Peds
Children with severe persistent asthma have frequent nighttime symptoms and have a PFE of less than ______.
< 60%
Which of the following drugs is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting β2-agonists
D- SABA Ephedrine and aminophylline are not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations.
When caring for a child with probable appendicitis, the nurse should be alert to recognize which of the following as a sign of perforation? a. Anorexia b. Bradycardia c. Decreased abdominal distention d. Sudden relief from pain
D- sudden relief from pain
The school nurse is conducting an assessment for pediculosis capitis (head lice) on a group of school-age children. Which describes a child with a positive head check? A. Maculopapular lesions behind the ears B. White, flaky particles throughout the entire scalp area C. Lesions in the scalp extending from the hairline to the neck D. White sacs attached to the hair shafts in the occipital area
D. White sacs attached to the hair shafts in the occipital area
Which of the following should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. Give with meals. b. Stop immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.
c. Adequate dosage will turn the stools a tarry green color.
The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which of the following is appropriate to relieve the abdominal discomfort during the evaluation? a. Place in Trendelenburg position. b. Apply moist heat to the abdomen. c. Allow child to assume position of comfort. d. Administer a saline enema to cleanse the bowel.
c. Allow child to assume position of comfort.
An important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA) would be which of the following? a. Apply ice packs to relieve acute swelling and pain. b. Administer acetaminophen to reduce inflammation. c. Teach child and family correct administration of medications. d. Encourage range-of-motion exercises during periods of inflammation.
c. Teach child and family correct administration of medications.
Which of the following may be beneficial in reducing the risk of Reye syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin for children with varicella or those suspected of having influenza
d. Avoidance of aspirin for children with varicella or those suspected of having influenza
Which of the following statements best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of infant's emaciated appearance. c. It results from a decreased intake of milk and the premature addition of solid foods. d. Clinical manifestations are related to a reduction in the amount of oxygen available to tissues.
d. Clinical manifestations are related to a reduction in the amount of oxygen available to tissues.
Major goals for the therapeutic management of juvenile idiopathic arthritis (JIA) include: a. control pain; preserve joint function. b. minimize use of joint; achieve cure. c. prevent skin breakdown; relieve symptoms. d. reduce joint discomfort; regain proper alignment.
a. control pain; preserve joint function.
Selective cholesterol screening is recommended for children over the age of 2 years with the following risk factors: a. body mass index (BMI) = 95th percentile. b. blood pressure = 50th percentile. c. parent with a blood cholesterol level of 200 mg/dl. d. recently diagnosed cardiovascular disease in a 75-year-old grandparent.
a. body mass index (BMI) = 95th percentile.
nhaled corticosteroids are currently the recommended first-line therapy for children with asthma over the age of 5 years. Children who are taking long-term inhaled steroids should be assessed frequently because which of the following may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome
c. Slowed growth
Which of the following is an accurate description of the physiologic defect caused by anemia? a. Increased blood viscosity b. Depressed hematopoietic system c. Presence of abnormal hemoglobin d. Decreased oxygen-carrying capacity of blood
d. Decreased oxygen-carrying capacity of blood
Which of the following is a major complication in a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen
ANS: C-- Water and sodium retention
Varicella is manifested as lesions in various stages of development—macule, papule, then vesicle, first appearing on the trunk and scalp.
TRUE. circle. then raised. and then filled AIRBORNE AND CONTACT ISOLATION
A child is admitted for nephrotic syndrome. The nurse recognizes that the child's prognosis is related to: a. admission blood pressure. b. creatinine clearance. c. amount of protein in urine. d. response to steroid therapy.
d. response to steroid therapy. Corticosteroids are the drugs of choice for nephrotic syndrome. If the child has not responded to therapy within 28 days of daily steroid administration, the likelihood of subsequent response decreases. The presence of significant proteinuria is used for diagnosis. It is not predictive of prognosis.
As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. Which of the following explains what staging means? a. Extent of the disease at the time of diagnosis b. Rate normal cells are being replaced by cancer cells c. Biologic characteristics of the tumor and/or lymph nodes d. Abnormal, unrestricted growth of cancer cells producing organ damage
A
Which of the following urine tests would be considered abnormal? a. pH 4.0 b. WBC: 1 or 2 cells/ml c. Protein level absent d. Specific gravity 1.020
ANS: A The expected pH ranges from 4.8 to 7.8.
The most useful measure of fluid balance status in a child with acute glomerulonephritis is: a. proteinuria. b. daily weight. c. specific gravity. d. intake and output.
ANS: B
Vesicoureteral reflux (VUR) with infection is the most common cause of pyelonephritis in children. In teaching the parent of a newly diagnosed 2-year-old, the nurse includes: a. limit fluids to reduce reflux. b. give cranberry juice twice a day. c. have siblings examined for VUR. d. surgery is indicated to reverse scarring.
ANS: C. Have siblings examined for VUR
Which of the following laboratory findings, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome? a. Low specific gravity b. Decreased hemoglobin c. Normal platelet count d. Reduced serum albumin
ANS: D Total serum protein concentrations are reduced, with the albumin fractions significantly reduced. Specific gravity is high and proportionate to the amount of protein in the urine. Hemoglobin and hematocrit are usually normal or elevated. The platelet count is elevated as a result of hemoconcentration.
A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea
a. Asthma Asthma may have these chronic symptoms. Pneumonia appears with an acute onset, fever, and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea occurs with acute respiratory distress or failure, and maybe stridor.
How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until they are approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."
b. "Make sure your child gets the pertussis vaccine."
The nurse is caring for a child with Kawasaki disease in the acute phase. Which of the following clinical manifestations would the nurse expect to observe? Select all that apply. a. Osler nodes b. Cervical lymphadenopathy c. Strawberry tongue d. Chorea e. Erythematous palms f. Polyarthritis
b. Cervical lymphadenopathy c. Strawberry tongue e. Erythematous palms
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which of the following? a. Admit to the hospital and observe for impending epiglottitis. b. Provide fluids that the child likes and use comfort measures. c. Control fever with acetaminophen and call if cough gets worse tonight. d. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.
b. Provide fluids that the child likes and use comfort measures.
The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily which of the following? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.
b. The mother's presence will reduce anxiety and ease child's respiratory efforts.
Which of the following statements is the most descriptive of asthma? a. It is inherited. b. There is heightened airway reactivity. c. There is decreased resistance in the airway. d. The single cause of asthma is an allergic hypersensitivity.
b. There is heightened airway reactivity.
One of the goals for children with asthma is to maintain the child's normal functioning. To accomplish this, one of the principles of treatment is to: a. limit participation in sports. b. reduce underlying inflammation. c. minimize use of pharmacologic agents. d. have yearly evaluations by health care provider.
b. reduce underlying inflammation.
"A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect: "a. Gross hematuria b. Dysuria c. Nausea and vomiting d. An abdominal mass"
"CORRECT: D The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms' tumor. Nausea and vomiting are rare in children with Wilms' tumor."
Aspirin - anti-platelet dosage: Given 48-72 hrs after afeb; 6-8 weeks give or bad ECG rest of life
3-5 mg/kg/day
Aspirin - antiinflammatory dosage:
80-100 mg/kg/day
A 17-year-old is returning to the surgical unit following Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, the nurse knows that initially: a. position changes are made by log rolling. b. assistance is needed to use the bathroom. c. head of bed is elevated to minimize spinal headache. d. passive range of motion is instituted to prevent neurologic injury.
A. Kept flat for at least 12 hrs & shouldn't walk until day 2 or 3
A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). Nursing considerations include: a. monitor heart rate. b. administer NSAIDs between meals. c. check for abdominal pain and bloody stools. d. expect inflammation to be gone in 3 or 4 days.
ANS: C
The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. The nurse's reply should be based on knowledge of which of the following? a. The antibiotic therapy contributes to labile blood pressure values. b. Hypotension leading to sudden shock can develop at any time. c. Acute hypertension is a concern that requires monitoring. d. Blood pressure fluctuations indicate that the condition has become chronic.
ANS: C- Acute hypertension is a concern that requires monitoring.
The nurse is examining a 3-year-old boy with acute otitis media. He has a mild earache and a temperature of 38.5 degrees C. Which action would be most appropriate? A) Obtain a culture of the middle ear fluid. B) Advise the parents to watch for worsening of symptoms. C) Administer antibiotics. D) Administer antivirals.
B) Advise the parents to watch for worsening of symptoms.
The nurse is assessing a 5-year-old girl who is anxious, has a high fever, speaks in a whisper, and sits up with her neck thrust forward. Based on these findings, the nurse would avoid which of the following interventions? A) Providing 100% oxygen B) Visualizing the throat C) Allowing the child to sit up D) Auscultating for lung sounds
B) Visualizing the throat
_______________ is an acute condition caused by respiratory syncytial virus.
Bronchiolitis
An important nursing intervention in the care of a child with bacterial conjunctivitis is A. intermittent warm, moist compresses to remove crusts on the eye area. B. oral antihistamines to minimize itching. C. continuous warm compresses to relieve discomfort. D. application of optic corticosteroids to reduce inflammation.
C. continuous warm compresses to relieve discomfort.
Which of the following clinical manifestations would be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Colicky, cramping, abdominal pain around the umbilicus
Colicky, cramping, abdominal pain around the umbilicus
What kind of isolation for RSV
Contact precaution
The immunizations ordered at 4-6 years of age include: DTaP, Polio, MMR, and Varicella.
DTaP, Polio MMR Varicella
Signs of aspirin toxicity=
Extended irritatbiliy Tinnitus Headache LOC Dizziness
The nurse is caring for a child hospitalized with Reye's syndrome. The nurse would closely monitor the child for which of the following during the acute stage? A) Increased intracranial pressure B) An increase in the blood glucose level C) A decrease in liver enzymes D) Protein in the urine
Increased intracranial pressure
Which of the following statements best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)? a. It has an autosomal dominant inheritance pattern. b. Onset occurs in later childhood and adolescence. c.It is characterized by presence of Gower sign, waddling gait, and lordosis. d. Disease stabilizes during adolescence, allowing for life expectancy to approximately age 40 years.
It is characterized by presence of Gower sign, waddling gait, and lordosis.
Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen in _______________
Kawasaki disease
C-reactive protein is elevated with kawasaki. What is normal range for C-reactive protein
Less than 1-3 mg/dL
Normal range for C-reactive protein
Less than 1-3 mg/dL
Erythrocyte Sed. rate is elevated with kawasaki. What is normal range for Erythrocyte Sed. rate
Less than 23-33 mL/hr
The immunizations ordered at 4-6 years of age include: DTaP, Polio, _______, and Varicella.
MMR
A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. The nurse suggests which of the following? a. Pizza b. Pretzels c. Popcorn d. Oatmeal cookies
Popcorn
The appendix is found on the _____- side
Right
_____________is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis
Scoliosis
Labs in nephrotic syndrome
Serum albumin reduced High specific gravity w/ amount of protein in urine H/H normal or elevated Platelet elevated as a result of hemocentration
Less than 60% PFE =
Severe persistent asthma
The fever of Kawasaki disease is unresponsive to antibiotics.
TRUE
When caring for the child with Kawasaki disease, the nurse should know which of the following? a. Aspirin is contraindicated. b. Principal area of involvement is the joints. c. Child's fever is usually responsive to antibiotics within 48 hours. d. Therapeutic management includes administration of gamma globulin and salicylates.
Therapeutic management includes administration of gamma globulin and salicylates.
Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance.
True
Which of the following conditions is often associated with severe diarrhea? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
a. Metabolic acidosis
The regulation of red blood cell (RBC) production is thought to be controlled by: a. hemoglobin. b. tissue hypoxia. c. reticulocyte count. d. number of RBCs.
b. tissue hypoxia.
A child taking oral corticosteroids for asthma is exposed to varicella. The child has not had the varicella vaccine and has never had the disease. What intervention should be taken to prevent varicella from developing? a. No intervention is needed unless varicella develops. b. Administer the varicella vaccine as soon as possible. c. The child should begin a course of oral antibiotics. d. The child should be prescribed acyclovir.
d. The child should be prescribed acyclovir.
Urinary obstruction prophylaxis abx ages
less than 2 mts. = amoxicilin Greater than 2 mts = baclfin
Varicella is manifested as lesions in various stages of development.. 1. 2. 3.
macule. papule. vesicle, first appearing on the trunk and scalp.
Substantial proteinuria and periorbital edema are common manifestations in __________
nephritic syndrome.
no heat packs for appendicitis
true
Children with mild persistent asthma have symptoms more than ______ times per week.
two Children with mild persistent asthma have symptoms more than 2 times per week & nighttime symptoms 3-4 times a week
What is the causative agent for erythema infectiosum (fifth disease)? A. Paramyxovirus B. Human parvovirus B19 C. Human herpesvirus type 6 D. Group A β-hemolytic streptococcus
B. Human parvovirus B19
What should be included in the care for a neonate who was diagnosed with pertussis? a. Monitoring hemoglobin level b. Hearing test before discharge c. Serial platelet counts d. Treatment of all close contacts with a prophylactic antibiotic
d. Treatment of all close contacts with a prophylactic antibiotic
The nurse is teaching the parents of a 7-year-old boy with asthma about the medications that have been prescribed, including a drug that is generally used as an adjunct to a beta-2 adrenergic agonist for treatment of bronchospasm. Which drug is the nurse describing? A) Ipratropium B) Montelukast C) Cromolyn D) Theophylline
A Ipratropium is an anticholinergic administered via inhalation to produce bronchodilation without systemic effects. It is generally used as an adjunct to a beta-2 adrenergic agonist. Montelukast decreases the inflammatory response by antagonizing the effects of leukotrienes. Cromolyn prevents release of histamine from sensitized mast cells. Theophylline provides for continuous airway relaxation.
The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. Which of the following statements by the parent would indicate a correct understanding of the teaching? a. "I can use an ice collar on my child for pain control along with analgesics." b. "My child should clear the throat frequently to clear the secretions." c. "I should allow my child be as active as tolerated." d. "My child should gargle and brush teeth at least three times per day."
A Pain control after a tonsillectomy can be achieved with an application of an ice collar and administration of analgesics. The child should avoid clearing the throat or coughing and does not need to gargle and brush teeth a certain number of times per day and should avoid vigorous gargling and toothbrushing. Also, the child's activity should be limited to decrease the potential for bleeding, at least for the first few days.
McBurney's Point
A point on the right side of the abdomen, about two-thirds of the distance between the umbilicus and the anterior bony prominence of the hip
A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should do which of the following? a. Make her lie down and rest quietly. b. Examine her oral pharynx and report to the physician. c. Auscultate her lungs and prepare for placement in a mist tent. d. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
ANS: D This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.
The nurse is preparing a staff education program about pediatric asthma. Which of the following concepts should the nurse include when discussing the asthma severity classification system? Select all that apply. a. Children with mild persistent asthma have nighttime symptoms less than two times a month. b. Children with moderate persistent asthma use a short-acting β-agonist more than two times per week. c. Children with severe persistent asthma have a peak expiratory flow (PFE) of 60% to 80% of predicted value. d. Children with mild persistent asthma have symptoms more than two times per week. e. Children with moderate persistent asthma have some limitations with normal activity. f. Children with severe persistent asthma have frequent nighttime symptoms.
ANS: D, E, F Children with mild persistent asthma have symptoms more than two times per week and nighttime symptoms three or four times per month. Children with moderate persistent asthma have some limitations with normal activity and need to use a short-acting β-agonist for symptom control daily. Children with severe persistent asthma have frequent nighttime symptoms and have a PFE of less than 60%.
"A child is admitted to the hospital with a diagnosis of Wilm's tumor, Stage II. Which of the following statements most accurately describes this stage? A) The tumor is less than 3 cm. in size and requires no chemotherapy. B) The tumor did not extend beyond the kidney and was completely resected. C) The tumor extended beyond the kidney but was completely resected. D) The tumor has spread into the abdominal cavity and cannot be resected."
Answer: C The staging of Wilm's tumor is confirmed at surgery as follows: Stage I, the tumor is limited to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V, bilateral renal involvement is present at diagnosis."
The nurse is preparing a community outreach program about the prevention of iron deficiency anemia in infants. Which of the following statements should the nurse include in the program? a. Whole milk can be introduced into the infant's diet in small amounts at 6 months. b. Iron supplements cannot be given until the infant is over 1 year of age. c. Iron-fortified cereal should be introduced to the infant at 2 months of age. d. Breast milk or iron-fortified formula should be used for the first 12 months.
Breast milk or iron-fortified formula should be used for the first 12 months.
An 18 year old patient is admitted with appendicitis. Which statement by the patient requires immediate nursing intervention? A. "The pain hurts so much it is making me nauseous." B. "I have no appetite." C. "The pain seems to be gone now." D. "If I position myself on my right side, it makes the pain less intense."
C. "The pain seems to be gone now." may be perforated!!
A patient is scheduled for appendectomy at noon. While performing your morning assessment, you note that the patient has a fever of 103.8 'F and rates abdominal pain 9 on 1-10. In addition, the abdomen is distended and the patient states, "I was feeling better last night but it seems the pain has become worst." The patient is having tachycardia and tachypnea. Based on the scenario, what do you suspect the patient is experiencing? A. Pulmonary embolism B. Colon Fistulae C. Peritonitis D. Hemorrhage
C. Peritonitis
An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires the following isolation: a. reverse isolation. b. airborne isolation. c. Contact Precautions. d. Standard Precautions.
CONTACT PRECAUTION RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.
A nurse should explain that ringworm is A. a noncontagious disorder. B. a sign of uncleanliness. C. expected to resolve spontaneously. D. spread by direct and indirect contact.
D. spread by direct and indirect contact.
Labs that indicate Kawasaki
Elevated CRP Elevated ESR Leukocytosis Normal labs: CRP: Less than 1-3 mg/dL ESR: 23-33 mL/hr
Celiac Disease s/s
"MALNOURISHED" Mouth ulcers Anemia DIARRHEA Greesy stools that smell bad Lactose intolerance (can't break down lactos) Nausea/vomiting Osteo change (thinning, fractures) Unexplained slow growth, delay puberty (children) and weight loss Rashes (very itchy dermatitis herpetiformis...elbows, backside, and knees)
The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of which of the following? a. Poor appetite b. Reduction of edema c. Restriction to bed rest d. Increased potassium intake
ANS: B
The nurse is conducting discharge teaching with the parent of a 7-year-old with nephrotic syndrome. Which of the following statements by the parent would indicate a correct understanding of the teaching? a. "My child needs to stay home from school for at least 1 more month." b. "I should not add additional salt to any of my child's meals." c. "My child will not be able to participate in contact sports while receiving the corticosteroid therapy." d. "I should measure my child's urine after each void and report the 24-hour amount to the health care provider."
ANS: B- "I should not add additional salt to any of my child's meals."
A hospitalized child with nephrotic syndrome is receiving high doses of prednisone. Which of the following is an appropriate nursing goal related to this? a. Stimulate appetite. b. Detect evidence of edema. c. Minimize risk of infection. d. Promote adherence to antibiotic regimen.
ANS: C
The diet of a child with chronic renal failure (CRF) usually is which of the following? a. Low in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K
ANS: C
Which of the following is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Severe dehydration d. Upper tract obstruction
ANS: C
he nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss which of the following? a. Regular diet b. Increased protein c. Fluid restrictions d. Decreased calories
ANS: C. --bc of severe edema
Which of the following is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)? a. Reduce blood pressure. b. Lower serum protein levels. c. Minimize excretion of urinary protein. d. Increase ability of tissue to retain fluid.
ANS: C. Minimize excretion of urinary protein. The objectives of therapy for the child with MCNS include reducing the excretion of urinary protein, reducing fluid retention, preventing infection, and minimizing complications associated with therapy. Blood pressure is usually not elevated in nephrotic syndrome. Serum protein levels are already reduced as part of the disease process. This needs to be reversed. The tissue is already retaining fluid as part of the edema. The goal of therapy is to reduce the edema.
Which of the following statements best represents infectious mononucleosis? a. Herpes simplex type 2 is principal cause. b. A complete blood count shows a characteristic leukopenia. c. A short course of ampicillin is used when pharyngitis is present. d. Clinical symptoms and blood tests are both needed to establish the diagnosis.
ANS: D The characteristics of the disease—malaise, sore throat, lymphadenopathy, central nervous system manifestations, and skin lesions—are similar to presenting signs in other diseases. Hematologic analysis (heterophil antibody and monospot) can help confirm the diagnosis. However, not all young children develop the expected laboratory findings. Herpes-like Epstein-Barr virus is the principal cause. Usually, an increase in lymphocytes is observed. Penicillin, not ampicillin, is indicated. Ampicillin is linked with a discrete macular eruption in infectious mononucleosis.
A parent asks the nurse how she will know whether her child has fifth disease. The nurse should advise the parent to be alert for which manifestation? a. Bull's-eye rash at the site of a tick bite b. Bright red rash on the cheeks that looks like slapped cheeks c. Maculopapular rash on the trunk that lasts for 2 days d. Lesions in various stages of development on the trunk
Bright red rash on the cheeks that looks like slapped cheeks The bull's-eye rash at the site of a tick bite is a manifestation of Lyme disease. Varicella is manifested as lesions in various stages of development—macule, papule, then vesicle, first appearing on the trunk and scalp. Roseola manifests as a maculopapular rash on the trunk that can last for hours or up to 2 days. Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance.
Which of the following explains why iron deficiency anemia is common during infancy? a. Cow's milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by 1 month of age. d. Dietary iron cannot be started until 12 months of age.
a. Cow's milk is a poor source of iron. Children between the ages of 12 and 36 months are at risk for anemia, since cow's milk is a major component of their diet and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by ages 5 to 6 months. Dietary iron can be introduced by breast-feeding, iron-fortified formula, and cereals during the first 12 months of life.
Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? a. Place the child in strict isolation; airborne and contact precautions. b. Continue to practice Standard Precautions. c. Pregnant women should avoid contact with the child. d. Screen visitors for immunity to measles.
a. Place the child in strict isolation; airborne and contact precautions. VARICELLA
Nursing care of the child with Kawasaki disease is challenging because of: a. the child's irritability. b. predictable disease course. c. complex antibiotic therapy. d. the child's ongoing requests for food.
a. the child's irritability.
A nurse is preparing for the admission of a child with a diagnosis of acute-stage Kawasaki disease. On assessment of the child, the nurse expects to note which clinical manifestation of the acute stage of the disease? a) cracked lips b) a normal appearance c) conjunctival hyperemia d) desquamation of the skin
c) conjunctival hyperemia In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal, but signs of inflammation may be present.
The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate which of the following? a. Sore throat b. Inspiratory stridor c. Complete obstruction d. Respiratory tract infection
c. Complete obstruction
When does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. During preadolescent growth spurt d. Adolescence
c. During preadolescent growth spurt
A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of which of the following? a. Propranolol b. Calcium gluconate c. Mannitol and/or furosemide d. Sodium, chloride, and potassium
c. Mannitol and/or furosemide
In a child suspected of having Wilms tumor an important priority is: a. intervening to minimize bleeding. b. monitoring temperature for infection. c. ensuring the abdomen is protected from palpation. d. teaching parents how to manage the parenteral nutrition.
c. ensuring the abdomen is protected from palpation. Wilms tumor, or nephroblastoma, is the most common malignant renal and intraabdominal tumor of childhood. The abdomen is protected and palpation is avoided. Careful handling and bathing are essential to prevent trauma to the tumor site. Before chemotherapy, the child is not myelosuppressed. Bleeding is not usually a risk. Infection is a concern after surgery and during chemotherapy, not before surgery. Parenteral therapy is not indicated before surgery.
A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The patient asks how long she will have to wear the brace. The appropriate answer is: a. for as long as you have been told. b. most preadolescents use the brace for 6 months. c. until your vertebral column has reached skeletal maturity. d. it will be necessary to wear the brace for the rest of your life.
c. until your vertebral column has reached skeletal maturity.
Which statement made by a parent indicates incorrect information about intervention for a child's fever? a. "I should keep her covered lightly when she has a fever." b. "I'll give her plenty of liquids to keep her hydrated." c. "I can give her acetaminophen for a fever." d. "I'll look for over-the-counter preparations that contain aspirin."
d. "I'll look for over-the-counter preparations that contain aspirin."
What discharge information should the nurse give to the parents of a male adolescent who has been diagnosed with the Epstein-Barr virus? a. It is particularly important to protect the adolescent's head during physical activities. b. The teen will feel like himself and be back to his usual routines in a week. c. The treatment of the Epstein-Barr virus is prolonged bed rest, usually lasting several months. d. Fatigue may persist, and the adolescent may need to increase school activities gradually.
d. Fatigue may persist, and the adolescent may need to increase school activities gradually. NO ACTIVITY
