PEDS exam 3 practice quizes

"The postoperative care of a preschool child who has had a brain tumor removed should include which of the following?" a. colorless drainage is to be expected b. analgesics are contraindicated because of altered consciousness c. positioning is on the operative side in the Trendelenberg position d. carefully monitor fluids due to cerebral edema"

"D CORRECT: Because of cerebral edema and the danger of increased intracranial pressure postoperatively, fluids are carefully monitored.A. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible.B. Analgesics can be used for postoperative pain.C. Child should not be positioned in Trendelenburg position postoperatively."

Which would be an early sign of respiratory distress in a 2-month-old? 1. Breathing shallowly. 2. Tachypnea. 3. Tachycardia. 4. Bradycardia.

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The nurse is caring for a 7-year-old with glomerulonephritis. Which of the followingfindings requires immediate attention? 1. The child sleeps most of the day and is very "cranky" when awake; blood pressureis 170/90. 2. The child's urine output is 190 mL in an 8-hour period and is the color ofCoca Cola. 3. The child complains of a severe headache and photophobia. 4. The child refuses breakfast and lunch and states that he "just is not hungry."

3. A severe headache and photophobiacan be signs of encephalopathy due tohypertension, and the child needsimmediate attention.

A parent asks the nurse what will need to be done to relieve the constipation of her child who also has cystic fibrosis (CF). Which is the nurse's best response? 1. "Your child likely has an obstruction and will require surgery." 2. "Your child will likely be given IV fluids." 3. "Your child will likely be given MiraLAX." 4. "Your child will be placed on a clear liquid diet."

3. CF patients with constipation commonly receive a stool softener or an osmotic solution such as polyethylene glycol 3350 (MiraLAX) orally to relieve their constipation TEST-TAKING HINT: Answer 1 can be eliminated because surgery is not indicated for constipation.

A 16-month-old with HUS has had blood and urine samples sent to the laboratory.Which of the following results are most consistent with his HUS? 1. Hematuria, massive proteinuria, elevated blood urea nitrogen, and creatinine. 2. Hematuria, mild proteinuria, decreased blood urea nitrogen, and creatinine. 3. Hematuria, mild proteinuria, increased blood urea nitrogen, and creatinine. 4. Ketonuria, proteinuria, elevated blood urea nitrogen, and creatinine.

3. Hematuria, mild proteinuria, increasedBUN, and creatinine are all presentin HUS.

The nurse is caring for a newborn male with hypospadias. His parents ask ifcircumcision is an option. Which is the nurse's best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helpsprevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may beneeded for repair of the defect.

What should be the nurse's first action with a child who has a high fever, dysphagia, drooling, tachycardia, and tachypnea? 1. Immediate IV placement. 2. Immediate respiratory treatment. 3. Thorough physical assessment. 4. Lateral neck radiographs..

4 2.Agitating the child may cause increased airway swelling and may lead to complete obstruction. 4. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. The child should be allowed to remain in the parent's lap until a lateral neck film is obtained for a definitive diagnosis.

A child is diagnosed with intussusception. The nurse collects data on the child, knowing that which is a characteristic of this disorder? 1.The presence of fecal incontinence 2.Incomplete development of the anus 3.The infrequent and difficult passage of dry stools 4.Invagination of a section of the intestine into the distal bowel

4.Invagination of a section of the intestine into the distal bowel Intussusception is an invagination of a section of the intestine into the distal bowel. It is the most common cause of bowel obstruction in children age 3 months to 6 years. Option 1 describes encopresis. Option 2 describes imperforate anus, and this disorder is diagnosed in the neonatal period. Option 3 describes constipation. Constipation can affect any child at any time, although it peaks at ages 2 to 3 years. Encopresis generally affects preschool and school-age children.

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. Which of the following is an important objective to decrease this risk? a. Minimize seizures. b. Prevent dehydration. c. Promote cardiac output. d. Reduce energy expenditure.

ANS: B In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

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.

ANS: D High-dose intravenous gamma globulin and salicylate therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. The fever of Kawasaki disease is unresponsive to antibiotics. It is responsive to antiinflammatory doses of aspirin and antipyretics.

The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which of the following complications? a. Hypoxemia b. Right-to-left shunt of blood c. Decreased workload on left side of heart d. Pulmonary vascular congestion

ANS: D In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular congestion. Hypoxemia usually results from defects with mixed blood flow and decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure would stop this. There is increased workload on the left side of the heart with a PDA.

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is which of the following? a. Notify the physician. b. Place child in Trendelenburg position. c. Apply a new bandage with more pressure. d. Apply direct pressure above catheterization site.

ANS: D When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified and a new bandage with more pressure can be applied after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. Trendelenburg position would not be a helpful intervention. It would increase the drainage from the lower extremities.

A child is brought to the emergency department after being accidentally struck in the lower back region with a baseball bat. When gathering assessment data, the nurse discovers that the child has hemophilia. The nurse should immediately assess for which data? 1. Slurred speech 2. Presence of hematuria 3. Complaints of headache 4. Change in respiratory rate

Correct Answer: 2 Rationale: Because the kidneys are located in the flank region of the body, trauma to the back area can cause hematuria, particularly in a child with hemophilia. The nurse would be most concerned about the child's airway and respiratory rate if the child had sustained an injury to the neck region. Slurred speech and headache are associated with head trauma.

The nurse is caring for a 5-year-old boy undergoing radiation treatment for a neuroblastoma. Which nursing diagnosis would be most applicable for this child? A) Activity intolerance related to anemia and weakness from medications B) Impaired skin integrity related to desquamation from cellular destruction C) Impaired oral mucosa related to the presence of oral lesions from malnutrition D) Imbalanced nutrition, less than body requirements related to nausea and vomiting

B) Impaired skin integrity related to desquamation from cellular destruction A nursing diagnosis for impaired skin integrity evidenced by desquamation of the radiation site would only be made for a child undergoing radiation therapy. Activity intolerance due to anemia and weakness, impaired oral mucosa evidenced by oral lesions, and malnutrition and anorexia due to nausea and vomiting are diagnoses that are common to both radiation and chemotherapy.

The nursing student is assigned to care for a child with hemophilia. The nursing instructor reviews the plan of care with the student. Which intervention on the student written plan of care requires correction? 1.Measure circumference of injured joints. 2.Blood transfusion of packed red blood cells. 3.Monitor temperature with oral thermometers. 4.Intravenous administration of recombinant factor.

Correct Answer: 2 Rationale: Hemophilia is a lifelong hereditary blood disorder associated with deficiency of clotting factors. It is inherited in a recessive manner via a genetic defect on the X chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX. Blood product transfusion is not the treatment of choice over administering recombinant factors intravenously. Measuring circumference of injured joints is appropriate to assess for enlarging hematomas or bleeding under the skin. The nurse should avoid taking rectal temperatures to decrease the risk for injury.

The nurse is collecting data on a 12-month-old child with iron deficiency anemia. Which finding should the nurse expect to note in this child? 1.Cyanosis 2.Bronze skin 3.Tachycardia 4.Hyperactivity

Correct Answer: 3 Rationale: Clinical manifestations of iron deficiency anemia will vary with the degree of anemia but usually include extreme pallor with a porcelain-like skin, tachycardia, lethargy, and irritability.

The nurse is collecting data on a 9-year-old child suspected of having a brain tumor. Which question should the nurse ask to elicit data related to the classic symptoms of a brain tumor? 1."Do you have trouble seeing?" 2."Do you feel tired all the time?" 3."Do you throw up in the morning?" 4."Do you have headaches late in the day?"

Correct Answer: 3 Rationale: The classic symptoms of children with brain tumors are headache and morning vomiting related to the child getting out of bed. Headaches worsen on arising but improve during the day. Fatigue may occur but is a vague symptom. Visual changes may occur, including nystagmus, diplopia, and strabismus, but these signs are not the hallmark symptoms with a brain tumor.

The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child? 1.Platelet count 2.Hematocrit level 3.Hemoglobin level 4.Partial thromboplastin time

Correct Answer: 4 Rationale: Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Results of tests that measure platelet function are normal; results of tests that measure clotting factor function may be abnormal. Abnormal laboratory results in hemophilia indicate a prolonged partial thromboplastin time. The platelet count, hemoglobin level, and hematocrit level are normal in hemophilia.

The nurse is caring for a child with hemophilia and is reviewing the results that were sent from the laboratory. Which result should the nurse expect in this child? 1.Shortened prothrombin time (PT) 2.Prolonged PT 3.Shortened partial thromboplastin time (PTT) 4.Prolonged PTT

Correct Answer: 4 Rationale: PTT measures the activity of thromboplastin, which is dependent on intrinsic factors. In hemophilia, the intrinsic clotting factor VIII (antihemophilic factor) is deficient, resulting in a prolonged PTT. The results in the remaining options are incorrect. The PT may not necessarily be affected in this disorder.

An infant is receiving digoxin (Lanoxin) for congestive heart failure. The baby's apical heart rate is assessed at 80 beats/minute. What intervention should the nurse implement? A. Call for a portable chest radiograph. B. Obtain a therapeutic drug level. C. Reassess the heart rate in 30 minutes. D. Administer digoxin immune Fab (Digibind) stat.

Correct Answer: B Rationale:Sinus bradycardia (rate of less than 90 to 110 in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level has the highest priority (B). (A) is not indicated at this time. (C) provides helpful assessment data but does not address the cause of the problem and delays needed intervention. (D) is indicated for serious life-threatening overdose with digoxin.

A child is diagnosed with Wilms' tumor. In planning teaching interventions, what key point should the nurse emphasize to the parents?" 1. Do not put pressure on the abdomen. 2. Frequent visits from friends and family will improve morale. 3. Appropriate protective equipment should be worn for contact sports. 4. Encourage the child to remain active."

Correct answer: 1. Do not put pressure on the abdomen. Palpation of Wilms' tumor can cause rupture and spread of cancerous cells. Frequent visitation might allow the child to be exposed to more infections, and activity and sports are discouraged because of the risk of rupture of the encapsulated tumor.

As a nurse, you know that which condition is caused by excessive levels of circulating cortisol: a) Cushing syndrome b) Graves disease c) Turner syndrome d) Addison disease

Cushing syndrome Explanation: Cushing syndrome is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol.

The nurse is aware that the infant born with hypoplastic left heart syndrome must acquire his or her oxygenated blood through: a. the patent ductus arteriosus. b. a ventricular septal defect. c. the closure of the foramen ovale. d. an atrial septal defect.

D Because the right side of the heart must take over pumping blood to both the lungs and systemic circulation, the ductus arteriosus must remain open to shunt the oxygenated blood from the lungs.

"A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client's chemotherapy regimen is to:" a. Prevent metabolic breakdown of xanthine to uric acid b. Prevent uric acid from precipitating in the ureters c. Enhance the production of uric acid to ensure adequate excretion of urine d. Ensure that the chemotherapy doesn't adversely affect the bone marrow"

"CORRECT: Answer A. The massive cell destruction resulting from chemotherapymay place the client at risk for developing renal calculi; addingallopurinol decreases this risk by preventing the breakdown of xanthineto uric acid. Allopurinol doesn't act in the manner described in the

The nurse is assigned to care for a child with hypertrophic pyloric stenosis scheduled for a pyloromyotomy. In which position should the nurse place the child during the preoperative period? 1.Prone with the head of the bed elevated 2.Supine with the head of the bed at a 30-degree angle 3.Supine with the head of the bed at a 45-degree angle 4.Prone with the head of the bed lowered to promote drainage

1.Prone with the head of the bed elevated In the preoperative period, the infant is positioned prone with the head of the bed elevated to reduce the risk of aspiration. Options 2, 3, and 4 are inappropriate positions to prevent this risk

The parent of a 4-month-old with cystic fibrosis (CF) asks the nurse what time to begin the child's first chest physiotherapy (CPT) each day. Which is the nurse's best response? 1. "Thirty minutes before feeding the child breakfast." 2. "After deep-suctioning the child each morning." 3. "Thirty minutes after feeding the child breakfast." 4. "Only when the child has congestion or coughing."

1. CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting. TEST-TAKING HINT: Answer 4 can be eliminated because of the word "only." There are very few times in health care when an answer will be "only." Answer 3 can be eliminated when one considers the risk of vomiting and aspiration that may occur if percussion is performed following eating

The nurse is working in a pediatric urgent care clinic. Which of the following patientscan be discharged without the need for a urinalysis to evaluate for a UTI? 1. A 4-month-old female who presents with a 2-day history of fussiness and poorappetite; her current vital signs include T 100.8°F (38.2°C) (axillary) and heart rate120 beats per minute. 2. An 8-year-old male who presents with a finger laceration; his mother states he hadsurgical reimplantation of his ureters 2 years ago. 3. A 12-yea

2. Although this child has had a history ofurinary infections, the child is currentlynot displaying any signs and thereforedoes not need a urinalysis at this time.

How will a child with respiratory distress and stridor and who is diagnosed with RSV be treated? 1. Intravenous antibiotics .2. Intravenous steroids .3. Nebulized racemic epinephrine. 4. Alternating doses of Tylenol and Motrin.

3 1. RSV is a viral illness and is not treated with antibiotics. 2. Steroids are not used to treat RSV. 3. Racemic epinephrine promotes mucosal vasoconstriction. 4. Tylenol and Motrin can be given to the child for comfort, but they do not improve the child's respiratory status.

Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease? a. "I should give my child a daily iron supplement." b. "It is important for my child to drink plenty of fluids." c. "He needs to wear protective equipment if he plays contact sports." d. "He shouldn't receive any immunizations until he is older."

b. "It is important for my child to drink plenty of fluids. "Prevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.

A 2-year-old has just been diagnosed with cystic fibrosis (CF). The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response? 1. "You can expect your child to develop a barrel-shaped chest." 2. "You can expect your child to develop a chronic productive cough." 3. "You can expect your child to develop bronchiectasis." 4. "You can expect your child to develop wheezing respirations."

4. Wheezing respirations and a dry, nonproductive cough are common early symptoms in CF. TEST-TAKING HINT: Answer 2 can be eliminated because of the word "chronic." "Chronic" implies that the disease process is advanced rather than in the initial stages. Answers 1 and 3 can be eliminated if the test taker has knowledge of signs and symptoms of advanced lung disease.

A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value which intervention would the nurse document in her plan of care. "" 1. Monitor closely for signs of infection. 2. Temp every four hours. 3. Isolation precautions 4. Use a small toothbrush for mouth care"

4. **Correct... Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production. If the platelet count is les than 20,000 than bleeding precautions need to be taken.

A 12-year-old girl diagnosed with hypothyroidism has been placed on Levothyroxine. The parents demonstrate an understanding of the medication when they state: 1. The medication will be taken for three months, then we will reassess to see if she still needs the medication. 2. The medication should only be given at night. 3. The medication will require us to do daily weight checks. 4. The medication will need to be taken for the remainder of her life

4. The medication will need to be taken for the remainder of the childs life because the body does not naturally regulate the hormones.

A beneficial effect of administering digoxin (Lanoxin) is that it a. Decreases edema b. Decreases cardiac output c. Increases heart size d. Increases venous pressure

A Digoxin has a rapid onset and is useful increasing cardiac output, decreasing venous pressure, and as a result, decreasing edema.

When monitoring the blood glucose level of a 12 y/o child with type 2 DM, your reading is 50mg/dL. Which is the most appropriate action? 1. encourange the child to get out of bed and increase activity 2. take the child's vital signs 3. ask the child about frequent urine output 4. give the child 4oz of OJ

give the child 4oz of OJ

The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, "How does Kawasaki disease affect my child's heart and blood vessels?" The nurse's response is based on the understanding that: a. inflammation weakens blood vessels, leading to aneurysm. b. increased lipid levels lead to the development of atherosclerosis. c. untreated disease causes mitral valve stenosis. d. altered blood flow increases cardiac workload with resulting heart failure.

A Inflammation of vessels weakens the walls of the vessels and often results in aneurysm.

Which is the nurse's best response to a parent who asks what can be done at home to help a child with upper respiratory infection (URI) symptoms and a fever get better? 1. "Give your child small amounts of fluid every hour to prevent dehydration." 2. "Give your child Robitussin at night to reduce his cough and help him sleep." 3. "Give your child a baby aspirin every 4 to 6 hours to help reduce the fever." 4. "Give your child an over-the-counter cold medicine at night."

ANS 1 1. It is essential that parents ensure their children remain hydrated during a URI. The best way to accomplish this is by giving small amounts of fluid frequently. 2. Over-the-counter cough and cold medicine is not recommended for any child younger than 6 years. 3. Aspirin is not given to children to treat a viral infection because of the risk of developing Reye syndrome .4. Over-the-counter cough and cold medicine is not recommended for any child younger than 6 years.

What would the nurse advise the parent of a child with a barky cough that gets worse at night? 1. Take the child outside into the more humid night air for 15 minutes. 2. Take the child to the ER immediately. 3. Give the child an over-the-counter cough suppressant .4. Give the child warm liquids to soothe the throat.

ANS 1 1. The night air will help decrease subglottic edema, easing the child's respiratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider.

40. Sherry, a 15-year-old patient, has been admitted for diabetic ketoacidosis. The nurse knows each of the following statements are true except: 1. This is the most common chronic complication for DM1. 2. This is deadly if not taken care of immediately. 3. This can cause frequent hospitalizations. 4. This is caused by too much insulin being release during illness.

ANS: 1 Feedback1. Ketoacidosis is an acute condition. 2. This can be deadly because of the rapids shifts in blood glucose levels. 3. Ketoacidosis requires close medical monitoring and insulin infusion. 4. Insulin release increases during the illness, causing further complications.

A school-age child has been diagnosed with strep throat. The parent asks the nurse when the child can return to school. Which is the nurse's best response? 1. "Forty-eight hours after the first documented normal temperature." 2. "Twenty-four hours after the first dose of antibiotics." 3. "Forty-eight hours after the first dose of antibiotics." 4. "Twenty-four hours after the first documented normal temperature."

ANS 2 .2. Children with strep throat are no longer contagious 24 hours after initiation of antibiotic therapy .TEST-TAKING HINT: The test taker can eliminate answers 1 and 4 given knowledge of the communicability of strep throat.

Which is the nurse's best response to parents who ask what impact asthma will have on the child's future in sports? 1. "As long as your child takes prescribed asthma medication, the child will be fine." 2. "The earlier a child is diagnosed with asthma, the more significant the symptoms." 3. "The earlier a child is diagnosed with asthma, the better the chance the child hasof growing out of the disease." 4. "Your child should avoid playing contact sports and sports that require a lotof running."

ANS 2 1. It is essential that the child take all of the scheduled asthma medications, but there is no guarantee the child will be fine and be able to play all sports. 2. When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging 3. Children diagnosed at an early age usually exhibit worse symptoms than those diagnosed later in life 4. Children with asthma are encouraged to participate in sports and don't necessarily need bronchodilator medication before, sports activities. .

Which assessment is of greatest concern in a 15-month-old? 1. The child is lying down, has moderate retractions, low-grade fever, and nasalcongestion. 2. The child is in the tripod position, has diminished breath sounds, and a muffledcough. 3. The child is sitting up and has coarse breath sounds, coughing, and fussiness. 4. The child is restless and crying, has bilateral wheezes, and is feeding poorly.

ANS 2 1. Retractions indicate some degree of respiratory distress but more information needs to be obtained. Other common symptoms of a respiratory illness include, low-grade fever, and nasal congestion and are not overly concerning. 2. When children are sitting in the tripod position, they are having difficulty breathing. The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds are indicative of a worsening condition. A muffled cough indicates that the child has some subglottic edema. This child has several signs and symptoms of a worsening respiratory condition. 3. Coarse breath sounds, cough, and fussiness are common signs and symptoms of a respiratory illness. 4. Restlessness, wheezes, poor feeding, and crying are signs and symptoms of a respiratory illness.

How does the nurse interpret the laboratory analysis of a stool sample containing excessive amounts of azotorrhea and steatorrhea in a child with cystic fibrosis (CF)? The values indicate the child is 1. Not compliant with taking her vitamins. 2. Not compliant with taking her enzymes. 3. Eating too many foods high in fat. 4. Eating too many foods high in fiber.

ANS 2 2. If the child were not taking enzymes, the result would be a large amount of undigested food, azotorrhea, and steatorrhea in the stool. Pancreatic ducts in CF patients become clogged with thick mucus that blocks the flow of digestive enzymes from the pancreas to the duodenum. Therefore, patients must take digestive enzymes with all meals and snacks to aid in absorption of nutrients. Often, teens are noncompliant with their medication regimen because they want to be like their peers. TEST-TAKING HINT: The test taker needs to understand the pathophysiology of CF and the impact it has on the gastrointestinal system. The test taker also must be familiar with the conditions azotorrhea and steatorrhea.

The nurse is providing care for a child who is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory result does the nurse expect with this condition? 1. Low urine-specific gravity 2. High urine and low serum osmolarity 3. High serum sodium level 4. Increase in the hematocrit level

ANS 2 1 This is incorrect. Because fluid is retained with the diagnosis of SIADH, the specific gravity of urine is expected to be high (less fluid to the ratio of solutes). 2 This is correct. With a diagnosis of SIADH, the nurse will expect to see high urine osmolarity but low serum osmolarity on laboratory tests. The kidneys are unable to conserve appropriate amounts of water, so the body retains water, leading to water intoxication, hyponatremia, and cellular edema. 3 This is incorrect. The expected laboratory finding with SIADH is a low serum sodium level. Sodium will follow water back into the cells. 4 This is incorrect. The expected laboratory finding with SIADH is a decreased hematocrit.

Which child is in the greatest need of emergency medical treatment? 1. 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions. 2. 6-year-old who has high fever, no spontaneous cough, and frog-like croaking. 3. 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, anda barky cough. 4. 13-year-old who has a high fever, stridor, and purulent secretions. 44 / 62

ANS 2 1. This child has signs and symptoms of acute laryngitis and is not in a significant amount of distress .2. This child has signs and symptoms of epiglottitis and should receive immediate emergency medical treatment. The patient has no spontaneous cough and has a frog-like croaking because of a significant airway obstruction. 3. This child has signs and symptoms of LTB and is not in significant respiratory distress. 4. This child has signs and symptoms of bacterial tracheitis and should be treated with antibiotics but is not the patient in the most significant amount of distress.

The nurse in a NICU nursery is providing care for a newborn diagnosed with congenital hypothyroidism. During hospitalization, which home-care concept will the nurse include in the newborn's care? 1. Mix thyroid replacement hormone medication in a bottle of milk. 2. Increase dietary fiber with a soy-based formula to prevent constipation. 3. Ask the breastfeeding mother to bring breastmilk to the hospital. 4. Administer hormone replacement medication using a medicine dropper.

ANS 3 1 This is incorrect. Instruct parents to administer medication via needleless syringe and not to put medication in a bottle, which may or may not be completely consumed. 2 This is incorrect. Instruct parents that formula should be milk-based and not soy-based, because soy-based formulas can break down the effects of the medication. 3 This is correct. Because the mother is breastfeeding, the nurse can use breastmilk for the administration of thyroid hormone replacement medications. The medication will be crushed and mixed with a small amount of breastmilk .4 This is incorrect. Medications are administered to newborns and infants using a needleless syringe to assure accurate dosage.

The nurse in a pediatric emergency department is providing care for a 1-year-old patient with a history of congenital adrenal hyperplasia (CAH). The patient is exhibiting the manifestations of a febrile illness. Which medical intervention does the nurse expect to be prescribed? 1. Laboratory testing for elevated serum 17-OHP level 2. Cultures and testing for the cause of the febrile illness 3. A quiet, cool environment for the patient 4. Administration of corticosteroids by injection

ANS 4 1 This is incorrect. Elevated serum 17-OHP at birth, along with other presenting symptoms, is a potential for CAH. If the levels continue to be elevated after birth, CAH is expected because normal growth and development will decrease 17-OHP as the infant matures. However, this testing is not expected for this patient. 2 This is incorrect. The cause of the febrile condition is not as important at this time as recognition and treatment of a possible adrenal crisis. 3 This is incorrect. The patient is not likely to need or benefit from being placed in a quiet, cool environment. 4 This is correct. Emergency administration of corticosteroids given via injection should be taught to the parents for use when the child is in a crisis, such as febrile illness, surgery, trauma, or severe stress. The nurse expects a prescription to continue the medication. The doses will need to be doubled or tripled during the period of crisis. This is referred to as "stress dosing."

81. Please select the most appropriate nursing diagnosis for a 15 year old with hyperthyroidism. Select all that apply .1. Disturbed body image related to changes in physical appearance 2. Imbalanced nutrition related to increased metabolic demands 3. Risk for decreased fluid volume related to excess salt excretion 4. Constipation related to thyroid medication side effects

ANS: 1, 2 Feedback 1. Body image according to normal growth and development is very important to an adolescent. If the adolescent with hyperthyroidism is having adverse effects, such as drastic weight loss, exopthalmus, or other complications, his/her sense of self-esteem will be altered. He/she will also have imbalanced nutrition since his/her metabolic needs exceed his/her nutritional needs. 2. Body image according to normal growth and development is very important to an adolescent. If the adolescent with hyperthyroidism is having adverse effects, such as drastic weight loss, exopthalmus, or other complications, his/her sense of self-esteem will be altered. He/she will also have imbalanced nutrition since his/her metabolic needs exceed his/her nutritional needs. 3. They do not loose salt with this disorder. Constipation is a side effect of hypothyroidism, not hyperthyroidism. 4. Diarrhea is an adverse event in children who have hyperthyroidism.

68. The nurse is administering an 0800 dose of NPH insulin to an insulin dependent diabetic child. Based on when the insulin peaks, the child would be at greatest risk for a hypoglycemic episode between: 1. Breakfast and lunch. 2. Bedtime and breakfast the next morning. 3. 0830 to a mid-morning snack. 4. Lunch and dinner.

ANS: 4 Feedback 1. A hypoglycemic reaction between breakfast and lunch would be associated with a short-acting insulin. 2. Between bedtime to breakfast the next morning would be associated with a long-acting insulin. 3. The 0830 to mid-morning hypoglycemia would be related to a rapid-acting insulin .4. NPH is an intermediate-acting insulin that peaks in 6-12 hours. If administered at 0800, the risk of a hypoglycemic reaction would be at its peak between lunch and dinner.

The primary nursing intervention to prevent bacterial endocarditis is which of the following? a. Counsel parents of high-risk children. b. Institute measures to prevent dental procedures. c. Encourage restricted mobility in susceptible children. d. Observe children for complications, such as embolism and heart failure.

ANS: A The objective of nursing care is to counsel the parents of high-risk children about the need for both prophylactic antibiotics for dental procedures and maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Restricted mobility in susceptible children is not indicated. Parents are taught to observe for unexplained fever, weight loss, or change in behavior.

Which of the following would the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? a)maintaining the joints in an extended position b) applying gentle traction to the child's affected joints c) supporting proper alignment with rolled pillows d) using a bed cradle to avoid the weight of bed lines on the joints

Answer D for a child with arthritis associated with rheumatic fever, the joints are usually so tender that even the weight of bed linens can cause pain. Use of the bed cradle is recommended to help remove the weight of the linens on painful joints. Joints need to be maintained in good alignment, not positioned inextension, to ensure that they remain functional.Applying gentle traction to the joints is not recommended because traction is usually used to relieve muscle spasms, not typically associated with rheumatic fever. Supporting the body in good alignment and changing the client's position are recommended, but these measures are not likely to relieve pain.

After 12 hours of labor, a G1P1 mother has just given birth to an infant with omphalocele. Which action should the nurse take first? 1) Place the infant in a radiant warmer 2) Establish an IV site in preparation for fluid and antibiotic administration 3) Cover the abdominal organs with a non-adherent sterile dressing. 4) Insert an orogastric tube and maintain low suction.

Answer: 3)Initially, the organs and/or sac need to be protected from rupture and infection, so a sterile dressing must be applied immediately. This also helps prevent further fluid losses. Next, the child should be placed in a radiant warmer to prevent hypothermia, which is a huge risk here. The nurse can then assess the child further, establish an IV site, and insert an orogastric tube.

The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure the nurse should: a) Tell the client they will be asleep. b) Give the client a bolus of fluids. c) Insert a urinary catheter .d) Assess the client for allergies.

Assess the client for allergies.Uses iodine.

The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is developing a teaching plan for the child and family about nutrition. Which of the following would the nurse be least likely to include? A) Emphasizing the intake of grains, fruits, and vegetables B) Featuring high-fiber foods if opioid analgesics are being taken C) Concentrating on consuming primarily high-calorie shakes and puddings D) Avoiding milk products if diarrhea is a problem

C) Concentrating on consuming primarily high-calorie shakes and puddings Providing high-calorie shakes and puddings with diet restrictions can help with weight gain, if that is a problem. However, concentrating on high-calorie shakes and puddings is not a good strategy. It is best to provide a balanced diet emphasizing grains, fruits, and vegetables. If pain is being treated with opioid analgesics, featuring high-fiber foods is important to help relieve constipation. Avoiding milk products is a good idea if diarrhea is a problem because lactose can make diarrhea worse.

A child diagnosed with stage IV neuroblastoma has undergone abdominal surgery to remove the tumor. He is now receiving chemotherapy. Which nursing diagnosis would be most important? A) Risk for infection related to chemotherapy B) Impaired skin integrity related to abdominal surgery C) Grieving related to advanced disease and poor prognosis D) Imbalanced nutrition related to adverse effects of chemotherapy

C) Grieving related to advanced disease and poor prognosis In stage IV neuroblastoma, there is metastasis to the bone, bone marrow, other organs, or distant lymph nodes. Additionally, the tumor was located in the abdomen, which is associated with a poor prognosis. Therefore, the most important diagnosis would be grieving. Although infection, skin integrity, and imbalanced nutrition may be relevant, they would not be the most important.

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess? a) Heat intolerance b) Facial edema c) Weight gain d) Constipation

Heat intolerance Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss and smooth, velvety skin. Constipation, weight gain, and facial edema are associated with

A 12 year old boy seen in the clinic, and a diagnosis of Hodgkin's disease is suspected . Which diagnostic test results confirm the diagnosis of Hodgkin's disease? 1 . Elevated vanillylmandelic acid urinary level. 2. The presence of blast cells in the bone marrow 3. The presence of Epsetin-Barr virus in the blood. 4. The presence of Reed-Sternberg cells in the lymph nodes

Correct Answer 4 . Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of gaint multinucleated cells ( Reed- Sternbergs cells) is the hallmark of this disease. The presence of blast cells in the bone marrow indicates leukemia. The Epstein-Barr virus is associated with infectious mononucleosis . Elevated levels of vanillylmandelic acid in the urine may be found in children with neroblastoma.

he nurse is caring for a 7-year-old girl who is undergoing a stem cell transplant. Which of the following would the nurse include in the child's postoperative plan of care? A) Assessing for petechiae, purpura, bruising, or bleeding B) Limiting blood draws to the minimum volume required C) Administering antiemetics around the clock as ordered D) Monitoring for severe diarrhea and maculopapular rash

D) Monitoring for severe diarrhea and maculopapular rash In the posttransplant phase, monitor closely for symptoms of graft-versus-host disease (GVHD) such as severe diarrhea and maculopapular rash progressing to redness or desquamation of the skin (especially on the palms of the hands or soles of the feet). During chemotherapy in the pretransplant phase, assess for petechiae, purpura, bruising, or bleeding to prevent hemorrhage; administer antiemetics around the clock as ordered to prevent the cycle of nausea, vomiting, and anorexia; and limit blood draws to the minimum volume required to prevent anemia.

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? a) Regular insulin b) Detemir c) Lispro d) NPH

Regular insulin Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

The nurse is caring for a child with gastroesophageal reflux disease (GERD). The child is feeding and begins to cough and gag. Which action should the nurse take first? Stop the feeding Elevate the head of the bed Auscultate the child's lung sounds Administer oxygen via nasal cannula

Stop the feedingCoughing and gagging are signs of respiratory distress. The nurse should immediately stop the feeding to ensure a patent airway.

A child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. What findings would the nurse expect to find to help confirm this condition? Select all that apply. a) Weight loss b) Urine specific gravity 1.033 c) Hypotension d) Serum osmolality 300 mOsm/kg e) Decreased ur

b e f

A child with Addison disease has been admitted with a history of nausea and vomiting for the past three days. The client is receiving IV glucocorticoids (e.g., Solu-Medrol). Which of the following interventions would the nurse implement? a) Glucometer readings as ordered b) Intake and output measurements c) Monitoring of sodium and potassium levels d) Daily weights

a

After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would the nurse suggest the mother carry out before she brings the child to see her doctor? a) Give her a glass of orange juice. b) Give her nothing by mouth so that a blood sugar can be drawn at the doctor's office. c) Give her a glass of orange juice with one unit regular insulin in it. d) Give her one uni

a

The nurse is caring for a 13-year-old girl with delayed puberty. When developing the plan of care for this child, what would be the priority? a) Monitoring for therapeutic and side effects of medication b) Involving the child in her therapy to give her a sense of control c) Helping the child discuss her feelings about her condition d) Encouraging the parents to discuss their concerns about the disorder

a

The child may have developed thyroid storm. Which clinical manifestations of thyroid storm should the nurse expect to find? Select all that apply. a) Temperature of 103.2° F (39.6° C) b) Apical heart rate of 172 beats per minute c) Wet bed linen and report of feeling "sweaty" d) Report of feeling very tired and wanting to nap e) Mild-mannered and compliant demeanor

a b c

On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention? a. Assessing neurological status b. Inserting an intravenous line c. Monitoring vital signs during platelet transfusions d. Providing family education about how to prevent bleeding

a. Assessing neurological status When platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.

What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit? a. With milk b. With orange juice c. With water d. On a full stomach

b itamin C (ascorbic acid) increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or juice high in vitamin C. From the options presented, the correct option is the only one that identifies the food highest in vitamin C.

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs .c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs.e. Notify the health care provider if your child begins to develop symptoms of a cold.

b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs.c. Give penicillin as prescribed.e. Notify the health care provider if your child begins to develop symptoms of a cold. The most important issues to teach the family of a child with sickle cell anemia are to (1) seek earlyintervention for problems, such as a fever of 38.5° C (101.3° F) or greater; (2) give penicillin as ordered; (3) recognize signs and symptoms of splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally. The nurse emphasizes the importance of adequate hydrationto prevent sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle. It is not sufficient to advise parents to "force fluids" or "encourage drinking." They need specific instructions on how many daily glasses or bottles of fluid are required. Many foods are also a source of fluid, particularly soups, flavored ice pops, ice cream, sherbet, gelatin, and puddi

In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for: a) bleeding tendencies. b) excessive cortisone secretion. c) dehydration. d) hypoglycemia.

c

A 12-year-old girl in the hospital suddenly experiences an extreme drop in blood pressure following discontinuation of prednisone. She appears gray and has no detectable pulse. Which of the following is the priority nursing intervention in this situation? a) Administration of insulin b) Administration of epinephrine c) Immediate replacement of cortisol d) Cardiopulmonary resuscitation

c Prednisone is corticosteroidal medication.

The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that this type of insulin would most likely be used in treating this child? a) Intermediate-acting insulin b) Long-acting insulin c) Rapid-acting insulin d) Regular insulin

c The introduction of rapid-acting insulin, such as lispro or humalog, has greatly changed insulin administration in children. The onset of action of rapid-acting insulin is less than 15 mi nutes. Rapid-acting insulin can even be used after a meal in children with un predic table eating habits. Regular, intermediate, and long-acting insulin all have a longer onset, peak, and duration than rapid acting insulin, and are more difficult to regulate in the child with unpredictable eating patterns.

You are caring for a school age child with Cystic Fibrosis. Which of the following sports would be the most appropriate for this child? a. Basketball b. Golf. c. Swimming d. Baseball

c. Swimming (exposure to moist humid air, exercise promotes deep breathing)

A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing? a. Aplastic b. Hyperhemolytic c. Vaso-occlusive d. Splenic sequestration

c. Vaso-occlusiveVaso-occlusive crisis, or painful crisis, is caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.

Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red b

c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is to :a) encourage increased fluid intake. b) measure urine output. c) weigh the client .d) check vital signs.

d

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is to :a) encourage increased fluid intake. b) measure urine output. c) weigh the client. d) check vital signs.

d

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to do? a) Request that someone call 911 b) Anticipate that the child will need intravenous glucose c) Dissolve a piece of candy in the child's mouth d) Administer subcutaneous glucagon

d

Which is a common clinical manifestation of Hodgkin disease? a. Petechiae b. Bone and joint pain c. Painful, enlarged lymph nodes d. Enlarged, firm, nontender lymph nodes

d. Enlarged, firm, nontender lymph nodes NON TENDER!NOT PAIN FUL

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

d. Painful swelling of hands and feet; painful joints A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If in the extremities,painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acutesurgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse resultsfrom sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasisresult from chronic vaso-occlusive phenomena.

Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n): a. decrease in leukocytes. b. increase in lymphocytes. c. vitamin C deficiency. d. decrease in blood platelets.

d. decrease in blood platelets.