Pediatrics Exam 5

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother?

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."

A client's mother asks the nurse, "When should my daughter have a pelvic examination?" Which response by the nurse is most appropriate?

"A pelvic exam is necessary at 18 to 20 years of age."

Which question would be most important for a nurse to ask when taking a history from a client who is suspected of having amenorrhea?

"Are you sexually active?"

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever?

"Children who have this diagnosis may have had strep throat."

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism?

Testis cannot be "milked" down inguinal canal

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?

"In most cases treatment is not necessary, only observation."

The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningeocele. They ask the nurse what exactly that means. Which would be the nurse's best reply?

"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved."

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals?

"It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms."

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"Pale, cool, or blue skin coloration is to be expected."

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching?

"The feeling of the heart skipping a beat is common."

The nurse is caring for a child who has a hip spica cast. The child's mother asks why is there a hole cut in it. What is the best response by the nurse?

"The window allows us to assess bowel sounds and helps to prevent abdominal distention."

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:

"These make a smooth edge on the cast so the skin is better protected."

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents?

"You and your coaches need to understand that you cannot play soccer for at least six weeks."

A 5-year-old child has undergone a cardiac catheterization and is being prepared for discharge home with the parents. The nurse is teaching the parents how to care for the child at home. The nurse determines that the teaching is successful based on which statement(s) by the parents? Select all that apply.

-"After several days, we do not need to keep any dressing on the site." -"If we notice any drainage or bleeding at the site, we will call the health care provider." -"If our child has pain, we can give acetaminophen or ibuprofen."

The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant's heart rate?

90 to 160 bpm

A nurse has provided care to several children during their well-child visits. The nurse has assessed each child's neurologic status. Which assessment finding indicates a problem requiring intervention?

A 4-year-old preschool-age child who consistently walks on tip toes

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present?

Abdominal mass

Which nursing diagnosis would best apply to a child with rheumatic fever?

Activity intolerance related to inability of heart to sustain extra workload

A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. What nursing interventions should be implemented? Select all that apply.

Administration of IV antibiotics at the hospital Instruct the parents on how to care for an IV line at home Instruct the parents regarding the importance of maintaining bed rest Institute infection-control precautions related to drainage tubes

A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?

Adolescence

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?

Advise the child that this is to be expected.

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?

Digoxin

The nurse is caring for a child admitted to the hospital for a cardiac catheterization. Upon return from the cardiac catheterization, which nursing action is priority?

Assess the dressing at the insertion site.

What information would be included in the care plan of an infant in heart failure?

Begin formulas with increased calories.

The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis?

Blood pressure 136/84

A child is born with a talipes disorder. The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?

Check the infant's toes for coldness or blueness.

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia?

Child A with a total cholesterol of 150 mg/dl and low-density lipoprotein (LDL) of 80 mg/dl.

A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate?

Creatinine clearance rate

A parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse?

Demonstrate love and acceptance at home.

The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.

Document any signs of pain. Check radial pulse in the both arms. Monitor the color of the nail beds in the right hand.

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this?

Encourage the child to take all the antibiotics if diagnosed with strep throat.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick

The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client?

Ensure traction weights are hanging freely, not touching the bed or floor.

The nurse is assessing an infant for peripheral edema. Based on the nurse's knowledge, the nurse would expect edema to occur in which area first?

Face

A client is being discharged with a diagnosis of toxic shock syndrome. What would be the priority for the nurse to teach the client?

Finish all antibiotic therapy.

The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid?

Folic acid above 0.4 mg/day

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?

Gowers sign

A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia?

Increased RBC

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother?

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?

Lower extremities

A nurse is administering digoxin to a 3-year-old child. What would be a reason to hold the dose of digoxin?

Nausea and vomiting

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?

Notify the doctor immediately.

The nurse is taking a history from an adolescent girl with suspected pelvic inflammatory disease (PID). What data will be most helpful in determining this girl's risk factors for PID?

Number of sexual partners

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?

Peeling hands and feet; fever

The nurse is caring for a 6-year-old with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?

Place the child in a knee-to-chest position.

When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover?

Polycythemia

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?

Presence of Moro reflex

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply.

Prone Right side lying Left side lying

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?

Risk for impaired skin integrity

Which nursing diagnosis will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot?

Risk for ineffective cardiopulmonary tissue perfusion

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant?

Risk for infection related to immunocompromised state

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

Serum potassium level

Which diagnostic measure is most accurate in detecting neural tube defects?

Significant level of alpha-fetoprotein present in amniotic fluid

The nurse is caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis. What would the nurse expect to administer if ordered?

Sodium bicarbonate tablets

At 3 years of age, a child has a cardiac catheterization. After the procedure, which interventions would be most important?

Taking pedal pulses for the first 4 hours

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

Tea-colored urine

The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis:

The child can live a more normal lifestyle.

A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which of these actions by the nurse would require immediate attention?

The child does not have intravenous access.

The nurse is caring for a hosptialized infant with a diagnosis of tetralogy of Fallot, awaiting surgical intervention. Which assessement finding would the nurse expect?

The child has periods of cyanosis and decreased pulse oxyimetery readings

A client has just completed a renal biopsy. Which manifestation should be given priority attention?

The child is not voiding.

A school nurse finds a 10-year-old's blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect?

The child will need the blood pressure checked two more times.

A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse?

The foreskin is needed for repair.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding?

The liver size increases in right-sided heart failure.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours.

A nurse is caring for an infant who just had open-heart surgery and the parents are asking why there are wires coming out of the infant's chest. What is the best response by the nurse?

These wires are connected to the heart and will detect if your infant's heart gets out of rhythm.

An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, what would lead the nurse to suspect that the adolescent has candidiasis?

Thick, white cheese-like discharge

A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education?

This is caused by an opening that usually closes by 1 week of age.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?

This test will check how blood is flowing through the heart.

The nurse is reviewing the causative organisms noted on laboratory reports. Which organism is transmitted solely by sexual contact?

Trichomonas

The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?

Type II

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction?

Wheezing

Which instruction should a nurse give to a client who has a history of urinary tract infection to prevent recurrence?

Wipe from front to back. Encourage fluids throughout the day. Finish all antibiotic prescribed.

A client has just been admitted to the unit with a history of recent strep infection, hematuria, and proteinuria. Based on these findings, the nurse would suspect which condition?

acute glomerulonephritis

A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition?

testicular torsion

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

Color Sensation Pulse Capillary refill

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction?

"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed."

The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.

A parent asks the nurse, "What is precocious puberty?" The nurse's response should be based on which statement?

"Precocious puberty is early sexual development."

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response?

"The cause is unknown and there are many environmental factors that may contribute to it."

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education?

"This medication will cure my child of this disorder."

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed?

"We can stop the penicillin when her symptoms disappear."

A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.

13.3

A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate?

80 beats/min

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:

epiphysiolysis of the proximal humerus.

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:

femoral pulse weaker than brachial pulse

Most urinary tract infections seen in children are caused by:

intestinal bacteria.

Which condition is a risk factor for the development of pelvic inflammatory disease?

multiple sexual partners

A client diagnosed with dysmenorrhea has several medications prescribed. Which medication should the nurse question?

oxycodone

A child diagnosed with acute glomerulonephritis will most likely have a history of:

recent illness such as strep throat.

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to:

take the child to a private room and interview her regarding her sexual history and partners.

After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding that:

the contrast material used has a diuretic effect.

A teenager comes to the clinic with fever, muscle pain, and a macular rash on the palms and soles of the feet. Based on these findings, what diagnosis would the nurse anticipate for this client?

toxic shock syndrome

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

unhooking a weight while providing pin care

Which of these laboratory results would be most important for the nurse to assess in a child who has a diagnosis of urinary tract infection?

urinalysis

Which cause of pediatric enuresis must be ruled out before psychological causes are investigated? Select all that apply

urinary tract infection small bladder capacity lack of awareness

A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition?

vulvovaginitis

The caregiver of a 1-year-old boy calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment?

"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."

A group of nursing students is discussing terminology related to the genitourinary system during a post-conference setting. One of the students asks what mittelschmerz is or what it means. A classmate of this student correctly answers that mittelschmerz is:

a dull, aching abdominal pain at ovulation.

The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond?

"It's great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain."

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta?

Pulses weaker in lower extremities compared to upper extremities

The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements? Select all that apply.

-"We will be sure to not allow our child to ride a bicycle for at least 2 weeks." -"We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." -"We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed."