PEDs Final

The nurse is educating the parents of a 4-year-old boy with a Wilms tumor who is about to have chemotherapy prior to surgery. Which statement by the parents indicates that the nurse should review the instructions about preventing infection? A. "He takes his antibiotic twice a day" B. "We check his temperature orally" C. "We keep him away from crowds" D. "He must be clean, and his teeth brushed"

A. "He takes his antibiotic twice a day" Rationale: The parents have heard the instructions for the antibiotic administration incorrectly. The trimethoprim-sulfamethoxazole should be administered twice daily for 3 consecutive days each week to prevent Pneumocystis pneumoniae. The parents understand to avoid rectal temperatures and crowds, and to maintain his hygiene meticulously.

The parents bring their 4-year-old son to the emergency department. The child is receiving chemotherapy for acute lymphoblastic leukemia. The parents report that the child has become lethargic and has had significant episodes of vomiting and diarrhea. What findings would lead the nurse to suspect the child may be experiencing tumor lysis syndrome? Select all that apply A. Hyperkalemia B. Hypophosphatemia C. Polyuria D. Hypocalcemia E. Hyperuricemia

A. Hyperkalemia D. Hypocalcemia E. Hyperuricemia Rationale: Tumor lysis syndrome is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, decreased or absent urine output, and hypocalcemia

The nurse is caring for a school-age child with tinea capitis. The child has open lesions from the disease and has lost hair in the areas affected. Which nursing diagnoses would be a part of this client's care plan? Select all that apply A. Impaired skin integrity B. Risk for infection C. Disturbed body image D. Bathing, self-care deficit E. Altered nutrition

A. Impaired skin integrity B. Risk for infection C. Disturbed body image Rationale: Tinea is a fungal disease of the skin occurring on any part of the body, in this case the head (scalp, eyebrows, or eyelashes). Since this child has open lesions and hair loss from affected areas, there is impairment of skin integrity (which makes the areas at risk for infection). Body image is disturbed since the hair loss is visible. There is no indication of bathing deficit or altered nutrition

The nurse is caring for a 13-year-old boy with acute myelogenous leukemia who is experiencing feelings of powerlessness due to the effects of chemotherapy. What intervention will best help the teen's sense of control? A. Involving the boy in decisions whenever possible B. Acknowledging the boy's feelings of anger with the disease C. Providing realistic expectations of treatment and outcomes D. Recognizing abilities that are unaffected by the disease

A. Involving the boy in decisions whenever possible Rationale: Involving the boy in the decision-making process will best help his sense of control. Whether he is included in important decisions about therapy or minor decisions like menus or dress, it will give him a sense of control over his situation. Acknowledging feelings of anger, recognizing his abilities, and providing realistic expectations will reduce body image disturbance and build self-esteem

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? A. On her side with the head flexed forward and knees flexed to the abdomen B. Sitting upright with the head flexed forward to the chest C. Supine with arms and legs pronated and extended. D. Prone with the arms flexed under the chest

A. On her side with head flexed forward and knees flexed to the abdomen Rationale: When a lumbar puncture is performed on a child, the child is placed on his or her side with the head flexed forward and knees flexed to the abdomen. An infant would be positioned sitting upright with the head flexed forward. A supine position with the arms and legs pronated and extended suggests decerebrate posturing. A prone position is not used for a lumbar puncture.

The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "sometimes, it seems like it just burst out of his mouth". A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find? A. Sausage-shaped mass in the upper mid abdomen B. Hard, moveable, olive-shaped mass in the right upper quadrant C. Tenderness over the McBurney point in the right lower quadrant D. Abdominal pain in the epigastric or umbilical region

B. Hard, moveable, olive-shaped mass in the right upper

The parents of a boy diagnosed with Hirschsprung disease are anxious and fearful of the upcoming surgery. The mother states, "I'm worried about having to care for our son's ostomy." Which intervention would be most helpful for the parents? A. Explaining to them about the diagnosis and surgery B. Having a wound, ostomy, and continence nurse meet with them C. Reinforcing that the ostomy will be temporary D. Teaching them about the medications used to slow stool output

B. Having a wound, ostomy, and continence nurse meet with them

A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful? A) "The tubes will stay in place for about a month and then fall out on their own." B) "His chances for ear infections now have dramatically decreased." C) "He should wear earplugs when swimming in a pool or a lake." D) "We should keep the ears protected with cotton balls for the first 24 hours."

C. "He should wear earplugs when swimming in a pool or a lake". Rationale: When pressure-equalizing tubes are inserted, the surgeon may recommend avoiding water entry into the ears. Therefore, earplugs are suggested when the child is in the bathtub or swimming.

A child is receiving methotrexate as part of his chemotherapy protocol. The nurse would anticipate administering which agent to counteract the toxic effects of methotrexate? A. Mesna B. Cyclosporine C. Leucovorin D. Nystatin

C. Leucovorin Rationale: Leucovorin is given as an antidote to methotrexate to reduce its toxic effects. Mesna is given when cyclophosphamide and ifosfamide are used to prevent hemorrhagic cystitis. Cyclosporine is an immunosuppressant used to treat graft-versus-host disease after hematopoietic stem cell transplant. Nystatin is used to treat mucositis or systemic fungal infection

After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful? A. Infants with congenital deformities have an increased risk for ear infection B. Ear infection typically increase as the child gets older C. The shorter and wider Eustachian tubes of an infant increase the risk D. Adenoids shrink as the child grows, allowing more bacteria to enter

C. The shorter and wider Eustachian tubes of an infant increase the risk Rationale: The infant has relatively short, wide, horizontally placed Eustachian tubes, allowing bacteria and viruses to gain access to the middle ear and resulting in an increased number of infections as compared to adults.

The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge? A. "I can't believe it. We're not unclean, poor people". B. "We'll have to get that special shampoo". C. "Everybody in the house will need to be checked". D. "That explains his complaints of itching on his neck".

A. "I can't believe it. We're not unclean, poor people". Rationale: Head lice is not an indication of poor hygiene or poverty. It occurs in all socioeconomic groups. Thus, the parents' statement about being unclean and poor reflects a lack of knowledge about the infection. A pediculicide is used to was the hair to treat the infestation. Household contacts need to be examined and treated if affected. Extreme pruritus is the most common symptom, with nits or lice especially behind the ears or at the nape of the neck.

The nurse is reviewing the laboratory test results of a child who is receiving chemotherapy. To calculate the child's absolute neutrophil count, in addition to the total number of white blood cells, which results would the nurse use? Select all that apply. A. Bands B. Segs C. Eosinophils D. Basophils

A. Bands B. Segs Rationale: To calculate the absolute neutrophil count, the nurse would add together the percentage of banded and segmented neutrophils and then multiply the total number of white blood cells reported on the complete blood count by the sum

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states " I had a sinus infection and sore throat a couple of days ago". The nurse suspects bacterial meningitis based on which findings? Select all that apply. A. Complaints of stiff neck B. Photophobia C. Absent headache D. Negative brudzinki sign E. Vomiting

A. Complaints of stiff neck B. Photophobia E. Vomiting Rationale: In addition to the adolescent's complaints and history, other finding suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive brudzinski sign, and vomiting.

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: A. Streptococcus group B B. Haemophilus influenzae type B C. Streptococcus pneumoniae D. Neisseria meningitidis What would the nurse highlight as the most common cause of meningitis in newborns?

A. Streptococcus group B Rationale: Meningitis due to strep group B along with Ecoli is the most common in newborns and infants. HIB is a common cause in infants between the ages of 6 to 9 months. S. Pneumoniae and N. Meningitides are common causes in children older than 3 months and in adults.

A nurse is instituting neutropenic precautions for a child. What information would the nurse most likely include? Select all that apply A. Placing the child in a semiprivate room B. Avoiding rectal exams, suppositories, and enemas C. Placing mask on the child outside the room D. Encouraging an intake of raw fruits and vegetables E. Discouraging fresh flowers in the child's room

B. Avoiding rectal, suppositories, and enemas C. Placing mask on the child outside the room E. Discouraging fresh flowers in the child's room Rationale: Generally, neutropenic precautions include placing the child in a private room; avoiding rectal suppositories, enemas, and examinations; placing a mask on the child when outside the room; avoiding the intake of raw fruits and vegetables; and not permitting fresh flowers or live plants in the room.

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority? A. Applying EMLA to the lumbar puncture site B. Educating the child and family about the testing procedures C. Administering promethazine as ordered for nausea D. Educating the family about chemotherapy and its side effects

B. Educating the child and family about the testing procedures Rationale: The priority would be educating the child and family about the testing procedures, so they know what to expect and understand why the tests are being performed. Applying EMLA to the lumbar puncture site will be done prior to the procedure. The family will be educated about chemotherapy and its side effects prior to the therapy beginning, and promethazine or other antiemetics will be administered once chemotherapy has begun

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 Rationale: 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 nurse is examining a 3-year-old boy with acute otitis media who has a mild earache and a temperature of 38.5°C. Which action will be taken. A. Obtain a culture of the middle ear fluid B. Instruct the parents to watch for worsening symptoms C. Administer antibiotics D. Administer antivirals

B. Instruct the parents to watch for worsening symptoms Rationale: In this case, the child will be continually observed. If the symptoms persist or become worse, antibiotics will be prescribed. This clinical practice guideline was developed by the American academy of pediatrics and the American academy of family physicians in order to avoid overusing antibiotics or obtaining a middle ear fluid culture with every occurrence of acute otitis media. Administering antiviral agents would not be appropriate for this child.

The nurse is describing the phases of treatment to a child who was diagnosed with leukemia and his parents. How would the nurse describe the induction stage? A. Intense therapy to strengthen remission B. Rapid promotion of complete remission C. Elimination of all residual leukemic cells D. Reduction of risk for central nervous system (CNS) disease

B. Rapid promotion of complete remission Rationale: Induction is done to rapidly produce a complete remission. Consolidation or intensification is the stage when remission is strengthened, and leukemic cell burden is reduced. Maintenance attempts to eliminate all residual leukemic cells, and CNS prophylaxis is the stage that attempts to reduce the development of CNS disease.

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma? A. The child has a maculopapular rash on his palms B. The parents report that their son is vomiting and not eating well C. The parents report that their son is irritable and not gaining weight D. Auscultation reveals wheezing with diminished lung sounds.

B. The parents report that their son is vomiting and not eating well. Rationale: Along with the swollen abdomen on one side, the parents reporting that the child is vomiting and anorexic points to the possibility of a neuroblastoma. Observing a maculopapular rash on the child's palms is a sign of graft-versus-host disease. The parents reporting that the child is irritable and not gaining weight suggests a possible brain tumor as well as malabsorption problems. Auscultation revealing wheezing with diminished lung sounds would suggest other problems, not a neuroblastoma.

The nurse is providing education to the parents of a child diagnosed with pinworms. Which statement is most important for the nurse to include in the teaching? A."Seal the child's clothing in a plastic bag for at least 10 days". B. "Be sure your child wears shoes at all times". C. "Make sure your child washes hand before eating food". D. After applying this special cream, leave it on for about 8 to 10 hours.

C. "Make sure your child washes hand before eating food". Rationale: The most effective measure to prevent pinworms or a recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.

The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool. The nurse would most likely document the stool's appearance as having what quality? A. Greasy B. Clay-colored C. Currant jelly-like D. Bloody

C. Currant jelly-like Rationale: The child with intussusception often exhibits currant jelly-like stools that may or may not be positive for blood.

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 Rationale: 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.

Which test result would the nurse least likely expect to find in a child diagnosed with Wilms tumor? A. Complete blood count (CBC) with normal limits B. Urinalysis positive for blood C. Mass on kidney D. Elevated homovanillic acid (HVA) with 24hr urine collection

D. Elevated HVA with 24hr urine collection Rationale: Levels of HVA and vanillylmandelic acid (VMA) will not be elevated with Wilms tumor; they are elevated with neuroblastoma. CBC, blood urea nitrogen (BUN), and creatinine usually are within normal limits. Urinalysis may reveal hematuria or leukocytes. Renal or abdominal ultrasound would reveal a mass on the kidney.

The nurse is caring for a 16-year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which is the priority nursing diagnosis? A. pain related to adverse effects of treatment verbalized by the child. B. nausea related to side effects of chemotherapy verbalized by the child. C. Constipation related to the use of opioid analgesics for pain D. Risk for infection related to neutropenia and immunosuppression

D. Risk for infection related to neutropenia and immunosuppression Rationale: The priority nursing diagnosis is risk for infection related to neutropenia and immunosuppression. The incomplete records for varicella zoster immunization can cause a problem since exposure to chickenpox could cause sepsis, so the nurse should contact the oncologist for approval to administer the vaccine. Certain vaccines are not administered when the child is immunosuppressed, so timing is crucial. Diagnoses for pain and nausea are valid for this child because he is undergoing chemotherapy, but they are not a priority. Likewise, the need for constipation management would not be necessary unless opioid use begins

A 16-year-old boy reports to the school nurse with headaches and a stiff neck. Which sign or symptom would alert the nurse that the child may have bacterial meningitis? A. Fixed and dilated pupils B. Frequent urination C. Sunset eyes D. Sunlight is "too bright"

D. Sunlight is "too bright" Rationale: Photophobia, or intolerance of light, is another symptom of bacterial meningitis. Fixed and dialed pupils are a symptom of head trauma and warrant prompt intervention. Frequent urinating is a symptom of type I Arnold-chairing malformation. Sunset eyes indicate increased intracranial pressure typical of hydrocephalus.