinal hernia.

The nurse is gathering health information on a child who is 8 years of age. The parent reports the child is extremely difficult to wake in the morning. Which other information will prompt the nurse to recommend screening for a sleep disorder? 1. The bedroom is shared with a sibling. 2. The nurse validates the child is obese. 3. There is a TV in the child's bedroom. 4. It is difficult to get the child to bed.

2. The nurse validates the child is obese. This is correct. Obesity in a child can cause sleep apnea, which can result in heavy snoring or choking sounds during sleep, as well as daytime fatigue, irritability, or learning problems in school. This finding will prompt the nurse to recommend screening for sleep disorder.

The nurse is providing care for a pediatric patient who received a concussion while playing football. The patient had brief loss of consciousness and now reports a headache with a pain level of 6 on a 0 to 10 scale. The patient states, "My team plays again in five days and I should be better." Which information is vital for the patient and parents to understand? 1. A realistic timeframe regarding complete recovery 2. Type of equipment to prevent a second head injury 3. The risk of acquiring second impact syndrome 4. The potential for long-term headaches

3) The risk of acquiring second impact syndrome This is correct. There is risk for a lethal condition known as second impact syndrome, in which the brain swells rapidly and the person succumbs quickly if a second concussion occurs before the first concussion has resolved. The patient's remark makes this information vitally important.

The nurse is providing teaching for the parents of a child diagnosed with hemolytic uremic syndrome (HUS) 10 months ago. Which statement by a parent indicates the teaching is understood? 1. "The diet will be low calorie, low carbohydrate, no added salt, and low potassium." 2. "Nonsteroidal medications are used only if acetaminophen is not effective." 3. "Careful skin inspection and care is given because of swelling and poor circulation." 4. "We can initially treat diarrhea with over-the-counter antidiarrheal medications."

3. "Careful skin inspection and care is given because of swelling and poor circulation." This is correct. The parent should provide skin care for peritoneal or hemodialysis catheter site and for possible breakdown related to edema and decreased perfusion.

11. The nurse is reviewing medications for the treatment of a heart rhythm disorder in a patient who is 8 years of age. The parent of the patient states that the physician recently prescribed medication to treat the patient's attention deficit-hyperactivity disorder. Using knowledge of recent professional recommendations, which statement by the nurse is correct? 1. "We need to remind the physician there is a heart condition." 2. "Do not start the medication until I can check for safety warnings." 3. "Children with heart disorders have a higher incidence of ADHD." 4. "Giving the medication can cause death if there is a cardiac issue."

3. "Children with heart disorders have a higher incidence of ADHD." This is correct. Joint statements by the AAP and the AHA show that children with heart conditions have a higher incidence of ADHD, but that medications used to treat ADHD have not been shown in most cases to cause heart disease or result in sudden cardiac death.

The nurse in a pediatric clinic is gathering information from the parent of a toddler who has anorexia, generalized edema, and joint pain following a bout with strep throat. Which question(s) will most likely give the nurse information for a specific condition? 1. "What behavior did you see to indicate joint pain?" 2. "When and where did you first notice swelling?" 3. "Is the child urinating, and what color is the urine?" 4. "How were you managing the symptoms at home?"

3. "Is the child urinating, and what color is the urine?" This is correct. The nurse may suspect a kidney disorder from the presenting symptoms and recent health history. The question about urination and the appearance of the urine will give the nurse information to validate a specific condition, which is acute postinfectious glomerulonephritis. The urine will appear tea-colored, cola-colored, or bright red.

The nurse in the emergency department of a pediatric hospital is providing care for a toddler with a sudden high fever. The parent states, "She has been grumpy all day and I thought she just needed a nap." Which finding does the nurse recognize as an indication of an immediate medical emergency? 1. The toddler keeps eyes closed or covered at all times. 2. The nurse elicits a positive Brudzinski's sign. 3. A rash of scattered red bumps is found on the skin. 4. The toddler cries when head and neck are moved.

3. A rash of scattered red bumps is found on the skin. This is correct. The scenario describes the existence of a specific bacterial infection such as Neisseria meningitides. This infection results in a purpuric rash, often combined with sepsis. Death can occur in hours after the rash appears. This finding is an immediate medical emergency.

The nurse is providing care for an adolescent patient admitted with a diagnosis of nephrolithiasis. The patient's symptoms include flank pain, hematuria, and vomiting. The nurse notices an hourly output of 20 mL/hour. Patient's medical history includes UTIs, type 1 diabetes mellitus, and one kidney at birth. Which medical prescription does the nurse expect immediately from the physician? 1. Increase IV fluids to 125 mL/hour. 2. Cover blood glucose on a sliding scale. 3. Establish NPO status and prepare patient for surgery. 4. Administer IV morphine 5 mg every 2 hours for pain.

3. Establish NPO status and prepare patient for surgery. This is correct. Children with a single kidney who have symptoms consistent with calculi (colicky flank pain, hematuria, vomiting, and abdominal pain) and have signs of acute renal failure (oliguria, azotemia, hypertension, hyperkalemia) are to be treated as a surgical emergency.

The nurse is preparing an 8-year-old patient for a cardiac catheterization. Which intervention will the nurse initiate immediately postprocedure? 1. Observe for signs and symptoms of infection. 2. Hold food and fluids until gag reflex returns. 3. Keep the involved extremity straight for 4 to 6 hours. 4. Notify physician if green or yellow drainage is noted.

3. Keep the involved extremity straight for 4 to 6 hours. This is correct. Immediately after the procedure the nurse will assure that the limb used for cardiac catheterization is kept straight with no movement for 4 to 6 hours. The child should be positioned flat on the back; a sandbag may be used on the extremity. All precautions are to prevent bleeding from the puncture site.

The nurse in a pediatric clinic is working with a preschool patient and a parent about managing the child's functional constipation. Which is the most important information for the nurse to share? 1. The child is allowed to select a reward for having a bowel movement. 2. The child is informed of the treatments for constipation and/or impaction. 3. Parental action is required for the onset of vomiting or severe abdominal pain. 4. The parents expect the child to sit on the toilet for a period of time each day.

3. Parental action is required for the onset of vomiting or severe abdominal pain. This is correct. The nurse needs to inform the parent of what actions to take if the child starts to vomit or has severe abdominal pain. Because the symptoms are indicative of a medical emergency, the caregiver should take the child to a medical facility for immediate evaluation.

The nurse is providing care for a 12-year-old patient who is hospitalized with generalized weakness and muscle wasting, which began in the hips, pelvic area, thighs, and shoulders. The physician suspects Duchenne muscular dystrophy. Which action by the physician does the nurse expect? 1. Prescribe physical therapy to improve muscle strength. 2. Suggest homeschooling until the acute stage ends. 3. Perform an echocardiogram to evaluate cardiac functioning. 4. Perform muscle biopsies to identify the stage of the disease.

3. Perform an echocardiogram to evaluate cardiac functioning. This is correct. The physician is likely to order cardiac testing, especially to rule out cardiomyopathy, a condition frequently associated with Duchenne muscular dystrophy.

A neonate is born with gastroschisis. Which action will the nurse perform immediately? 1. Prepare the mother for a serious birth defect in the neonate. 2. Promote nonnutritive sucking to fulfill the neonate's needs. 3. Protect the defect with a nonadherent sterile saline dressing. 4. Place an orogastric tube to decompress the neonate's intestines.

3. Protect the defect with a nonadherent sterile saline dressing. This is correct. Immediately after birth, the nurse will support and wrap the defect to prevent fluid loss and hypothermia. The nurse uses sterile normal saline with a nonadherent dressing. The neonate is placed under warmer to prevent heat loss through the opening/exposed contents

The nurse is performing well-baby checks in a pediatric clinic. During physical examination of a 1-month-old infant, the nurse notices a dimple with a tuft of hair in the lumbar sacral area indicative of spina bifida. Which developmental delays does the nurse expect for this infant? 1. There may be issues related to bowel and bladder control. 2. Some degree of paralysis of the lower limbs is expected. 3. The infant is not expected to experience physical delays. 4. Muscles of the legs will be flaccid with some sensory loss.

3. The infant is not expected to experience physical delays. This is correct. The infant is exhibiting the characteristics of spina bifida occulta, which occurs from a section of the spinal vertebrae being malformed, but the spinal cord and nerves are normal. No developmental delays are expected with this condition.

A parent brings a child who is 8 years of age to the pediatric clinic and tells the nurse, "I think he has Tourette's syndrome. He recently began some eye-blinking and grimacing actions." Which information does the nurse provide to help the parent distinguish between transient tic of childhood and Tourette's syndrome? 1. Vocal tics frequently become chronic in children with transient tic of childhood diagnosis. 2. Transient tic of childhood begins with a high level of tic activity and usually disappears completely by age 12. 3. Tourette's syndrome is a disorder of complex motor and vocal tics that have been present for more than 1 year. 4. Tourette's syndrome is a disorder of complex motor and vocal tics that develop between the ages of 3 to 8 years.

3. Tourette's syndrome is a disorder of complex motor and vocal tics that have been present for more than 1 year. This is correct. Tourette's syndrome is a disorder of complex motor and vocal tics that have been present for more than 1 year and began before the child's 18th birthday.

An adult female arrives in the emergency department following a spontaneous birth at home. The female indicates that no prenatal care has been received. Which assessment finding about the female causes the nurse greatest concern for the newborn? 1. A laboratory result reveals a positive hepatitis A anti-HAV-total. 2. The mother is emaciated and has indications of drug abuse. 3. The mother has no permanent address and denies having family. 4. A laboratory result reveals a positive hepatitis B e antigen (HBeAg).

4. A laboratory result reveals a positive hepatitis B e antigen (HBeAg). This is correct. A positive laboratory test for hepatitis B e antigen (HBeAg) causes the nurse greatest concern. The test is positive in blood only when the virus is present, and it can be passed to others. An HBeAg-positive mother indicates a 90% chance of the newborn acquiring the infection.

The nurse is performing a developmental assessment on a toddler at age 3 years. The nurse notices a variety of mixed developmental milestones that have been missed during the visit. Which delay does the nurse expect to be of greatest concern to the parent? 1. Difficulty putting small objects into a bottle 2. An inability to kick a ball back to the nurse 3. Difficulty with and reluctance to self-dress 4. An inability to express needs with language

4. An inability to express needs with language This is correct. Language is an important developmental milestone, and the inability to verbally express needs by the age of 3 years is a real concern. The most common parental concern is delayed development of expressive language.

The nurse is providing care for a 7-year-old child whose admitting diagnosis is poststreptococcal glomerulonephritis. The nurse expects which care to be prescribed for the child? 1. Hemodialysis 2. Nifedipine orally 3. Increase fluids 4. Antibiotic therapy

4. Antibiotic therapy This is correct. The nurse will expect that antibiotic therapy will be prescribed to eradicate the offending organism if present. A common cause of poststreptococcal glomerulonephritis is either a missed strep diagnosis or uncompleted antibiotic therapy.

The nurse is assessing a 7-year-old child at a pediatric clinic. The nurse notices that several developmental milestones have been missed or are late during previous visits. The parent states, "I know she is a little slow, but she will catch up quickly." Which action by the nurse is warranted? 1. Explain to the parent that rapid development takes place in infancy and early childhood. 2. Suggest activities in the home that may improve mental and physical development. 3. Recommend that the child be placed in special classes aimed at promoting development. 4. Ask the parent detailed questions about the pregnancy, birth, and early childhood health.

4. Ask the parent detailed questions about the pregnancy, birth, and early childhood health. This is correct. The nurse needs to further assess for possible contributing factors for the child's developmental delays. Along with information about the pregnancy, birth, and early childhood health, the nurse will explore the family health history and home environment.

The nurse in the newborn nursery is providing care for a neonate with an open spinal cord defect. The neonate will be transported to a pediatric surgery hospital as soon as possible. Which description of the nurse's care of the neonate is correct? 1. Using aseptic technique, place a sterile plastic bag around the defect and loosely tie it closed. 2. Place the newborn prone on a loose diaper and cover the defect with a second saline-moistened diaper. 3. Position the newborn on the side with a moistened dressing on the defect; wrap the defect and newborn in a blanket. 4. Cover the defect with a sterile dressing moistened with warm sterile normal saline, using aseptic technique.

4. Cover the defect with a sterile dressing moistened with warm sterile normal saline, using aseptic technique. This is correct. The nurse must exercise caution to keep the defect covered and protected until surgical correction can occur. Using aseptic technique, the nurse should cover the defect with a sterile dressing moistened with warm sterile normal saline. The neonate will be positioned prone and lying on an open diaper.

The NICU nurse is providing care for a neonate who presents with an overabundance of secretions that the neonate cannot manage. The nurse also identifies the neonate is anorectal and exhibits some limb deformity. Which assessment process will the nurse perform first? 1. Check whether there are deformities of the palate. 2. Check for choking after a feeding tube is passed. 3. Observe if cyanosis occurs during bottle feeding. 4. Determine the extent to which a feeding tube can be passed

4. Determine the extent to which a feeding tube can be passed This is correct. Because of the presence of anatomical and physiological manifestations, the nurse will attempt to assess for tracheoesophageal atresia. The first assessment is to determine the extent to which a feeding tube can be passed. Performing this assessment first will help prevent liquids from entering the respiratory system.

The pediatric nurse in an acute care facility is providing care for a patient who is 12 years of age with a history of sickle cell anemia. During this hospitalization, it is determined that the patient has experienced a stroke. Which teaching is most important for the nurse to provide to the patient and parents? 1. A need for intensive physical and speech therapies 2. Reasons to have a designated social worker 3. The necessity for an individualized education plan 4. Manifestations of increased intracranial pressure

4. Manifestations of increased intracranial pressure This is correct. Screening for the development of hydrocephalus in indicated, because it is a common complication of pediatric stroke. Important teaching for the patient and parents is related to the manifestations of increased intracranial pressure, which occurs with hydrocephalus.

The pediatric nurse receives a medical prescription to obtain a urine sample for culture from an infant 6 months of age diagnosed with a UTI. By which method will the nurse collect the sample? 1. Applying clean catch techniques 2. Attaching an external urine bag 3. Catching urine in a sterile diaper 4. Performing urinary catheterization

4. Performing urinary catheterization This is correct. Urine cultures should be obtained by catheterization or suprapubic tap to decrease secondary contamination of the urine specimen.

The nurse is providing care to a school-age child admitted because of the presence of colicky abdominal pain, palpable purpura on the lower extremities, edema of the face and lips, and anorexia. The suspected diagnosis is Henoch-Schönlein purpura. Which diagnostic test result does the nurse expect to validate the diagnosis? 1. Elevated serum creatinine 2. Positive for proteinuria 3. Stool positive for occult blood 4. Renal biopsy shows IgA deposition

4. Renal biopsy shows IgA deposition This is correct. Increased IgA from either a skin or kidney biopsy is a histological confirmation of Henoch-Schönlein purpura.

A high school male adolescent arrives at the emergency department following a fall sustained while rock climbing. The physician prescribes diagnostic tests to rule out acute kidney injury (AKI). Which diagnostic finding does the nurse report immediately to the health-care provider? 1. Serum creatinine level of 0.6 2. Hematocrit level of 38% 3. Serum BUN of 20 mg/dL 4. Serum potassium of 5.7 mEq/L

4. Serum potassium of 5.7 mEq/L This is correct. A normal serum potassium level is between 3.5 and 5.0 mEq/L; the patient's potassium level is elevated. The nurse will report this finding immediately to the physician as elevated potassium levels can interfere with normal cardiac functioning.

The nurse is informing a new mother of the concern about her newborn who is 36 hours old and has not passed any meconium. The nurse shares a suspicion of Hirschsprung's disease. The mother asks the nurse multiple questions about the condition. Which information will the nurse provide? 1. Retained meconium is a source of severe infection in newborns. 2. A positive diagnosis indicates the newborn is terminally ill. 3. The absence of nerves in the colon also indicates mobility issues. 4. The condition is congenital and causes blockage of the intestines.

4. The condition is congenital and causes blockage of the intestines. This is correct. Hirschsprung's disease is a congenital condition that causes blockage of the intestine because of a lack of nerves in the bottom segment of the colon. These nerves normally allow the muscles in the wall of the bowel to contract and move digested material toward the anus to be eliminated.

A parent brings a 12-month-old toddler to the pediatrician because the toddler cries a lot and then stops on her own. The parent has noticed a little blood in the diaper every time it is wet. Assessment reveals a temperature of 101.3°F (38.5°C). Which condition does the nurse anticipate after a urinalysis? 1. Hypospadias 2. Henoch-Schönlein purpura 3. Acute kidney injury 4. Urinary tract infection

4. Urinary tract infection This is correct. Symptoms of a UTI in infants and young children do not mimic the typical urinary symptoms in adults and may be as subtle as fever alone. Intermittent crying can be a sign of painful urination.

A 21-month-old toddler with tetralogy of Fallot, diagnosed 1 week ago, just fell down and is now crying and becoming cyanotic. What interventions are indicated? (Select all that apply.) (even though there will not be any select all that apply questions on exam 3, this is still a good question in which to practice) A. Administer oxygen B. Place the toddler in a semi-Fowler position C. Offer a pacifier D. Comfort and soothe by holding the child E. Bring the child's knees to the chest

A. Administer oxygen C. Offer a pacifier D. Comfort and soothe by holding the child E. Bring the child's knees to the chest

Reviewing the chart of an infant with a pediatric heart condition, the nurse notes that an antibiotic has been ordered as part of the child's therapy. Which of the following disorders would warrant treatment with an antibiotic? Select all that apply. 1.( even though there will not be any select all that apply questions on exam 3, this is still a good question in which to practice) A. Tetralogy of Fallot B. Kawasaki syndrome C. Rheumatic heart disease D. Congestive heart failure E. Hypertension

A. Tetralogy of Fallot B. Kawasaki syndrome C. Rheumatic heart disease

What are the treatments for Kawasaki disease?

Admit to hospital Administer intravenous immunoglobulin, oral aspirin Also monitor for coronary artery aneursyms, and promote comfort, needs temps for 2 weeks

What is Atrial Septal Defect?

An atrial septal defect allows oxygen-rich (red) blood to pass from the left atrium, through the opening in the septum, and then mix with oxygen-poor (blue) blood in the right atrium.

The nurse is caring for a six-year-old who is very tired and experiencing frequent episodes of vomiting. The nurse knows that which of the following positions will reduce the risk of aspirating? A. Reverse Trendelenberg B. Side-lying C. Supine D. Prone

B. Side-lying

A 10-year-old boy has been admitted with a diagnosis of "rule out appendicitis." While the nurse was conducting a routine assessment, the boy stated, "It doesn't hurt anymore." What would the nurse suspect? A. The patient is having difficulty expressing pain. B. The appendix has ruptured. C. The patient is exhibiting attention seeking behavior. D. The patient is afraid of going to surgery.

B. The appendix has ruptured.

The nurse is caring for a child with a urinary tract infection (UTI). Which intervention is the priority? a. Provide adequate nutrition to speed healing. b. Prevent enuresis. c. Administer ordered antibiotics on schedule. d. Restrict fluids to provide kidney rest.

C. Administer ordered antibiotics on schedule.

The pediatric nurse knows that which of the following is most helpful in distinguishing congenital heart disease from pulmonary disease in a newborn who has respiratory distress? A. Respiratory rate of 64 breaths/min B. Results of a CBC (complete blood count) C. Decreased PO2 in arterial blood gas D. Gestational age less than 30 weeks

C. Decreased PO2 in arterial blood gas

What is Truncus Arteriosis? (TA)

It occurs when the blood vessel coming out of the heart in the developing baby fails to separate completely during development, leaving a connection between the aorta and pulmonary artery

what are the s/s of RF?

Jones criteria: presence of two major manifestations or one major manifestation and two minor manifestations: -Carditis - pericardial inflammation and valves ----Aschoff bodies - Inflamed hemorrhagic bullous lesion ----Polyarthritis -edema, inflammation and effusions in joints -Erythema marginatum - non pruritic transitory rash on trunk and proximal extremities -Subcutaneous nodules - bony prominences

what is rheumatic heart disease

Manifestation of Rheumatic fever. May be self-limited or lead to progressive deformity of the valve. Typical lesion is a perivascular granuloma. MC valve affected is mitral (80%), then aortic valve (20%).

What are the treatmeat goals for CHF in pedi?

Reduce Cardiac Workload -Treatment: rest, oxygen Improve Cardiac Output -Treatment: digoxin, positioning Remove Excess Fluid -Treatment: diuretics

What are the S/S and treatments for VSD

S/S: CHF- Depending on size of VSD and Failure to Thrive Murmur Treatment- Observation or surgical repair

1. As safety is of the highest priority, which activity should an adolescent just diagnosed with epilepsy avoid? a. Swimming, even with a friend. b. Being in a car at night. c. Participating in any strenuous activities. d. Returning to school right away.

a. Swimming, even with a friend.

What are tet spells? what are treatments?

-occurs in tetralogy of fallot -hypoxic episode caused by rapid drop in amount of O2 in the blood Older child squat, as a nurse give morphine, 100% oxygen and bring PT's knees to chest, fluid replacement for blood volume expansion

The nurse is providing care for a 9-year-old patient diagnosed with postinfectious glomerulonephritis. The nurse is aware of hypertension and a prescribed dose of nifedipine 0.5 mg/kg/dose every 4 hours. The patient weighs 63 pounds. Which dose does the nurse give every 4 hours? 1. 14 mg 2. 18 mg 3. 22 mg 4. 30 mg

1. 14 mg This is correct; 63 pounds/2.2 kg = 28.6 kg × 0.5 mg = 14.3 mg (round down).

A 9-year-old male patient arrives at the emergency department with suprapubic tenderness, nausea, vomiting, and painful urination. Which laboratory result does the nurse expect from a urinalysis? 1. White blood cells: 15,000 cells/μL 2. Positive for glucose and protein 3. Potassium: 3.5-5.0 mEq/L 4. Hematocrit: 37%

1. White blood cells: 15,000 cells/μL This is correct. The patient's symptoms are indicative of a urinary tract infection (UTI). An elevation in the white blood cell count supports the presence of an infection.

The nurse is performing a physical assessment on a 7-year-old child as a requirement for playing a sport at school. The nurse reports which assessment finding as abnormal and requests a follow-up from a primary care physician? 1. Systolic blood pressure is 84 mm Hg. 2. Systolic blood pressure is 90 mm Hg and diastolic is 20 mm Hg. 3. Pulse oximeter reading is 95% on room air. 4. PMI is at 4th or 5th intercostal space at the midclavicular line

2. Systolic blood pressure is 90 mm Hg and diastolic is 20 mm Hg. This is correct. Wide pulse pressures—diastolic pressures are low, with a wide gap between diastolic and systolic pressures—are indicative of such processes as patent ductus arteriosus.

A 6-year-old patient is brought to the pediatrician's office with symptoms of feeling ill, periorbital edema, weight gain, and anorexia. The nurse suspects nephrotic syndrome. Which laboratory value confirms the nurse's suspicion? 1. Serum sodium of 138 mEq/L 2. Serum potassium of 4.5 mEq/L 3. A high level of protein in the urine 4. Low serum levels of HDL and LDLs

3. A high level of protein in the urine This is correct. Nephrotic syndrome manifests with massive proteinuria (greater than 50 mg/kg/day).

The nurse is providing information to the parents of a toddler who is scheduled for surgery for the replacement of the pulmonic valve. The parents have many questions about the function of the valve. Which information from the nurse is correct? 1. The valve must work correctly to get oxygen from the lungs to the body. 2. If the valve does not work correctly, blood is kept from entering the heart. 3. When the valve is defective, the blood leaving the heart is decreased. 4. A defect in the valve causes less blood to get to the lungs for oxygenation.

4. A defect in the valve causes less blood to get to the lungs for oxygenation. 4 This is correct. When there is a defect in the right pulmonic valve, the blood has difficulty leaving the right ventricle and getting to the lungs for reoxygenation. This explanation by the nurse correctly describes the function of the valve and the purpose of the surgery.

The nurse in a pediatric clinic is obtaining information about a 7-month-old infant with GI symptoms. The parent informs the nurse that bloating, flatulence, and foul-smelling stools occurred with the introduction of wheat cereal. Which additional information will cause the nurse to initiate emergency care? 1. Dental enamel defects of the teeth 2. Presence of dermatitis herpetiformis 3. Severe vomiting and diarrhea 4. Weight loss indicated by thinness of extremities

4. Weight loss indicated by thinness of extremities This is incorrect. Weight loss, in which the infant may appear very skinny in the extremities but normal weight in the face, is not unexpected in an infant with celiac disease. This finding will be of concern but does not warrant initiating emergency care.

What is transposition of the great arteries (TGA)

Arteries are reversed causing blood flow/circulation to be reversed. This result in blood not being able to meet the body's demand's due to low oxygen.

What is total anomalous pulmonary venous return? (TAVPR)

Blood circles to and from the lungs and never gets out to the body. Most often in obstructed TAVPR, the pulmonary veins run into the abdomen, passing through a muscle (diaphragm). This muscle squeezes the veins and narrows them, causing the blood to back up into the lungs. This type causes symptoms early in life and can be rapidly deadly if not recognized and surgically corrected.

A 10-month-old child is recovering from a cleft lip repair, and the provider has determined the child would benefit from restraints post-operatively. Which kind of restraints would the nurse most likely apply to this child? A. A jacket restraint B. A mummy restraint C. Elbow restraints D. None, unless the child demonstrated being uncooperative

C. Elbow restraints

The fetal heart allows oxygenated blood to flow through the right atria, through a fetal pathway and out into the fetus's systemic circulation. What is the name of the fetal pathway? A. Infundibulum B. Ductus arteriosus C. Foramen ovale D. Ductus venosus

C. Foramen ovale

A baby is born at term and, due to respiratory distress and cyanosis, an echo was done. Severe aortic stenosis is diagnosed. The nurse would be correct by immediately: A. Starting oxygen at 2 Lpm via nasal cannula B. Preparing for an EKG and echocardiogram C. Preparing to establish intravenous access and starting a PGE-1 infusion Preparing for intubation and hand ventilating

C. Preparing to establish intravenous access and starting a PGE-1 infusion

What is coarctation of the aorta?

Congenital narrowing of the aorta- common in a short segment where arteries to head and arm take off The left ventricle has to work hard since it must generate a high pressure than normal to force blood through narrow aorta to the lower part of the busy. If too narrow it can cause CHF due to inadequate blood flow to the rest of the body as ventricles are not strong enough to perform task May not be detect until child is older when a heart murmur or high blood pressure is detected

Which intervention is necessary to obtain accurate urinalysis data? a. Force fluids for one hour prior to specimen collection. b. Cleanse the specimen container with povidone-iodine (Betadine) prior to collection. c. Allow the urine to cool to room temperature before taking it to the lab. d. Provide client/parent education for specimen collection before the specimen is obtained.

D. Provide client/parent education for specimen collection before the specimen is obtained.

What are cyanotic heart defects?

Disease that cause decrease in blood flow: Tetralogy of Fallot or Triscupid Artesia or Mixed Blood Flow: TGA, TAPVR, Truncus Ateriosus, or HLHS

What are acyanotic heart defects?

Diseases that either Cause an increase in pulmonary blood flow: ASD, VSD, PDA or AVC or Obstruction to blood flow from ventricles: Coarctation of aorta, Aortic Stenosis or Pulmonic Stenosis

What are the s/s of CHF in older children?

Exercise Intolerance Dyspnea Abdominal Pain Peripheral Edema Skin Mottling Pallor

What is tretology of fallot?

Four defect involved: to help remember say SHOV(E) S) Stenosis of Pulmonic Valve H) Hypertrophy of Right Ventricle O) Overriding of Aorta V) Ventricular Spetal Defect (vsd) Oxygen of cyanotic baby with Tetraology of Fallot doesn't work

What are the signs and symptoms of Artrial Septal Defect?

Heart Murmurs Shortness of Breath Poor or Delayed Growtn

What is rheumatic fever?

Inflammatory disease occurring 1 to 3 weeks after untreated group A β-hemolytic streptococcal pharyngitis (GABHS)

What are S/S of Kawasaki syndrome?

Ned 4/5 symptoms and fever for over 5 days to diagnosis CRASH Conjunctivitis Rash Adenopathy (Unilateral enlargement of cervical lymph nodes) Strawberry Tongue/Red throat Hands and Feet Desquamation /arthritis Fever - BURN Extreme irritability (can last up to 2 months)

What are the s/s of progressive CHF?

Tachycardia Tachypnea Nasal Flaring, Grunting Crackles Signs of Fluid Retention Edema in face Jugular vein distension Hepatomegaly, Cardiomegaly

How is ASD treated?

Through: - surgical closure (pulmonary hypertension) -Cardiac Catheterization

What are the s/s of CHF in infants

Tires Easily when Feeding Loses Weight Sweats Is Irritable Is Prone to Infections

What is a ventricular septal defect?

Ventricular septal defect is opening between the right and left ventricles.

What is patent ductus arteriosus- acyanotic?

When the Ductus Arteriosus remains open after birth causing blood to flow from the aorta into the pulmonary artery increasing pulmonary blood flow

=A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. Which of the following terms best exemplifies this phenomenon? a. Absence seizure. b. Akinetic seizure. c. Non-epileptic seizure. d. Simple spasm seizure.

a. Absence seizure.

1. The nurse is caring for a child with nephrotic syndrome who is receiving prednisone. Which would the nurse monitor for in this child? a. Infection b. Urinary retention c. Easy bruising d. Hypoglycemia

a. Infection

What is hypoplastic left heart syndrome?

all of the structures on the left side of the heart (the side which receives oxygen-rich blood from the lungs and pumps it out to the body) are severely underdeveloped one of the most complex cardiac defects seen in the newborn and remains probably the most challenging to manage of all congenital heart defects. It is one of a group of cardiac anomalies that can be grouped together under the description single ventricle defects.

An infant has been admitted for treatment of hypospadias. When planning care for this child, which intervention would the nurse include? a. Parent education regarding steroid therapy b. Addressing parental anxiety related to functioning and appearance of the penis c. Home health teaching of proper straight catheterization techniques d. Monitoring for signs and symptoms of nephrotic syndrome

b. Addressing parental anxiety related to functioning and appearance of the penis

Which is the best action for the nurse to take during a child ' s seizure? a. Administer the child ' s rescue dose of oral diazepam (Valium). b. Ensure the child is in a safe place and airway is patent. c. Place a tongue blade in the child ' s mouth to prevent aspiration. d. Call the physician

b. Ensure the child is in a safe place and airway is patent.

When reviewing a urinalysis report of a client with acute glomerulonephritis, which finding would be expected? a. Decreased creatinine clearance b. Decreased specific gravity c. Proteinuria d. Decreased erythrocyte sedimentation rate (ESR)

c. Proteinuria

What is Aortic Stenosis?

narrowing of the aortic valve

What is pulmonary valve stenosis?

narrowing of the pulmonary valve