Peds Exam 2

The nurse is caring for a 6-year-old in the early stages of acute hepatitis. Which of the following manifestations should the nurse expect to find? 1. Nausea, vomiting, and generalized malaise. 2. Nausea, vomiting, generalized malaise, and pain in the left upper quadrant. 3. Nausea, vomiting, generalized malaise, and yellowing of the skin and sclera. 4. Yellowing of the skin and sclera without any other generalized complaints.

1. The early stages of acute hepatitis are referred to as the anicteric phase, during which the child usually complains of nausea, vomiting, and generalized malaise.

The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate postoperative period. 1. Right side-lying. 2. Left side-lying. 3. Supine. 4. Prone.

3. The supine position is preferred because there is decreased risk of the infant rubbing the suture line.

The nurse in the pediatric clinic is providing instructions to the parents of a 2-year- old child who has just been diagnosed with acute hepatitis. Which of the following would be an appropriate activity for the nurse to recommend? 1. Riding a bike in an enclosed area such as a basement. 2. Playing basketball. 3. Playing video games in bed. 4. Playing with puzzles in bed.

4. Playing with puzzles is a developmen- tally appropriate activity for a 3-year- old on bedrest.

Which of the following findings demonstrated by a child should cause the nurse to suspect the presence of Enterobius vermicularis (pinworm)? A. Bloody diarrhea B. Perianal itching C. Moderate dehydration D. Abdominal pain

B

The nurse is reviewing the discharge instructions of a child diagnosed with encopresis. Which of the following instructions should the nurse question? 1. Limit the intake of milk. 2. Encourage positive reinforcement for appropriate toileting habits. 3. Obtain a complete dietary log. 4. Follow up with a child psychologist or psychiatrist.

2. Positive reinforcement is encouraged. The use of negative reinforcement is discouraged, however, as it may cause the child to attempt to be controlling by holding on to the stool.

The nurse is caring for an infant with biliary atresia. The parents ask why the child is receiving cholestyramine. Select the nurse's best response. 1. To lower your child's cholesterol. 2. To relieve your child's itching. 3. To help your child gain weight. 4. To help feedings be absorbed in a more efficient manner.

2. The primary reason cholestyramine is administered to the child with biliary atresia is to relieve pruritus.

The parents of a 6-year-old being evaluated for appendicitis tell the nurse the physician diagnosed their child as having a positive Rovsing sign. They ask the nurse what this means. Select the nurse's best response. 1. "Your child's physician should answer that question." 2. "A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated." 3. "A positive Rovsing sign means pain is felt when the physician removes the hand from the abdomen." 4. "A positive Rovsing sign means pain is felt in the right lower quadrant when the child coughs."

2. A positive Rovsing sign occurs when the left lower quadrant is palpated and pain is felt in the right lower quadrant.

The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response. 1. "It sounds like you are feeling discouraged. Would you like to talk about it?" 2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" 3. "Although breastfeeding is not an option, you have the option of pumping your milk and then feeding it to your baby with a special nipple." 4. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."

2. Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction.

A 7-year-old is being seen in the pediatric clinic. The child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which of the following pharmacological measures is most appropriate? 1. Natural supplements and herbs. 2. A stimulant laxative. 3. A stool softener. 4. Pharmacological measures are not used in pediatric constipation.

3 A stool softener is the drug of choice because it will lead to easier evacuation.

The nurse in the pediatric clinic receives a call from the parent of a 5-year-old and states that the child has been having diarrhea for 24 hours. The parent explains that the child vomited twice 2 hours ago and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response. 1. "You can offer clear diet soda such as Sprite and ginger ale." 2. "Pedialyte is really the best thing for your child, who, if thirsty enough, will eventually drink it." 3. "Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it. Try offering small amounts in a spoon, medicine cup, or syringe." 4. "It really does not matter what your child drinks as long as it is kept down. Try offering small amounts of fluids in medicine cups."

3 Pedialyte is the first choice, as recom- mended by the American Academy of Pediatrics. Offering the child appropri- ate choices may allow the child to feel empowered and less likely to refuse the Pedialyte. Small, frequent amounts are usually better tolerated.

The nurse is caring for a 3-month-old male who is being evaluated for possible Hirschsprung disease. His parents call the nurse and state that his diaper contains a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which of the following should be the nurse's next action? 1. Reassure the parents that this is an expected finding and not uncommon. 2. Call a code for a potential cardiac arrest, and stay with the infant. 3. Immediately obtain all vital signs with a quick head-to-toe assessment. 4. Obtain a stool sample for occult blood.

3. All vital signs need to be evaluated because the child with enterocolitis can quickly progress to a state of shock. A quick head-to-toe assessment will allow the nurse to evaluate the child's circulatory system.

The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. The nurse is sending the child home. Which of the following is likely to be included in the discharge teaching? 1. Administer Immodium as needed. 2. Administer Kaopectate as needed. 3. Continue breastfeeding per routine. 4. The infant may return to day care 24 hours after antibiotics have been started.

3. Breastfeeding is usually well tolerated and helps prevent death of intestinal villi and malabsorption.

The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response. 1. "Add 2 ounces of apple or pear juice to the child's diet." 2. "Be sure your child eats a lot of fresh fruit such as apples and bananas." 3. "Encourage your child to drink more fluids." 4. "Decrease bulky foods such as whole-grain breads and rice."

3. Increasing fluid consumption helps to decrease the hardness of the stool.

The nurse is caring for a 5-year-old who has just returned from having an appendectomy. Which of the following is the optimal way to manage pain? 1. Intravenous morphine as needed. 2. Liquid Tylenol with codeine as needed. 3. Morphine administered through a PCA pump. 4. Intramuscular morphine as needed.

3. Morphine administered through a PCA pump offers the child control over managing pain. The PCA pump also has the benefit of offering a basal rate as well as an as-needed rate for optimal pain management.

1. The nurse is reviewing the basic anatomy and physiology of the genitourinary system. e The nurse knows that the bladder capacity of a 3-year-old could be estimated to be approximately how much? 1.1.5 oz. 2.3 oz. 3.4 oz. 4.5 oz.

4. The capacity of the bladder can beestimated by adding 2 to the child's agein years.

The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse's best response. 1. "Replace the next feeding with regular water, and see if that is better tolerated." 2. "Do not allow your baby to eat any solids; give half the normal formula feeding, and see if that is better tolerated." 3. "Do not allow your baby to eat or drink anything for 24 hours to give the stomach a chance to rest." 4. "Give your child a very small amount of Pedialyte. If vomiting continues, wait a half hour, and then give half of what you previously gave."

4. Offering small amounts of clear liquids is usually well tolerated. The amount can be halved if the child vomits as long as the child does not appear to be dehydrated. The child in this scenario is described as playful and therefore does not appear to be at risk for dehydration.

The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response. 1. "The palate and the lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight." 2. "The palate and the lip are usually not repaired until the baby is approximately 6 months old so that the mouth has had enough time to grow." 3. "The lip is repaired in the first few months of life, but the palate is not usually repaired until the child is 3 years old." 4. "The lip is repaired in the first few weeks of life, but the palate is not usually re- paired until the child is 18 months old."

4. The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old.

The nurse is caring for a 6-year-old with hepatitis. The child is hungry and wants to eat dinner. Which of the following foods should be offered? 1. A tuna sandwich on whole wheat bread and a cup of skim milk. 2. Clear liquids, such as broth, and Jell-O. 3. A hamburger, French fries, and a diet soda. 4. A peanut butter sandwich and a milkshake.

1. A diet that is high in protein and carbohydrates helps maintain caloric intake and protein stores while preventing muscle wasting. A low-fat diet prevents abdominal distention.

A 4-month-old female is brought to the emergency department with severe dehydra- tion. Her heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which of the following would the nurse expect to do immediately? 1. Administer a bolus of normal saline. 2. Administer a bolus of D10W. 3. Administer a bolus of normal saline with 5% dextrose added to the solution. 4. Offer the child an oral rehydrating solution such as Pedialyte.

1. Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution.

The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. When taking the child's temperature, the nurse notes that the child has a fever of 101.8°F (38.8°C). The nurse notes the child's breath sounds are slightly diminished in the right lower lobe. Which of the following actions is most appropriate for this patient? 1. Teach the child how to use an incentive spirometer. 2. Encourage the child to blow bubbles. 3. Obtain an order for intravenous antibiotics. 4. Obtain an order for acetaminophen.

2. Blowing bubbles is a developmentally appropriate way to help the preschooler take deep breaths and cough.

A 3-year-old has a recurrent UTI. She had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed results within normal range. The child has had no other problems until this visit. Choose the nurse's best response. 1.The nurse should prepare for the following tests: urinalysis, urine culture, and VCUG. 2.Signs and symptoms of renal failure should be evaluated. 3.The nurse should prepare the child for likely admission to the pediatric unit. 4.Send the child home on an antibiotic and instruct the parent to offer the child lots of fluids.

1. Urinalysis and urine culture are rou-tinely used to diagnose UTIs. VCUG isused to determine the extent of urinary tract involvement when the child has asecond UTI within 1 year.

The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is noted to be restless, with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115.The parents state that the child has not urinated in 12 hours. After estab- lishing a saline lock, the nurse reviews the physician's orders. Which of the following orders should the nurse question? 1. Administer a saline bolus of 10 mL/kg, which may repeat if child does not urinate. 2. Recheck serum electrolytes in 12 hours. 3. After the saline bolus, begin maintenance fluids of D5 1/4 NS with 10 mEq KCl/L. 4. Give clear liquid diet as tolerated.

3. Potassium is contraindicated because the child has not yet urinated. Potassium is not added to the maintenance fluid until kidney function has been verified.

The nurse is caring for a 2-month-old infant diagnosed with GER. Which of the following should the nurse include in the plan of care to decrease the incidence of symptoms of GER? 1. Place the infant in an infant seat immediately after feedings. 2. Place the infant in the prone position immediately after feeding to decrease the risk of aspiration. 3. Encourage the parents not to worry because most infants outgrow GER within the first year of life. 4. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding.

4. Keeping the infant in an upright position is the best way to decrease the symptoms of GER. The infant can also be placed in the supine position with the head of the crib elevated. A harness can be used to keep the child from sliding down.

The nurse is caring for an infant newly diagnosed with Hirschsprung disease. Which of the following does the nurse understand about this infant's condition? 1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. 3. There is a small-bowel obstruction leading to ribbon-like stools. 4. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention.

1 In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumu- lation of bowel contents and abdominal distention.

The nurse is caring for a 4-week-old infant with biliary atresia. Which of the following manifestations would the nurse expect to see? 1. Abdominal distention, enlarged liver, enlarged spleen, clay-colored stool, and tea-colored urine. 2. Abdominal distention, multiple bruises, bloody stools, and hematuria. 3. Yellow sclera and skin tones, excessively oily skin, and prolonged bleeding times. 4. No manifestations until the disease has progressed to the advanced stage.

1. The infant with biliary atresia usually has an enlarged liver and spleen. The stools appear clay-colored due to the ab- sence of bile pigments. The urine is tea- colored due to the excretion of bile salts.

The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a male and wants to know if her new baby will likely have the disorder. Select the nurse's best response. 1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." 2. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." 3. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." 4. "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."

1. There is a genetic component to Hirschsprung disease, so any future siblings are also at risk.

The nurse is working in the pediatric clinic and is seeing many children with diarrhea. Which of the following children can most likely be discharged without further evaluation? 1. A 2-year-old who has had 24 hours of watery diarrhea that has changed to bloody diarrhea in the past 12 hours. 2. A 10-year-old who has just returned from a Scout camping trip. 3. A 2-year-old who had a relapse of one diarrhea episode after restarting a normal diet. 4. A 6-year-old who has been having vomiting and diarrhea for 2 days and has decreased urine output.

3. It is common for children to have a relapse of diarrhea after resuming a regular diet.

The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take? 1.The nurse notifies the physician because this urine output is too low. 2.The nurse encourages the patient to increase oral intake in order to increase urine output. 3.The nurse records the patient's urine output in the chart. 4.The nurse administers isotonic fluid intravenously to help with the rehydration process.

3. Recording the patient's urine output in the chart is the appropriate action because the urine output is within theexpected range of 0.5-1 mL/kg/hr

The nurse is caring for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix. Which of the following is the best position for the child? 1. Semi-Fowler. 2. Prone. 3. Right side-lying. 4. Left side-lying.

3. The right side-lying position promotes comfort and allows the peritoneal cavity to drain.

The nurse is about to receive a 4-year-old from the recovery room after an appendectomy for a non-ruptured appendix. The parents have not seen the child since the surgery and ask what to expect. Select the nurse's best response. 1. "Your child will be very sleepy, have an intravenous line in the hand, and have a nasal tube to help drain the stomach. If your child needs pain medication, it will be given intravenously." 2. "Your child will be very sleepy, have an intravenous line in the hand, and have white stockings to help prevent blood clots. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 3. "Your child will be wide awake and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 4. "Your child will be very sleepy and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously."

4. In the immediate postoperative period, the child is usually sleepy but can be roused. The child usually has an intravenous line for hydration and pain medication.

The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response. 1. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until the constipation resolves." 2. "A permanent stool diversion, called a colostomy, will be placed by the surgeon to bypass the narrowed area." 3. "Daily bowel irrigations will help your child maintain regular bowel habits." 4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much of your child's bowel is involved."

4. The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached.

The nurse is caring for an infant with biliary atresia who is scheduled for a Kasai procedure. Which of the following is an accurate description of this surgery? 1. A palliative procedure in which a bile duct is attached to a loop of bowel to assist with bile drainage. 2. A curative procedure in which a connection is made between a bile duct and a loop of bowel to assist with bile drainage. 3. A curative procedure in which a bile duct is banded to prevent bile leakage. 4. A palliative procedure in which a bile duct is banded to prevent bile leakage.

1. The Kasai procedure is a palliative pro- cedure in which a bile duct is attached to a loop of bowel to assist with bile drainage.

The nurse is providing discharge instructions to the parents of a 10-year-old who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the child's parent states: 1. "We will wait a few days before allowing our child to return to school." 2. "We will wait 2 weeks before allowing our child to return to sports." 3. "We will call the pediatrician's office if we notice any drainage around the wound." 4. "We will encourage our child to go for walks every day."

2. The child should wait 6 weeks before returning to any strenuous activity.

The nurse is administering Prilosec to a 3-month-old with GER. The child's parents ask the nurse how the medication works. Select the nurse's best response. 1. "Prilosec is a proton pump inhibitor that is commonly used for reflux in infants." 2. "Prilosec decreases stomach acid, so it will not be as irritating when your child spits up." 3. "Prilosec helps food move through the stomach quicker, so there will be less chance for reflux." 4. "Prilosec relaxes the pressure of the lower esophageal sphincter."

2. This accurate description gives the parents information that is clear and concise.

The nurse is caring for a 6-week-old infant with cerebral palsy and GER. After two hospital admissions for aspiration, the child is scheduled for a Nissen fundoplication. The nurse knows that this procedure involves which of the following? 1. The fundus of the stomach is wrapped around the inferior stomach, mimicking a lower esophageal sphincter. 2. The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter. 3. The fundus of the stomach is wrapped around the middle portion of the stomach, decreasing the capacity of the stomach. 4. The fundus of the stomach is dilated, decreasing the likelihood of reflux.

2. The Nissen fundoplication involves wrapping the fundus of the stomach around the inferior esophagus, creating a lower esophageal sphincter or cardiac sphincter.

The mother of a newborn asks the nurse why she has to nurse so frequently. The nurse replies using which of the following principles? 1. Formula tends to be more calorically dense, and formula-fed babies require fewer feedings than breastfed babies. 2. The newborn's stomach capacity is small, and peristalsis is slow. 3. The newborn's stomach capacity is small, and peristalsis is more rapid than in older children. 4. Breastfed babies tend to take longer to complete a feeding than formula-fed babies.

3. The small-stomach capacity and rapid movement of fluid through the digestive system account for the need for small frequent feedings.

. The nurse is caring for a 4-month-old with GER. The infant is due to receive Reglan (metoclopramide). Based on the medication's mechanism of action, when should this medication be administered? 1. Immediately before a feeding. 2. 30 minutes after the feeding. 3. 30 minutes before the feeding. 4. At bedtime.

3. Reglan increases gastric emptying and should be administered 30 minutes before a feeding.

The nurse is caring for a 10-year-old who is being evaluated for possible appendicitis. The child has been complaining of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which of the following should be the nurse's next action? 1. Cancel the ultrasound, and obtain an order for oral Zofran. 2. Cancel the ultrasound, and prepare to administer an intravenous bolus. 3. Prepare for the probable discharge of the patient. 4. Immediately notify the physician of the child's status.

4. The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix.

The nurse is teaching feeding techniques to new parents. The nurse emphasizes the importance of slowly warming the formula and testing the temperature prior to feed- ing the infant. The parent of a newborn asks, "Will my baby spit out the formula if it is too hot or too cold?" Select the nurse's best response. 1. "Babies have a tendency to reject hot fluids but not cold fluids, which could result in abdominal discomfort." 2. "Babies have a tendency to reject cold fluids but not hot fluids, which could result in esophageal burns." 3. "Your baby would most likely spit out formula that was too hot, but your baby could swallow some of it, which could result in a burn." 4. "Your baby is too young to be physically capable of spitting out fluids and will automatically swallow anything."

4. "Your baby is too young to be physically capable of spitting out fluids and will automatically swallow anything."

A 2-month-old male is brought to the pediatric clinic. The infant has had vomiting and diarrhea for 24 hours. The infant's anterior fontanel is sunken. The child is irrita- ble, and the nurse notes that the infant does not produce tears when he cries. Which of the following tasks will help confirm the diagnosis of dehydration? 1. Urinalysis obtained by bagged specimen. 2. Urinalysis obtained by sterile catheterization. 3. Analysis of serum electrolytes. 4. Analysis of cerebrospinal fluid.

The analysis of serum electrolytes offers the most information and assists with the diagnosis of dehydration.