Peds Exam 5

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 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

A nurse working in an emergency room of a large pediatric hospital receives a transfer call from a reporting nurse at a local community hospital. The nurse will soon receive a 4-month-old who has been diagnosed with an intussusception. The infant is described as very lethargic with the following vital signs, T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which of the following is the most appropriate action for the receiving nurse? 1. Prepare to accompany the infant to a computed tomography scan to confirm the diagnosis. 2. Prepare to accompany the infant to the radiology department for a reducing enema. 3. Prepare to start a second intravenous line to administer fluids and antibiotics. 4. Prepare to get the infant ready for immediate surgical correction.

4 Mixed with perotonitis, it is a medical emergency

The nurse is assessing a 3-week-old with suspected bacterial meningitis. Isolation and respiratory precautions have already been initiated. Which clinical assessment by the nurse would warrant immediate intervention? 1. The neonate is irritable. 2. The neonate has a rectal temperature of 100.6° F (38.1°C). 3. The neonate is quieter than usual. 4. The neonate's respiratory rate is 24 breaths per minute.

4 Normal is 30 to 60 per min

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

Which would be the most appropriate teaching to the parents of a female child in the emergency department who is awake, alert, and has no respiratory distress after a near-drowning experience? 1. "She will most likely be discharged, and you should watch for any cough or trouble breathing." 2. "She will need to have a preventive tube for breathing and ventilation to ensure her lungs are clear." 3. "She will be fine but sometimes antibiotics are started as a preventive." 4. "She will most likely be admitted for at least 24 hours and observed for respiratory distress or any swelling of the brain."

4 can cause cerbral edema

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 irritable, 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

3

After airway, breathing, and circulation have been assessed and stabilized, which intervention should the nurse implement for a child diagnosed with encephalitis? 1. Assist with a lumbar puncture, and give reassurance. 2. Obtain a throat culture, then begin antibiotics. 3. Perform initial and serial neurological assessments. 4. Administer antibiotics and antipyretics.

3

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

The nurse is caring for a 3-year-old undergoing evaluation for celiac disease. Which of the following would the nurse expect to be included in the child's diagnostic workup? 1. Obtain complete blood count and serum electrolytes. 2. Obtain complete blood count and stool sample; keep child NPO. 3. Obtain stool sample and prepare child for jejunal biopsy. 4. Obtain complete blood count and serum electrolytes; monitor child's response to gluten-containing diet.

3

The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which of the following statements made by the parents would be typical of a child with this diagnosis? 1. "The baby is a very fussy eater and just does not want to eat." 2. "The baby tends to have a very forceful vomiting episode approximately 30 minutes after most feedings." 3. "The baby is always hungry." 4. "The baby is happy in spite of getting really upset on spitting up."

3

The nurse is teaching the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy. The nurse should tell them that some of the progressive complications include which of the following? 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, and dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech.

3

The nurse is caring for a newborn with a myelomeningocele who will have a surgical repair tomorrow. The nurse should do which of the following? 1. Offer formula every 3 hours. 2. Turn the infant back to front every 2 hours. 3. Place a wet dressing on the sac. 4. Provide pain medication every 4 hours.

3 Protect the sac to help prevent infection

Which would be the most appropriate discharge instructions for a child with a right wrist sprain 3 hours ago? 1. "You should rest, elevate the wrist above the heart, apply heat wrapped in a towel, and use the sling when walking." 2. "You can use the wrist, but stop if it hurts; elevate the wrist when not in use, and use the sling when walking." 3. "You should rest, apply ice wrapped in a towel, elevate the wrist above the heart, and use the sling when walking." 4. "You do not have to take any special precautions; do not use any movements that cause pain, and apply alternate heat and ice, each wrapped in a towel

3 RICE for 24 hours

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

The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals? 1. Eggs, bacon, rye toast, and lactose-free milk. 2. Pancakes, orange juice, and sausage links. 3. Oat cereal, breakfast pastry, and nonfat skim milk. 4. Cheese, banana slices, rice cakes, and whole milk.

4

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 Gower sign for assessing Duchenne muscular dystrophy can be elicited by having a patient do which of the following? 1. Close the eyes and touch the nose with alternating index fingers. 2. Hop on one foot and then the other. 3. Bend from the waist to touch the toes. 4. Walk like a duck and rise from a squatting position

4 Children with muscular dystrophy display the Gower sign, which is great difficulty rising and standing from a squatting position due to the lack of muscle strength.

GERD

Transfer of gastric contents into the esophagus. About 50% of infants less than 2 months have this disease. Symptoms: 1. Spitting up 2. Excessive fussiness 3. Weight loss, FTT 4. Respiratory problems

Bilary atresia children may end up needing a transplant of what organ

liver

Hirschsprung disease results in:

most common type or cause. • Neonatal bowel obstruction

myelomeningocele

most severe form of spina bifida in which the spinal cord and meninges protrude through the spine

cleft palate

occurs in the midline and may involve hard & soft palate.

intussusception

occurs when one section of intestine slips or telescopes into another section of intestine

pinworms signs

peds pt with perianal pruritis especially at night

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

supine to prevent rubbing the suture line

celiac disease

GI manifestations usually noted several months after the introduction of Gluten containing grains into the diet. Steatorrhea, foul-smelling stools, malnutrition, anemai, anorexia Management: DIET- High in calories & proteins Complication- risk of developing lymphoma

Bacterial meninigitis can be prevented by what vax

HiB

bilary atresia symptoms

Jaundice, urine dark and stains diaper Stools lighter and white or tan Hepatomegaly Poor weight gain, FTT Pruritus, irritability

GERD older kids

Older kids develop symptoms that include: 1. Heartburn 2. Abdominal pain 3. Chronic cough- Nocturnal asthma 4. Dysphagia 5. Non-cardiac chest pain Appendicitis

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

Stool softeners

Appendicitis s/sx

Symptoms include: NOT always straightforward 1. Fever 2. Vomiting 3. Abdominal pain 4. Elevated Complete blood count (CBC) 5. RLQ pain

Cleft Lip

-may be unilateral or bilateral- its where the maxillary and median nasal processes fail to fuse.

A nurse is receiving an infant with myelomeningocele from an outside hospital. Which of the following priority items should be placed at the newborn's bedside? 1. A bottle of normal saline. 2. A rectal thermometer. 3. Extra blankets. 4. A blood pressure cuff.

1 Before the surgical closure of the sac, the infant is at risk for infection. A sterile dressing is placed over the sac to keep it moist and help prevent it from tearing

A 4-month-old female is brought to the emergency department with severe dehydration. 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

Which of the following will help a school-aged child with muscular dystrophy stay active longer?

1. Normal activities, such as swimming. 2

A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse's assessment follows: awake, pale, thin child lying in bed, multiple contractures, drooling, coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which of the following nursing diagnoses is most important? 1. Potential for skin breakdown: lying in one position. 2. Alteration in nutrition: less than body requirements. 3. Potential for impaired social support: mother sole caretaker. 4. Alteration in elimination: diarrhea.

2

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

The nurse is teaching family members of a child newly diagnosed with muscular dystrophy about early signs. The nurse knows that teaching was successful when a parent states that which of the following signs may indicate the condition early? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity.

2

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 Pain felt in RLQ when LLQ is palpated

Which would be the most appropriate nursing intervention when caring for a child newly admitted with a mild head concussion and no cervical spine injury? 1. Keep head of bed flat, side rails up, and safety measures in place. 2. Elevate head of bed, side rails up, and safety measures in place. 3. Observe for drainage from any orifice and notify physician immediately. 4. Continually stimulate the child to keep awake to check neurological status.

2 The head of the bed should be elevated to decrease intracranial pressure. Side rails should be up to help ensure the child stays in bed, and age-appropriate safety measures should be instituted.

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 nurse is caring for an infant with pyloric stenosis. The parents ask if any future children will likely have pyloric stenosis. Select the nurse's best response. 1. "You seem worried; would you like to discuss your concerns?" 2. "It is very rare for a family to have more than one child with pyloric stenosis." 3. "Pyloric stenosis can run in families. It is more common among males.

3

functional constipation

does not have a physical (anatomical) or physiological (hormonal or other body chemistry) cause. It may have a neurological, psychological or psychosomatic cause.

The key to surviving bilary atresia is

early diagnosis

Hirschsprung disease diet

high calorie, low residue, high protein

Infants with pyloric stenosis vomit immediately after a feeding, especially as the pylorus becomes more

hypertrophied

gower sign

indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use their hands and arms to "walk" up their own body from a squatting position due to lack of hip and thigh muscle strength.

encopresis

involuntary defecation not attributable to physical defects or illness fecal incontinence or soiling

Way to dx MD

muscular biopsy

myelomeningocele post surgery comp

tethered cord (constipation, bilat leg pain)

Gastroesophageal Reflux

the upward flow of acid from the stomach into the esophagus

. 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.

blow bubbles

Which of the following has the potential to alter a child's level of consciousness? Select all that apply. 1. Metabolic disorders. 2. Trauma. 3. Hypoxic episode. 4. Dehydration. 5. Endocrine disorders

All of them

Crohn's Disease is

Chronic inflammatory process involving GI tract from mouth to anus.

Cleft lip and palate problems

Complications: Aspiration, ear infections & hearing loss, speech and language delay, dental problems

Hirschsprung disease

Congenital absence of normal nervous function in colon, results in absence of peristaltic movement

Crohns

IBD: stictures, fistulas, perianal involvement, skip lesions, cobble stone, transmural

intussusception facts

Intussusception is the most common cause of intestinal obstruction in children younger than 3

Classic symptom of appendicitis

McBurney Point * Right Lower Quadrant

isotonic solutions

NS LR D5W it's the same solute/water concentration as inside cells and the cells retain their normal size.

Gastroesophageal Reflux manifestations

Projectile vomiting, thicken formulas with cereal

.Ulcerative Colitis- inflammation of colon and rectum with distal colon and rectum most affected

SX include: diarrhea, rectal bleeding, abdominal pain associated with urgency

intussusception signs and symptoms

Screaming and pulling knees to chest Passage of Red, currant, jelly-like stools ( mixed with blood and mucus) Tender, distended abdomen Palpable sausage- like mass in upper R quadrant

pinworms

Small, visible, white parasitic worms that commonly infect the intestines of young children

Cleft palate post op rules

The child should not have anything hard in the mouth, such as crackers, cookies, or a spoon No pacifiers, straws, or anything that creates suction No yaunkers

DMD comp

The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems.

bilary atresia

a condition in infants in which the bile ducts outside and inside the liver are scarred and blocked. Bile can't flow into the intestine, so bile builds up in the liver and damages it. The damage leads to scarring, loss of liver tissue and function, and cirrhosis.

hypertonic solution

a solution that causes a cell to shrink because of osmosis

idiopathic constipation

cause is unknown

hypotonic solutions

contains less solute concentration than the cell; water will tend to enter the cell and swell it

Most common cause of emergency surgery in children

appendicitis

The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which of the following could be a causative factor? Select all that apply. 1. Hypothyroidism. 2. Muscular dystrophy. 3. Myelomeningocele. 4. Drinks a lot of milk. 5. Active in sports.

1, 2, 3, 4. 1. Hypothyroidism can be a causative factor in constipation. 2. Weakened abdominal muscles can be seen in muscular dystrophy and can lead to constipation. 3. Myelomeningocele affects the innervation of the rectum and can lead to constipation. 4. Excessive milk consumption can lead to constipation.

Which of the following children may need extra fluids to prevent dehydration? Select all that apply. 1. A 7-day-old receiving phototherapy. 2. A 6-month-old with newly diagnosed pyloric stenosis. 3. A 2-year-old with pneumonia. 4. A 13-year-old who has just started her menses. 5. A 2-year-old with full-thickness burns to the chest, back, and abdomen.

1, 2, 3, 5. Menses isn't a risk for dehydration

The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. The mother and father. 2. The sister. 3. The brother. 4. The aunts and all female cousins. 5. The uncles and all male cousins

1, 2, 4 Women carry the disease and pass it on to males who are affected

The parents of a child being evaluated for celiac disease ask the nurse why it is important to make dietary changes. Select the nurse's best response.

1. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems."

The nurse receives a call from the mother of a 6-month-old who describes her child as sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response.

1. "Your infant will need to have some tests in the emergency room to determine if anything serious is going on." Signs of intussusception

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.

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 accumulation of bowel contents and abdominal distention

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.

Which assessment is most important after any injury in a child?.

2. Serial assessments of level of consciousness

The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask the purpose of is the enema. Select the nurse's most appropriate response. 1. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception." 2. "The enema will confirm the diagnosis. Although very unlikely, the enema may also help fix the intussusception so that your child will not immediately need surgery." 3. "The enema will help confirm diagnosis and has a good chance of fixing the intussusception." 4. "The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the intussusception will recur."

3. "The enema will help confirm diagnosis and has a good chance of fixing the intussusception."

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 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 repaired 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.

Each member of the family of a child diagnosed with pinworms is prescribed a single dose of pyrantel pamoate (Antiminth). Which of the following should the nurse teach the parents regarding administration of this drug? 1. Fever and rash are common adverse effects. 2. The medication kills the eggs in about 48 hours. 3. The drug may stain the feces red. 4. The dose may be repeated in 2 weeks.

4. As the first treatment kills the adult worms, a second treatment is done in 2 weeks to treat emerging parasites

myelomeningocele post care

A normal saline dressing is placed over the sac to prevent tearing, which would allow the cerebrospinal fluid to escape and microorganisms to enter and cause an infection.

hypotonic fluids

D2.5W, 0.45 NS moves water into cell, causing cell to swell and burst

hypertonic iv fluids

D5 NaCl. D5 in Lactated ringers. D5 0.45% NaCl.

The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response.

Drink more fluids

Hirschsprung disease - another explanation

absent ganglion cells in submucosal/myenteric plexus rectosigmoid

The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. The nurse should tell them which of the following?

1. Muscular dystrophies are disorders associated with progressive degeneration of muscles, resulting in relentless and increasing weakness.

The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which of the following would the nurse expect to find in the plan of care? 1. Keep infant NPO; begin intravenous fluids at maintenance. 2. Keep infant NPO; begin intravenous fluids at maintenance; place NGT to low wall suction. 3. Obtain serum electrolytes; keep infant NPO; do not attempt to pass NGT due to obstruction from pylorus. 4. Offer infant small frequent feedings; keep NPO 6 to 8 hours before surgery

2 IV fluids, NPO, NGT to decompress

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

Which of the following manifestations suggests that an infant is developing NEC? 1. The infant absorbs bolus orogastric feedings at a faster rate than previous feedings. 2. The infant has bloody diarrhea. 3. The infant has increased bowel sounds. 4. The infant appears hungry right before a scheduled feeding.

2

A child with a newly applied left leg cast initially feels fine, then starts to cry and tells his mother his leg hurts. Which assessment would be the nurse's first priority? 1. Cast integrity. 2. Neurovascular integrity. 3. Musculoskeletal integrity. 4. Soft-tissue integrity.

2 neurovascular increased Pain out of proportion with injury, Pallor of extremity, Paresthesia, Pulselessness at distal part of extremity, and Paralysis post cast application (5 Ps).

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 ar

2 child should wait 6 weeks before playing sports

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

30 min before feeding

The nurse is caring for an 18-month-old infant whose cleft palate was repaired 12 hours ago. Which of the following should be included in the plan of care? 1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a pacifier. 2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. 3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. 4. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions.

3 Pain meds need to be given regularly to prevent crying which stresses the suture lines

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 . 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 discussing nutrition with the parents of a child with Duchenne muscular dystrophy. The nurse tells the parents that which of the following foods would be best for their child? 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain.

4 low cal food because they eventually become obese once immobile