Peds Exam 4

The nurse is interviewing the mother of a 6-month-old being seen at a well-child visit. The mother reports she has used an over-the-counter topical ointment intended for adults on her child for a skin rash. What is the most appropriate response by the nurse? A) "This is dangerous so please do not do this again." B) "Why did you do that instead of contacting your doctor?" C) "Children have thin skin and can absorb medications differently than adults." D) "How often do you use this medication?"

C) "Children have thin skin and can absorb medications differently than adults."

A child has been prescribed growth hormone. When collecting data from this patient, which report is of the greatest concern? A) "I sometimes have headaches." B) "I feel tired." C) "My hips often hurt." D) "I take this medication with food."

C) "My hips often hurt."

After teaching a class about inborn errors of metabolism, the instructor determines that additional teaching is needed when the class identifies what as an example of an inborn error of metabolism? A) Galactosemia B) Maple syrup urine disease C) Achondroplasia D) Tay-Sachs disease

C) Achondroplasia

The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? A) Interrupted family process related to the child's diagnosis B) Deficient knowledge deficit related to the genetic disorder C) Grieving related to the child's poor prognosis D) Ineffective coping related to stress of providing care

C) Grieving related to the child's poor prognosis

A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy? A) Rapid weight gain B) Complaints of headaches C) Height increase of 4 inches D) Growth plate closure

C) Height increase of 4 inches

The nurse is assessing a 4-year-old boy whose mother was 40 years old when he was born. Which finding suggests this child has a genetic disorder? A) Inquiry determines the child had feeding problems. B) Observation shows nasal congestion and excess mucus. C) Inspection reveals low-set ears with lobe creases. D) Auscultation reveals the presence of wheezing.

C) Inspection reveals low-set ears with lobe creases.

When caring for an 8-year-old boy injured in an automobile accident, the nurse demonstrates understanding of the principles of Pediatric Advanced Life Support (PALS) by which action? A) Assisting ventilation with a bag-valve-mask (BVM) device B) Treating ventricular fibrillation using a defibrillator C) Managing compensated shock to prevent decompensated shock D) Treating supraventricular tachycardia using cardioversion

C) Managing compensated shock to prevent decompensated shock

The nurse is assessing an infant and notes that the infant's urine has a mousy or musty odor. What would the nurse suspect? A) Maple syrup urine disease B) Tyrosinemia C) Phenylketonuria D) Trimethylaminuria

C) Phenylketonuria

After teaching the parents of a child with attention deficit/hyperactivity disorder about ways to control the child's behavior, the nurse determines a need for additional teaching when the parents state: A)"If he starts to act out, we'll have him do a time-out to help him refocus." B)"We can use a reward system when he behaves appropriately." C)"If he misbehaves, we need to punish him instead of reward him." D)"We need to help him set realistic goals that he can achieve."

C)"If he misbehaves, we need to punish him instead of reward him."

As part of their orientation to their pediatric clinical rotation, an instructor is teaching a group of students how to perform cardiopulmonary resuscitation (CPR) on a child. Two students return demonstrate the skill using an infant manikin. What action indicates the proper technique? A)Compressing 30 times for every 2 breaths B)Placing the heel of the hand on the midsternum C)Giving 2 breaths followed by 15 compressions D)Using two hands to perform chest compressions

C)Giving 2 breaths followed by 15 compressions

A child with depression is prescribed fluoxetine. The nurse identifies this as belonging to which class of drugs? A)Atypical antidepressant B)Tricyclic antidepressant C)Selective serotonin reuptake inhibitor D)Psychostimulant

C)Selective serotonin reuptake inhibitor

A group of students are working on a presentation for a local health fair about safety for children. When developing this presentation, the students would address what cause as the most common in pediatric injury? A)Sports B)Firearm use C)Falls D)Automobile accidents

C. Falls

A nurse educating a 13-year-old adolescent with diabetes mellitus about how to self-monitor and control the disease. Which of the following statements by the nurse would promote a healthy way to self-control the disease?

"Check your glucose level twice a day and the glycosylated hemoglobin every 3 months."

The nurse is caring for an adolescent girl with anorexia nervosa. What findings would indicate to the nurse that the girl requires hospitalization? A)Weight gain of one-half pound per week B)Food refusal C)Body mass index of 18 D)Soft, sparse body hair and dry, sallow skin

B)Food refusal

The nurse is providing client education to an adolescent newly diagnosed with type 1 diabetes mellitus. Which statement by the adolescent indicates that the nurse's teaching has been effective?

"If I take my insulin, I can eat any kind of carbohydrate I want."

The nurse working in a pediatric mental health clinic is assessing a 4-year-old child who has suffered from physical abuse. Which type of therapy does the nurse anticipate will be most helpful in developing a trusting relationship as well as assisting in determining the patient's current emotional state? A)Behavioral therapy B)Play therapy C)Cognitive behavioral therapy D)Family therapy

B)Play therapy

Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?

"Kids can usually be managed with an oral agent, meal planning, and exercise."

The nurse is teaching the mother of a child with phenylketonuria (PKU) about diet and realizes the mother needs further instruction when she makes which of the following statements?

"Lots of fish and meat will help him." Explanation: Patients with PKU need to avoid high-protein foods including meats, fish, poultry, eggs, cheese, milk, nuts, beans, peas, and flour. The food exchange list includes vegetables, fruits, breads, cereals, fats, and miscellaneous "free foods" allowed on the diet.

A newborn has just been diagnosed with phenylketonuria (PKU). The physician and nurse have taught the parents about the defect. What statement by the parents demonstrates a need for further instruction?

"nothing can be done medically to manage this condition"

A nurse is educating the family of a small child with phenylketonuria about meal choices. Which of the following meal choices by the parents indicate to the nurse that they understand the dietary management of this disease? A. Steak and a drink sweetened with Aspartame B. Hamburger and mashed potatoes C. Yogurt and orange juice D. A bowl of cereal with strawberries and apple juice

A bowl of dry cereal with strawberries and apple juice Foods low in phenylalanine include vegetables, fruits, juices, some breads, and some cereals. Steak and aspartame are high in phenylalanine and should be avoided. Hamburger may have high phenylalanine levels. Dairy products are high in phenylalanine and should be avoided. Mashed potatoes, if made from scratch, and orange juice are acceptable foods.

The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? A) "After bathing, I need to rub his skin everywhere to make sure he is completely dry." B) "I must make sure I use lukewarm water instead of hot water." C) "Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment." D) "We should leave his skin moist before applying medication or moisturizer."

A) "After bathing, I need to rub his skin everywhere to make sure he is completely dry."

A 6-year-old child has been diagnosed with growth hormone deficiency. The child's mother requests more information about this condition. Which statements should be included in the nurse's response? Select all that apply. A) "The majority of children who have this condition are born of normal weight and length." B) "There are several potential causes of this condition." C) "This condition is most likely related to dwarfism in past generations of your family." D) "Most children with this condition are nutritionally deprived." E) "Your child most likely does not eat adequate amounts of protein."

A) "The majority of children who have this condition are born of normal weight and length." B) "There are several potential causes of this condition."

The parents bring their 3-year-old son to the emergency department after he ingested some of his mother's medicine. Which assessment would be of critical importance for this child? A) Assessing mental status and skin moisture and color B) Evaluating the effectiveness of the child's breathing C) Noting the child's pulse rate and quality D) Auscultating all lung fields for signs of edema

A) Assessing mental status and skin moisture and color

When the nurse is assessing a 2-day-old newborn and suspects Down syndrome, what factors would lead to this assessment? Select all that apply. A) Flat facial profile B) Downward slant to the eyes C) Large tongue compared to mouth D) Simian crease E) Epicanthal folds F) Rigid joints

A) Flat facial profile C) Large tongue compared to mouth D) Simian crease E) Epicanthal folds

The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. What is the priority nursing diagnosis? A) Imbalanced nutrition, less than body requirements related to the effects of hypotonia B) Deficient knowledge related to the presence of a genetic disorder C) Delayed growth and development related to a cognitive impairment D) Impaired physical mobility related to poor muscle tone

A) Imbalanced nutrition, less than body requirements related to the effects of hypotonia

The nurse is caring for a 9-year-old patient newly diagnosed with diabetes. The patient has polyuria, polydipsia, and weight loss. Which nursing diagnoses will the nurse include in the care plan? Select all that apply. A) Imbalanced nutrition: less than body requirements B) Deficient fluid volume C) Deficient knowledge regarding disease process D) Noncompliance

A) Imbalanced nutrition: less than body requirements B) Deficient fluid volume C) Deficient knowledge regarding disease process

A child has a tracheal tube in place and will be receiving medications via this tube. Which medications would the nurse expect to be administered in this manner? Select all that apply. A) Lidocaine B) Adenosine C) Atropine D) Dopamine E) Epinephrine F) Naloxone

A) Lidocaine C) Atropine E) Epinephrine F) Naloxone

A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which condition? A) Syndrome of inappropriate antidiuretic hormone (SIADH) B) Thyroid storm C) Cushing syndrome D) Vitamin D toxicity

A) Syndrome of inappropriate antidiuretic hormone (SIADH)

The nurse is obtaining the health history for a 15-month-old boy from the parents. The child is not yet speaking. Which finding would be eliminated as a risk factor for a possible genetic disorder? A) The child is male and Caucasian. B) The grandmother and father have hearing impairments. C) The child was a breech delivery 3 weeks early. D) The mother was 37 when she became pregnant

A) The child is male and Caucasian.

What finding would lead the nurse to suspect that a child has Turner syndrome? A) Webbed neck B) Microcephaly C) Gynecomastia D) Cognitive delay

A) Webbed neck

A child is undergoing rapid sequence intubation and is receiving atropine. The nurse understands that this agent is used to: A) lessen the vagal effects of intubation. B) reduce intracranial pressure. C) induce amnesia. D) provide short-term paralysis.

A) lessen the vagal effects of intubation.

When teaching a class about trisomy 21, the instructor would identify the cause of this disorder as: A) nondisjunction. B) X-linked recessive inheritance. C) genomic imprinting. D) autosomal dominant inheritance.

A) nondisjunction.

A child is receiving therapy in which he is learning to replace automatic negative thought patterns with alternative ones. The nurse interprets this as which type of therapy? A)Cognitive therapy B)Behavioral therapy C)Milieu therapy D)Individual therapy

A)Cognitive therapy

A nurse is preparing a program for a parent group about various techniques that can be used to manage behavior. What would the nurse be least likely to include? A)Focus the child's attention on the negative behavior. B)Set limits with the child for responsible behavior. C)Ignore inappropriate behaviors. D)Provide positive feedback for self-control efforts.

A)Focus the child's attention on the negative behavior.

A nurse is preparing a teaching session for a group of parents with children newly diagnosed with attention deficit/hyperactivity disorder (ADHD). When explaining this disorder to the parents, what would the nurse include as being involved? Select all that apply. A)Impulsivity B)Inattention C)Distractibility D)Hyperactivity E)Defiance F)Anxiety

A)Impulsivity B)Inattention C)Distractibility D)Hyperactivity

A school-age child diagnosed with depression is receiving antidepressant therapy. What behavior would the nurse instruct the parents to watch for and to notify the physician immediately if the child demonstrates it? A)Loss of interest B)Gastric upset C)Sedation D)Urinary retention

A)Loss of interest

A nurse is caring for a 5-year-old girl with depression. The girl is having difficulty coping with her feelings of sadness and fear, which stem from her parents' separation and recent divorce. The girl has been prescribed antidepressant medication but the mother thinks the girl would benefit from therapy. The nurse anticipates a referral to a therapist that specializes in: A)individual therapy. B)play therapy. C)behavioral therapy. D)hypnosis.

B)play therapy.

A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control? A) 9.0% B) 8.2% C) 7.3% D) 6.9%

B) 8.2% Feedback: For a child 6 years of age and younger, the target HbA1C level should be less than 8.5% but greater than 7.5%. For children between the ages of 6 to 12 years, the target HbA1C level is less than 8%. For children and adolescents between 13 to 19 years of age, the target HbA1C level would be less than 7.5%.

The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include? A) Getting cervical radiographs between 3 and 5 years of age B) Adhering to the special dietary needs of the child C) Getting an echocardiogram before 3 months of age D) Monitoring for symptoms of respiratory infection

B) Adhering to the special dietary needs of the child

The nurse is reviewing the laboratory test results of a child with Addison disease. What would the nurse expect to find? A) Hypernatremia B) Hyperkalemia C) Hyperglycemia D) Hypercalcemia

B) Hyperkalemia

When teaching the parents of a child with phenylketonuria, the nurse would instruct them to include which food in the child's diet? A) Milk B) Oranges C) Meat D) Eggs

B) Oranges

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved?

Antidiuretic hormone Explanation: Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

The pediatric nurse is conducting an information session for parents regarding genetic alterations in children. Which comments by the parents of a child with a cleft palate indicate learning occurred during the session? Select all that apply. A) "I can't believe that it is because of my genes that our child has this disorder." B) "Our child will need to be counseled when reaching adulthood since the risk for passing along the gene that causes cleft palate is increased." C) "While I'm not sure what they are, I know that environmental factors have likely played a role in our child's cleft palate." D) "I wish we had genetic testing before having children. We might have felt a little more prepared for the possibility of disorders in our children." E) "This makes it almost certain that if we have more children they will have cleft palate as well."

B) "Our child will need to be counseled when reaching adulthood since the risk for passing along the gene that causes cleft palate is increased." C) "While I'm not sure what they are, I know that environmental factors have likely played a role in our child's cleft palate." D) "I wish we had genetic testing before having children. We might have felt a little more prepared for the possibility of disorders in our children."

What would lead the nurse to suspect that an adolescent has bulimia? A)Body mass index less than 17 B)Calluses on back of knuckles C)Nail pitting D)Bradycardia

B)Calluses on back of knuckles

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is to:

Check vital signs

As a nurse, you know that which condition is caused by excessive levels of circulating cortisol:

Cushing syndrome

The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. What would the nurse include as a major congenital anomaly? A) Overlapping digits B) Polydactyly C) Umbilical hernia D) Cleft palate

D) Cleft palate

A nurse is teaching the parents of an infant with congenital adrenal hyperplasia about the signs and symptoms of adrenal crisis. The nurse determines that the teaching was successful when the parents correctly identify what sign of adrenal crisis? A) Bradycardia B) Constipation C) Fluid overload D) Persistent vomiting

D) Persistent vomiting

When providing guidance to the parents of a child with Down syndrome, which interaction would be most appropriate? A) Encourage the parents to home-school the child. B) Advise the parents that the child will need monthly thyroid testing. C) Instruct them on the need for yearly dental visits. D) Teach the parents about the need for a high-fiber diet.

D) Teach the parents about the need for a high-fiber diet.

A child with attention deficit/hyperactivity disorder is prescribed long-acting methylphenidate. What information would the nurse include when teaching the child and his parents about this drug? A)"Give the drug three times a day: morning, midday, and after school." B)"This drug may cause drowsiness, so be careful when doing things." C)"Some increase in appetite may occur, so watch how much you eat." D)"Take this drug every day in the morning when you wake up."

D)"Take this drug every day in the morning when you wake up."

The nurse is caring for an adolescent girl with a suspected anxiety disorder. The girl states that she is constantly double-checking that she has unplugged her curling iron and must make sure that everything is in perfect order in her room before she leaves the house. The nurse interprets these findings as indicating which disorder? A)Generalized anxiety disorder B)Posttraumatic stress disorder C)Social phobia D)Obsessive-compulsive disorder

D)Obsessive-compulsive disorder

When assessing the adolescent with anorexia, what would the nurse expect to find? A)Tachycardia B)Hypertension C)Fever D)Sparse body hair

D)Sparse body hair

A group of students are working on a presentation for a local health fair about safety for children. When developing this presentation, the students would address what cause as the most common cause of pediatric death? A)Sports B)Firearm use C)Falls D)Automobile accidents

D. Automobile accidents

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis A) Deficient fluid volume related to dehydration B) Excess fluid volume related to edema C) Deficient knowledge related to fluid intake regimen D) Imbalanced nutrition, more than body requirements related to excess weight

Deficient fluid volume related to dehydration

A 4-year-old diagnosed with diabetes insipidus is being discharged. Which information below is most important to emphasize to the parents?

Diabetes insipidus is different from diabetes mellitus. Explanation: Having all caregivers trained in injections ensures that medication will be given and the need to give it to the child will be understood. All children should wear a medical alert tag upon diagnosis. For the caregiver to have a good understanding and provide good management of the child's care, the difference between diabetes insipidus and diabetes mellitus must be established. This is a rare disorder that needs to be closely managed throughout the child's life, and it is not curable.

The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on what findings? Select all that apply. A) Blurred vision B) Dry, flushed skin C) Diaphoresis D) Slurred speech E) Fruity breath odor F) Tachycardia

Diaphoresis Slurred speech Tachycardia

A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections?

Elevate the subcutaneous tissue before the injection.

The nurse performing neonatal screenings knows that the cardiovascular system is the system most commonly affected by a metabolic disorder.

False

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is:

Graves Disease

A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition?

Graves Disease

A nurse caring for a child with Grave's disease is administering propylthiouracil (PTU). The child has been on this drug for a few weeks and now has sudden symptoms of a sore throat. What is the priority intervention for the nurse?

Hold the dose and call the health care provider.

The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for evaluation because the child has had persistent vomiting. What finding would lead the nurse to suspect that the child is experiencing an acute adrenal crisis? A) Hypernatremia B) Bradycardia C) Hypertension D) Hyperkalemia

Hyperkalemia

After teaching a group of nursing students about shock in children, the instructor determines that the teaching was successful when the students identify which type of shock as most common? A) Septic B) Cardiogenic C) Hypovolemic D) Distributive

Hypovolemic

You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him?

Injections of rGH

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver?

Metformin

The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. What would be most important for the nurse to incorporate into the plan of care when working with this family?

Presenting the information in a nondirective manner

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?

Regular insulin

A child is receiving desmopressin (DDAVP) for the treatment of central diabetes insipidus. The child sneezes immediately after receiving the morning dose. Which is the best action made by the nurse?

Repeat the full dose immediately

The nurse is providing education to a teenaged boy diagnosed with impetigo. Which statement by the boy indicates the need for further education? a) "This condition is contagious." b) "I can continue to attend school while taking the prescribed antibiotics." c) "I will need to cover my son's skin lesions with bandages until it has healed." d) "It is important to remove the crusts before applying any topical medications."

c) "I will need to cover my son's skin lesions with bandages until it has healed." Impetigo is an infectious bacterial infection. The crusts should be removed after soaking prior to applying topical medications. Leaving the lesions open to air is not contraindicated. Children diagnosed with impetigo may attend school during treatment.

A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses?

Subcutaneously in the outer thigh

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms?

Syndrome of inappropriate antidiuretic hormone

A 9-year-old child with Graves' disease is seen at the pediatrician's office with a complaint of sore throat and fever. The nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse?

The child may have developed leukopenia.

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with disorder? A) The parents report that their child had "a cold or flu" recently. B) Blood pressure is decreased when checking vital signs. C) The parents report that their son "can't drink enough water." D) Auscultation reveals Kussmaul breathing.

The parents report that their son "can't drink enough water."

A 6-year-old boy has a moon-faced, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child?

Tumor of the adrenal cortex

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect?

Type 1 diabetes mellitus Explanation: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphasia, enuresis, and weight loss.

The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children. The nurse most likely is referring to: a) impetigo. b) seborrheic dermatitis. c) candidiasis. d) miliaria rubra.

a) impetigo. Impetigo is a superficial bacterial skin infection.

The nurse is providing care to a child who is intubated and the child's condition is deteriorating. What would the nurse do first? A) Check if the tracheal tube is obstructed B) Assess for displacement of the tracheal tube C) Look for signs of a possible pneumothorax D) Check the equipment for malfunction

assess for displacement of the tracheal tube

A group of students are preparing for a class exam on skin disorders. As part of their preparation, they are reviewing information about acne vulgaris and its association with increased sebum production. The students demonstrate understanding of the information when they identify which areas as having the highest sebaceous gland activity? Select all that apply. a) Shoulders b) Back c) Neck d) Face e) Upper chest

b) Back d) Face e) Upper chest The face, upper chest, and back are the areas of highest sebaceous activity and thus the most common areas for acne lesions to occur. The neck and shoulders are not typical areas involved with acne.

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client?

fluid replacement

The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has:

polyphagia

The nursing diagnosis most applicable to a child with growth hormone deficiency would be:

risk for situational low self-esteem related to short stature.

An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions?

urine output