Pediatric Final Exam
Providing teaching about car seat use to the mother of a 6-month-old infant. Statement that indicates understanding of the teaching?
"I should secure the car seat using lower anchors and tethers instead of the seat belt."
A nurse is providing teaching to an adolescent about how to manage tinea pedis. Which of the following statements by the adolescent indicates an understanding of the teaching?
"I should wear sandals as much as possible."
A nurse is providing discharge teaching to the parent of an 18-month-old toddler who has dehydration as a result of acute diarrhea. Statement by the parent that indicates and understanding of the teaching?
"I will monitor my child's # of wet diapers"
A child with osteomyelitis asks the nurse, "What is a 'sed' rate?" What is the best response for the nurse?
"It tells us how you are responding to the treatment."
A nurse is teaching the parents of a school-age child who has a new diagnosis of osteomyelitis of the tibia. The nurse should identify that which of the following statements by the parents indicates an understanding of the teaching?
"My child will receive antibiotics for several weeks."
A nurse is providing discharge teaching to the parent of a school-age child who has moderate persistent asthma. Which of the following instructions should the nurse include?
"Pulmonary function tests will be performed every 12-24 months to evaluate how your child is responding to therapy."
A nurse is providing teaching to the parent of a school-age child who has oral candidiasis and is to begin taking oral nystatin. Which of the following instructions should the nurse include?
"Shake the medication prior to administration."
The nurse is preparing a school-age child for computed tomography (CT scan) to assess cerebral function. Which statement should the nurse include when preparing the child?
"The scan will not hurt."
What nursing assessment and care holds the highest priority in the initial care of a child with a major burn injury?
Establishing and maintaining the child's airway
Providing anticipatory guidance to the mother of a toddler. Expected behavior characteristics of the toddler to be included in the teaching?
Expresses likes and dislikes
A nurse is assessing the pain lvl of a 3-yr-old toddler. Appropriate pain assessment scale to use?
FACES pain rating scale.
When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from
Falls
A recommendation to prevent neural tube defects is the supplementation of
Folic acid for all women of childbearing age
Juvenile arthritis should be suspected in a child who exhibits
Joint swelling and pain lasting longer than 6 weeks
Which term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?
Kyphosis
After a tonic-clonic seizure, it would not be unusual for a child to display
Lethargy and confusion
The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. The most essential part of nursing assessment to detect early signs of a worsening condition is
Level of consciousness
A child is brought to the emergency department in generalized tonic-clonic status epilepticus. Which medication should the nurse expect to be given initially in this situation?
Lorazepam (Ativan)
A nurse is reviewing the lab report of an infant who is receiving tx for severe dehydration. The nurse should identify that which of the following lab values indicates effectiveness of the current tx?
Sodium 140 mEq/L
A nurse is caring for a 10-year-old child following a head injury. Findings that indicate the development of diabetes insipidus?
Sodium 155 mEq/L
A nurse is assessing a pt. who has a new diagnosis of celiac disease. Expected clinical manifestations?
Steatorrhea
The pediatric nurse understands that cellulitis is most often caused by:
Streptococcus or Staphylococcus organisms
A nurse in an ED is performing a physical assessment on a 2-wk-old male infant. Manifestation that is the priority to report to the provider?
Substernal retractions
A nurse in an ED is assessing a 3-month-old infant who has rotavirus and is experiencing acute vomiting and diarrhea. Manifestations that indicate moderate to severe dehydration?
Sunken anterior fontanel
A nurse knows that which exercise is best for a child with juvenile arthritis?
Swimming in a heated pool
A charge nurse in an ED is preparing an in-service for a group of newly licensed nurses on the clinical manifestations of child maltreatment. Which of the following clinical manifestations should the charge nurse include as suggestive of potential physical abuse?
Symmetric burns of the lower extremities
The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. Which of the following is the most essential part of the nursing assessment to detect early signs of a worsening condition?
The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of an injury than do alterations of vital signs or focal neurologic signs
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on the knowledge that?
children are better able to manage the diabetes
The nurse is admitting a child who has been diagnosed with Kawasaki disease. What is the most serious complication for which the nurse should assess in Kawasaki disease?
coronary aneurysm
Impetigo ordinarily results in:
No scarring
A 4-year-old child with a long leg cast complains of "fire" in his cast. The nurse should
Notify the physician immediately.
A nurse is planning developmental activities for a newly admitted 10-year-old child who has neutropenia. Which of the following actions should the nurse plan to take?
Provide the child with a book about adventure.
Which of the following statements best describes a subdural hematoma?
bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present?
blurred vision
If a child has a concussion, a second concussion will have no further ill effects. Is this statement true or false?
false
What is the best nursing action when a child with type 1 diabetes mellititus is sweating, trembling, and pale?
give the child a glass of orange juice
A beneficial effect of administering digoxin is that it:
decreases edema
New parents ask the nurse, "Why is it necessary for our baby to have the newborn blood test?" The nurse explains that the priority outcome of mandatory newborn screening for inborn errors of metabolism is:
early identification of serious genetically transmitted metabolic diseases
Chelation therapy is begun on a child with b-thalassemia major. The purpose of this therapy is to:
eliminate excess iron
What is the best response to a father who tells the nurse that his son "daydreams" at home and his teacher has observed this behavior at school?
"Tell me about your son's activity when you notice the daydreams."
When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of:
Asthma
Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include
Avoiding using any latex product
Nursing care of the infant who has had a myelomeningocele repair should include
Measurement of head circumference
The nurse should recommend medical attention if a child with a slight head injury experiences which of the following?
Medical attention should be sought if the child exhibits confusion or abnormal behavior, loses consciousness, has amnesia, has fluid leaking from the nose or ears, complains of blurred vision, or has an unsteady gai
With what beverage should the parents of a child with ringworm be taught to give griseofulvin?
Milk
A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is which of the following?
Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures
A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action should be which of the following?
Signs of brainstem injury include deep, rapid, periodic or intermittent, and gasping respirations. Wide fluctuations or noticeable slowing of the pulse, widening pulse pressure, or extreme fluctuations in blood pressure are consistent with a brainstem injury
The Glasgow Coma Scale consists of an assessment of:
eye opening and verbal and motor responses
What procedure is contraindicated in the care of a child with a minor partial-thickness burn injury wound?
leaving all loose tissue or skin intact
Assessing a school-age child immediately postop following a perforated appendix repair. Expected findings?
Absence of peristalsis
Which of the following types of seizures may be difficult to detect?
Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure
During painful episodes of juvenile arthritis, a plan of care should include what nursing intervention?
Proper positioning of the affected joints to prevent musculoskeletal complications
A nurse is providing teaching to the parents of a toddler about the administration of prescribed eye drops and eye ointment. Instructions to include?
"Administer the eye drops 3 minutes before the ointment."
Providing discharge teaching to the parents of a 3-month-old infant following cheiloplasty. Appropriate instructions to include?
"Apply a thin layer of antibiotic ointment on your baby's suture line daily for the next 3 days."
A nurse is teaching the parents of a toddler who has cognitive impairment about toilet training. Instructions to include in the teaching?
"Award the child with a sticker when he sits on the potty chair."
Providing teaching to the parents of a preschooler who has heart failure and who is beginning to take digoxin twice daily. Appropriate instructions to include?
"Brush the child's teeth after giving the medication."
A nurse is creating an educational plan to teach parents about protecting their children from sunburns. Instructions to be included?
"Choose a waterproof sunscreen with an SPF of at least 15."
A nurse is providing teaching to the family of a school-age child who has juvenile idiopathic arthritis. Instructions to be included in the teaching?
"Encourage the child to perform independent self-care"
A nurse is teaching the parent of a newborn about ways to prevent SIDS. Instructions to be included?
"Give the infant a pacifier at bedtime."
Which statement by an adolescent indicates an understanding about factors that can trigger migraine headaches?
"I am learning to relax because I get headaches when I am worried about stuff."
Which statement made by a parent indicates an understanding about the management of a child with cellulitis?
"I have been putting a warm soak on my son's arm every 4 hours."
A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. Which statement made by the mother indicates a correct understanding of the teaching?
"I should expect my child to have some behavioral changes after the accident."
The nurse should expect a child who has frequent tension type of headaches to describe headache pain as
"There is a rubber-band squeezing my head."
What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition?
"There may be no definitive cause identified."
A nurse in a provider's office is caring for a school-age child who has varicella. The parent asks the nurse when her child will no longer be contagious. Appropriate response by the nurse?
"When your child's lesions are crusted, 6 days after they appear."
A nurse is providing dietary teaching to the parent of a school-age child who has cystic fibrosis. Appropriate statement to make?
"You should offer your child high-protein meals and snacks throughout the day."
Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI) of the brain?
"Your head will be restrained during the procedure."
A nurse is caring for a hospitalized preschooler. The child's mother is going home for a few hrs while another relative stays with the child. Statement that the nurse should make to explain to the child when her mother will return?
"Your mommy will be back after you eat."
How much folic acid is recommended for women of childbearing age?
0.4 mg
A nurse is reviewing the dietary choices of an adolescent who has iron deficiency anemia. The nurse should identify that which of the following menu items has the highest amount of iron?
1/2 cup of raisins
A nurse is preparing to administer ibuprofen 5 mg/kg every 6 hr PRN for temps. above 38.0C (100.5F) to an infant who weights 17.6 lbs. The infant has a temp. of 38.4C (101.2F). Available is ibuprofen liquid 100 mg/5mL. How many mL should the nurse administer to the infant per dose? (Nearest whole #)
2 mL
Which of the following is descriptive of a concussion?
A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head.
Receiving change-of-shift report on 4 children. Which should be assessed 1st?
A toddler who has a concussion and an episode of forceful vomiting
A mother reports that her child has episodes where he appears to be staring into space. This behavior is characteristic of which type of seizure?
Absence
A nurse in an ED is caring for a school-age child who is experiencing an anaphylactic rxn. Priority action by the nurse?
Administer IM epinephrine to the child.
A nurse is caring for a preschooler who is scheduled for hydrotherapy tx for wound debridement following a burn injury. Appropriate action to take prior to the procedure?
Administer an analgesic to the child.
A school age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to:
Administer an antiemetic before chemotherapy begins
A nurse is creating a plan of care for a toddler who has minimal change nephrotic syndrome (MCNS) and 3+ pitting edema. Interventions to be included in the plan of care?
Administer corticosteroids to the toddler.
What is an appropriate nursing intervention for the child with a tension headache?
Administer pharmacologic headache relief measures.
A nurse is preparing to administer an immunization to a 4-yo child. Which of the following actions should the nurse plan to take?
Administer the immunization using a 24-gauge needle
A 3-year-old child is hospitalized after a near- drowning accident. The child's mother complains to the nurse, "This seems unnecessary when he is perfectly fine." The nurse's best reply would be which of the following?
All children who have a near-drowning experience should be admitted to the hospital for observation. Although many children do not appear to have suffered adverse effects from the event, complications such as respiratory compromise and cerebral edema may occur 24 hours after the incident
A young boy will receive a bone marrow transplant. This is possible because one of his older siblings is a histocompatible donor. This type of BMT is termed:
Allogenic
A nurse is performing hearing screenings for children at a community health fair. Which of the following children should the nurse refer to a provider for a more extensive hearing evaluation?
An infant who is 8 months old and is not yet making babbling sounds.
Which statement best describes a subdural hematoma?
Bleeding occurs between the dura and the cerebrum.
Preparing an adolescent for lumbar puncture. Appropriate action?
Apply topical analgesic cream to the site 1 hr prior to the procedure.
Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy?
Arrange for tutoring and school work
When infants are seen for fractures, which nursing intervention is a priority?
Assess for child abuse. Fractures in infants are often nonaccidental.
A school nurse is assessing a school-age child's BP while he is seated in a chair. The child starts to experience a tonic-clonic seizure. Appropriate action to take first?
Assist the child to a side-lying position on the floor
A nurse is creating a plan of care for a preschooler who has Wilm's tumor and is scheduled for surgery. Which of the following interventions should the nurse include?
Avoid palpating the abdomen when bathing the child before surgery
What is the major concern guiding treatment for the child with Legg-Calvé-Perthes disease?
Avoid permanent deformity.
Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's?
Because soft tissues are resilient in children, dislocations and sprains are less common than in adults.
A nurse is reviewing the lab report of a school-age child who is experiencing fatigue. Which of the following findings should the nurse recognize as an indication of anemia?
Hematocrit 28%
Which neurologic diagnostic test gives a visualized horizontal and vertical cross section of the brain at any axis?
CT scan
A nurse in the ED is caring for a toddler who has partial-thickness burns on his right arm. Which action should the nurse take?
Cleanse the affected area with mild soap and water.
Which change in status should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury?
Confusion and altered mental status
A nurse is explaining to parents how the central nervous system of a child differs from that of an adult. Which statement accurately describes these differences?
Coordination and fine motor skills develop as myelinization of peripheral nerves progresses.
Patient and parent education for the child who has a synthetic cast should include
Covering the cast with plastic and waterproof tape to keep it dry while bathing or showering
A nurse is assessing an infant who has pneumonia. Which of the following findings is the priority for the nurse to report to MD?
Nasal flaring
A nurse is caring for a school-age child who has primary nephrotic syndrome and is taking prednisone. Following 1 wk of tx, which of the following clinical manifestations indicates to the nurse that the medication is effective?
Decreased edema
When assessing the child with osteogenesis imperfecta, the nurse should expect to observe
Discolored teeth
A nurse at an urgent care clinic is assessing an adolescent client who has an upper respiratory tract infection. Which of the following findings should the nurse recognize as a manifestation of pertussis?
Dry, hacking cough
During a 14-year-old's physical examination, the nurse identifies that he plays soccer and football and is complaining of knee pain when he rises from a squatting position, and difficulty with weight bearing. The nurse should suspect
Duchenne muscular dystrophy
A nurse is caring for a toddler who has spastic (pyramidal) cerebral palsy. Expected clinical manifestations? (select all)
Negative Babinski reflex is incorrect. A child who has spastic cerebral palsy will exhibit a positive Babinski reflex.
A nurse should expect which cerebral spinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis? Select all that apply.
Elevated white blood count (WBC), Decreased glucose, Cloudy in color
Creating a plan of care for a newly-admitted adolescent who has bacterial meningitis. How long should the nurse plan to maintain the adolescent in droplet precautions?
For 24 hr following initiation of antimicrobial therapy
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that
Frequent, serial casting is tried first.
Which type of seizures involves both hemispheres of the brain?
Generalized
Creating a plan of care for an infant who has an epidural hematoma with a skull fracture. Appropriate action to include?
Implement seizure precautions for the infant
In caring for a child with a compound fracture, the nurse should carefully assess for
Infection
A boy who has fractured his forearm is unable to extend his fingers. The nurse knows that this
May indicate compartmental syndrome
A nurse is caring for a 15-year-old pt following a head injury. Which of the following findings should the nurse identify as an indication that the child is developing syndrome of inappropriate anitidiuretic hormone secretion (SIADH)?
Mental confusion
A nurse in the ED is caring for a school-age child who has epiglottis. Which of the following actions should the nurse take?
Monitor the child's O2 saturation
A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Nursing care for this child includes (select all that apply)
Monitoring and maintaining systemic blood pressure, Administering corticosteroids, Monitoring for respiratory complications
A 6-year-old patient who has been placed in skeletal traction has pain, edema, and fever. The nurse should suspect
Osteomyelitis
A nurse is caring for a school-age child who has peripheral edema. Following assessments that confirm peripheral edema?
Palpate the dorsum of the child's feet
The nurse is assessing a premature newborn infant auscultates a continuous machinery like murmur. This finding is associated with congenital heart defect?
Pantent ductus arteriosus
A nurse is preparing to collect a sample from a toddler for a sickle-turbidity test. Appropriate action to take?
Perform a finger stick
A nurse is providing teaching about social development to the parents of a preschooler. Which of the following play activities should the nurse recommend for the child?
Playing dress-up
What should be the nurse's first action when a child with a head injury complains of double vision and a headache, and then vomits?
Report this information to the physician
What is the priority nursing intervention for the child with ascending paralysis as a result of Guillain-Barré syndrome (GBS)?
Respiratory assessment
A nurse is assessing a 3-yo toddler at a well-child visit. Which of the following manifestations should the nurse report to the MD?
Respiratory rate 45/min
A nurse is providing dietary teaching to the parent of a school-age child who has celiac disease. The nurse should recommend that the paretn offer which of the following foods to the child?
Rice pudding
Discharge planning for the child with juvenile arthritis includes the need for
Routine ophthalmologic examinations to assess for visual problems
Planning care for a toddler who has a serum lead leverl of 4 mcg/dL. Appropriate action to take?
Schedule the toddler for a yearly rescreening.
A nurse is auscultating the lungs of an adolescent who has asthma. The nurse should identify the sound as which of the following?
Tachypnea
A father calls the clinic nurse because his 2-yearold child was bitten by a black widow spider. The nurse should advise the father to:
Take child to emergency department.
A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports that he will not stop crying even after taking acetaminophen with codeine. He also will not straighten the fingers on his right arm. The nurse tells the mother to
Take him to the emergency department.
A nurse is assessing the vital signs of a 10-year-old child following a burn injury. Clinical manifestation that indicate early septic shock?
Temperature 39.1C (102.4F)
A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school. Breathing is not impaired, but some postictal confusion occurs. The most appropriate initial action by the school nurse is which of the following?
The EMS should be called to transport the child because this is the child's first seizure
A nurse is assessing an adolescent who received a sodium polystryrene sulfonate enema. Which of the following findings indicates effectiveness of the medication.
The adolescent's serum potassium level is 4.1 mEq/L
What should the nurse teach parents when the child is taking phenytoin (Dilantin) to control seizures?
The child should use a soft toothbrush and floss the teeth after every meal.
What nursing actions are indicated when the nurse is administering phenytoin (Dilantin) by the intravenous route to control seizures? Select all that apply.
The child will require monitoring of therapeutic serum levels while taking this medication, It must be given in normal saline, It must be filtered.
When a child with a musculoskeletal injury on the foot is assessed, what is most indicative of a fracture?
The inability of the child to bear weight
A nurse in the ED is caring for an adolescent who has severe abdominal pain due to appendicitis. Which of the following locations should the nurse identify as McBurney's point? (Hotspot)
The lower R. quadrant of the abdomen between the umbilicus and the anterior iliac crest.
A nurse in an ED is caring for an adolescent who reports painful urination. Behaviors that suggest possible child maltreatment?
Uses mood-elevating substances.
Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm?
The skin color, temperature, movement, sensation, and capillary refill of the extremity
Which factor is important to include in the teaching plan for parents of a child with Legg-Calvé-Perthes disease?
There is a disturbance in the blood supply to the femoral epiphysis.
A nurse is teaching parents the difference between pediatric fractures and adult fractures. Which observation is true about pediatric fractures?
They seldom are complete breaks.
A nurse is caring for a preschooler who has been receiving IV fluids via a peripheral IV catheter. When preparing to discontinue the IV fluids and catheter, which of the following actions should the nurse plan to take?
Turn of the IV pump Occlude the IV tubing Remove the tape securing the catheter Apply pressure over the catheter insertion site.
What is the most appropriate nursing action when a child is in the tonic phase of a generalized tonic-clonic seizure?
Turn the child's body on the side.
The vector reservoir for agents causing viral encephalitis in the United States is which of the following?
Viral encephalitis, not attributable to a childhood viral disease, is usually transmitted by mosquitoes and ticks. The vector reservoir for most agents pathogenic for humans and detected in the United States are mosquitoes and ticks; therefore most cases of encephalitis appear during the hot summer months
The skin condition commonly known as "warts" is the result of an infection by which organism?
Virus
A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What should the nurse suggest to remove this material?
Wash the area with warm water and soap.
A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests:
Watery discharge from the nose that is positive for glucose suggests leaking of CSF from a skull fracture.
An important nursing intervention when caring for a child who is experiencing a seizure would be which of the following?
When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity.
A nurse in a provider's office is preparing to administer immunizations to a toddler who has asthma during a well-child visit. Which of the following actions should the nurse plan to take?
Withhold the influenza vaccine
When assessing a child for possible congenital heart defects, where should the nurse measure blood pressure?
all four extremeties
What are the nursing priorities for a child with sickle cell disease in vasoocclusive crisis?
hydration and pain management
Which problem is most often associated with myelomeningocele?
hydrocephalus
A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem. Which metabolic alteration that is related to growth hormone deficiency should the nurse explain to the parent?
hypoglycemia
A neonate is displaying mottled skin, has a large fontanel and tongue, is lethargic and is having difficulty feeding. The nurse recognizes that this is most suggestive of
hypothyroidism
A child who has been in good health has a platelet count of 45,000/mm3, petechiae, and excessive bruising that covers the body. The nurse is aware that these signs are clinical manifestations of
immune thrombocytopenic purpura
Which statement best describes beta-thalassemia major (Cooley anemia)?
increased incidence occurs in families of Mediterranean extraction
Which sign, exhibited by a hospitalized child, should the nurse recognize as a characteristic of diabetes insipidus?
increased urination
Which postoperative intervention should be questioned for a child after a cardiac catheterization?
keep the affected leg flexed and elevated
An assessment of a 7 month old infant with hemoglobin level of 6.5 mg/dl is likely to reveal an infant who is
lethargic, pale, and irritable
Diabetes insipidus is a disorder of the
posterior pituitary
A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention?
relax any eating pressures
Prolonged seizure activity, in the form of either a single seizure lasting 30 minutes or recurrent seizures lasting more than 30 minutes, with no return to a normal level of consciousness is known as _________________.
status epilepticus
A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what condition occurs?
temperature above 37.7, turning blue or bluer than normal , new frequent coughing
An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. The initial treatment of secondary hypertension initially involves:
treating the underlying disease
What is the most descriptive of the pathophysiology of leukemia?
unrestricted proliferation of immature white blood cells
The nurse discovers a heart murmur in an infant 1 hour after birth. She is aware that fetal shunts are closed in the neonate at what point?
within several days of birth
Which of the following is a clinical manifestation of increased intracranial pressure (ICP) in infants? (Select all that apply.)
Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants.
Which of the following neurologic diagnostic tests gives a visualized horizontal and vertical cross section of the brain at any axis?
A CT scan provides a visualization of the horizontal and vertical cross sections of the brain at any axis
A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is which of the following?
A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and the promotion of comfort and relief of anxiety
The most common clinical manifestation(s) of brain tumors in children is which of the following?
Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestation(s) of brain tumors in children
A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which of the following in the response?
A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure free for 2 years and has a normal electroencephalogram (EEG).
What should the nurse teach an adolescent who is taking tretinoin (Retin-A) to treat acne?
Apply sunscreen before going outdoors.
Electric injury to a child often results in instant death because the electric current disrupts the rhythm of the heart. Is this statement true or false?
true
When caring for the child with Reye syndrome, the priority nursing intervention would be which of the following?
Accurate and frequent monitoring of intake and output is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema
Which of the following may be beneficial in reducing the risk of Reye syndrome?
Although the etiology of Reye syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye syndrome, so use of aspirin is avoided
The nurse teaches parents to alert their health care provider about which adverse effect when a child receives valproic acid (Depakene) to control generalized seizures?
Bruising
What clinical manifestations would suggest hydrocephalus in a neonate?
Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates.
Which finding in an analysis of cerebrospinal fluid (CSF) is consistent with a diagnosis of bacterial meningitis?
CSF appears cloudy.
The process of burn shock continues until what physiologic mechanism occurs?
Capillaries regain their seal.
An important nursing consideration when caring for a child with impetigo contagiosa is to:
Carefully wash hands and maintain cleanliness when caring for an infected child.
A nurse is teaching parents about prevention of diaper dermatitis. Which should the nurse include in the teaching plan?( Select all that apply.):
Clean the diaper area gently after every diaper change with a mild soap, Use a protective ointment to clean dry intact skin, Wash cloth diapers in hot water with a mild soap and double rinse.
Which of the following types of seizures involves both hemispheres of the brain?
Clinical observations of generalized seizures indicate that the initial involvement is from both hemisphere
Which type of fractures describes traumatic separation of cranial sutures?
Commuted
The management of a child who has just been stung by a bee or wasp should include the application of:
Cool compresses
A young child's parents call the nurse after their child was bitten by a raccoon in the woods. The nurse's recommendation should be based on which of the following?
Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immune globulin (HRIG) as soon as possible
Children taking phenobarbital and/or phenytoin may experience a deficiency of:
Deficiencies of vitamin D and folic acid have been reported in children taking phenobarbital and phenytoin
What best describes a full-thickness (thirddegree) burn?
Destruction of all layers of skin evident with extension into subcutaneous tissue
Which of the following types of fractures describes traumatic separation of cranial sutures?
Diastatic skull fractures are traumatic separations of the cranial sutures
An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which of the following interventions should be included in the child's postoperative care?
Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus.
Where do the lesions of atopic dermatitis most commonly occur in the infant? (Select all that apply.):
Extensor surfaces of arms and legs, cheeks and back
The nurse is preparing a school-age child for computed tomography (CT scan) to assess cerebral function. The nurse should include which of the following statements in preparing the child?
For CT scans, the child must be immobilized. It is important to emphasize to the child that at no time is the procedure painful.
Which of the following drugs would be used to treat a child who has increased ICP resulting from cerebral edema?
For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction.
Ringworm, frequently found in schoolchildren, is caused by a(n):
Fungus
The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on which of the following?
H. influenzae type b meningitis has been virtually eradicated in areas of the world where the vaccine is administered routinely
What is a sign of increased intracranial pressure (ICP) in a 10-year-old child?
Headache
When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with observable distended scalp veins, the nurse recognizes these signs as indicative of
Hydrocephalus
Spastic cerebral palsy is characterized by:Hypertonicity and poor control of posture, balance, and coordinated motion.
Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy
The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on knowing that:
Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.
Five-year-old José is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which of the following?
José should be told what he will look and feel like after surgery. This includes the size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing
What should be included in teaching a parent about the management of small red macules and vesicles that become pustules around the child's mouth and cheek?
Keep the child home from school for 24 hours after initiation of antibiotic treatment.
A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend:
Keeping child quiet and come to emergency department
The primary treatment for warts is:
Local destruction
Which of the following is the initial clinical manifestation of generalized seizures
Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation
When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised that a week ago the child had recovered from which of the following?
Most cases of Reye syndrome follow a common viral illness such as varicella or influenza
The most common problem of children born with a myelomeningocele is
Neurogenic bladder
Parents of a child with lice infestation should be instructed carefully in the use of antilice products because of which potential side effect?
Neurotoxicity
Which of the following terms is used to describe a child's level of consciousness when the child is arousable with stimulation?
Obtundation describes a level of consciousness in which the child is arousable with stimulation.
A child with a head injury sleeps unless aroused, and when aroused responds briefly before falling back to sleep. What should the nurse chart for this child's level of consciousness?
Obtunded
An appropriate nursing intervention when caring for an unconscious child would be which of the following?
Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema
Treatment for herpes simplex virus (types 1 or 2) includes:
Oral antiviral agent
The nurse is caring for a child with severe head trauma after a car accident. Which of the following is an ominous sign that often precedes death?
Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea
When changing an infant's diaper, the nurse notices small bright red papules with satellite lesions on the perineum, anterior thigh, and lower abdomen. This rash is characteristic of:
Primary candidiasis
A child experiences frostbite of the fingers after prolonged exposure to the cold. Which intervention should the nurse implement first?:
Rapid rewarming of the fingers by placing in warm water
When taking a history on a child with a possible diagnosis of cellulitis, what should be the priority nursing assessment to help establish a diagnosis?
Recent infections or signs of infection
Which of the following is the priority nursing intervention when a child is unconscious after a fall?
Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishment of an adequate airway is always the first priority
A nurse is instructing parents on treatment of pediculosis (head lice). Which should the nurse include in the teaching plan? (Select all that apply.):
Retreat the hair and scalp with a pediculicide in 7 to 10 days, Items that cannot be washed should be dry cleaned or sealed in plastic bags for 2 to 3 weeks, Combs and brushes should be boiled in water for at least 10 minutes.
Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?
Stupor
Which of the following terms is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?
Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation
What finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy?
Sudden jerking movement caused by stimuli
The depth of a burn injury may be classified as:
Superficial, superficial partial thickness, deep partial thickness, or full thickness
What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration?
Swab nystatin suspension onto the oral mucous membranes after feedings.
A toddler fell out of a second-story window. She had brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a CT scan is required when she "seems fine." The nurse should explain that she:
The child's history of the fall, brief loss of consciousness, and vomiting four times necessitates evaluation of a potential brain injury. The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan
The nurse is preparing a school-age child for computed tomography (CT scan) to assess cerebral function. The nurse should include which of the following statements in preparing the child?
The oculovestibular response (caloric test) involves the instillation of ice water into the ear of a comatose child. The caloric test is painful and is never performed on an awake child or one who has a ruptured tympanic membrane.
A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. Which of the following statements made by the mother indicates a correct understanding of the teaching?
The parents are advised of probable posttraumatic symptoms that may be expected. These include behavioral changes and sleep disturbance
The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as which of the following?
The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding
Rocky Mountain spotted fever is caused by the bite of a:
Tick
The treatment of brain tumors in children consists of which of the following therapies? (Select all that apply.)
Treatment for brain tumors in children may consist of surgery, chemotherapy, and radiotherapy alone or in combination.
To assess the child with severe burns for adequate perfusion, the nurse monitors:
Urine output
Which nursing assessment is applicable to the care of a child with herpetic gingivostomatitis?
Urine output, mucous membranes, and skin turgor
How should the nurse explain positioning for a lumbar puncture to a 5-year-old child?
You will lie on your side and bend your knees so that they touch your chin."
Which of the following best describes a neuroblastoma?
a silent tumor with few symptoms. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site
Baclofen given intrathecally is best suited for children with severe spasticity that interferes with activities of daily living and ambulation
most common problem of children born with a myelomeningocele is: Neurogenic bladder. Myelomeningocele is one of the most common causes of neuropathic bladder dysfunction among children.
The primary clinical manifestation of scabies is:
pruritus
A new mother calls the pediatrician's office concerned because her newborn has developed a salmon colored, irregularly shaped spot between the eyes. The lesion becomes darker when the baby is crying. This skin lesion is called a(n) ____________.
salmon patch
