Peds test 2

A nurse evaluates the results of diagnostic tests on a client's cerebrospinal fluid (CSF). Which fluid results alerts the nurse to possible VIRAL meningitis? (Select all that apply.) a. Clear b. Cloudy c. Increased protein level d. Normal glucose level e. Bacterial organisms presentf. Increased white blood cells

A, C, D

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests: a. diabetic coma. b. brainstem injury. c. upper respiratory tract infection. d. leaking of cerebrospinal fluid (CSF).

D

Mucus and edema obstruct narrow airways

D

Parents have understood teaching about prevention of childhood otitis media if they make which statement? a."We will only prop the bottle during the daytime feedings." b."Breastfeeding will be discontinued after 4 months of age." c."We will place the child flat right after feedings." d."We will be sure to keep immunizations up to date."

D

The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching? a."My child will have an allergic reaction if he comes in contact with yeast products." b."My child may have an upset stomach if he eats a food made with wheat or barley." c."My child will probably develop an allergy to peanuts." d."My child should not eat bananas or kiwis."

D

Excessive vomiting can result in metabolic acidosis

False, metabolic alkalosis

For otitis media, it is acceptable to only give a portion of the antibiotic prescription because the medication is so expensive

NO the full prescription should be taken as drug resistance is much more expensive to treat and a ruptured ear drum decreases the amount of pain and can result in hearing loss.

A sweat chloride test is used to diagnose cystic fibrosis. (>60 mEq / L)

True

For a child with appendicitis, a sudden decrease in pain can indicate perforation or rupture putting the child at risk for peritonitis.

True

Cardiopulmonary resuscitation is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible? a.Radial b.Carotid c.Femoral d.Brachial

B

β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action? a.Liquefy secretions b.Dilate the bronchioles c.Reduce inflammation of the lungs d.Reduce infection

B

A Myelomeningocele should be covered with a sterile, moist, non-adherent dressing until surgery can be performed.

true

A child has been bitten by a raccoon in the woods. Cleansing of the wound and Antirabies prophylaxis needs to be given (HRIG - human rabies immunoglobulin and the rabies vaccine)

true

Careful handwashing can prevent Hepatitis A in daycares and school settings (Fecal- oral transmission or contaminated food / water

true

Dehydration can result in delayed skin turgor, sunken fontanel, lethargy and tachycardia

true

Folic acid supplements for all women of child bearing age is recommended to prevent neural tube deficits.

true

For a child with constipation, the following foods would be high in fiber; raw apples, raw grapes, raw carrots, bran pancakes, whole grain breads.

true

For a child with spastic cerebral palsy, there is an intrathecal pump that be inserted and can deliver medicine to decrease spasticity (Baclofen (Lioresal)

true

Slowed growth should be investigated in a child with long term inhaled corticosteroid use to treat asthma

true

Spastic cerebral palsy is characterized by hypertonicity as well as poor control of balance, posture and coordinated movement.

true

Vaccinations for Haemophilus influenza B have dramatically decreased the incidence of meningitis.

true

Spastic cerebral palsy is characterized by: a.Hypertonicity and poor control of posture, balance, and coordinated motion. b.Athetosis and dystonic movements. c.Wide-based gait and poor performance of rapid, repetitive movements. d.Tremors and lack of active movement.

A

The most common problem of children born with a myelomeningocele is: a.Neurogenic bladder. b.Intellectual impairment. c.Respiratory compromise. d.Cranioschisis.

A

Which problem is most often associated with myelomeningocele? a.Hydrocephalus b.Craniosynostosis c.Biliary atresia d.Esophageal atresia

A

Which information should the nurse teach families about reducing exposure to pollens and dust (Select all that apply)? a.Replace wall-to-wall carpeting with wood and tile floors. b.Use an air conditioner. c.Put dust-proof covers on pillows and mattresses. d.Keep humidity in the house above 60%. e.Keep pets outside.

A, B, C

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which of the following interventions should be included in the child's postoperative care? (Select all that apply.) a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output.f. Monitor for abdominal distention.

A, E, F

A neonate born with myelomengocele is scheduled for surgery tomorrow. Proper positioning and feeding include, prone position, turning the infant's head to the side and bottle feeding

True

Beta-adrenergic agonists and methylxanthines work to dilate bronchioles.

True

For a child diagnosed with BACTERIAL meningitis, cerebrospinal fluid would show increased white blood cells, decreased glucose (bacterial eating the glucose), increased protein (bacteria), and a cloudy color.

True

If a child comes into the hospital with severe dehydration, the health care team will start with IV rehydration fluids and then progress to oral rehydration fluids once the child is stable

True

Oral rehydration solutions (such as pedialyte) are first line treatment for diarrhea in children. Clear liquids have too much sugar

True

The diet for a cystic fibrosis child should be high in protein and carbohydrates.

True

To reduce pollen and dust, carpets should be replaced by wood, tile or linoleum flooring, dust-proof covers should be applied to pillows and mattresses, air conditioners should be used and humidity should be kept less than 60%

True

An unconscious child is draining clear fluid from their nares after a motor vehicle accident. The drainage tests positive for glucose.

True, It is cerebrospinal fluid.

A child has been seizure free for 2 years. The parent asks when the anti-seizure medications can be stopped. A stepwise approach to gradually reducing the medications is recommended to gradually reduce doses.

true

A child has head trauma and multiple fractures with variable levels of consciousness. Pain management should be discussed with practitioners to assure neurologic status is not compromised and pain is managed.

true

A stool specimen is taken from a child with diarrhea. Neutrophils and red blood cells indicate gastroenteritis. Parasitic infections are seen with increased eosinophils

true

A young boy has just been diagnosed with Duchenne's (pseudohypertrophic) muscular dystrophy. Genetic counseling is important as it is an X-linked recessive disorder.

true

An infant has Respiratory Synctial Virus (RSV) and should be encouraged to drink 8oz of formula every 4 hours, be placed on noninvasive oxygen monitoring, and care should be clustered to encourage the infant to rest.

true

An infant has hydrocephalus and has a ventriculoperitoneal shunt surgically placed. Post operatively, the nurse would be assessing for abdominal distention, intake and output, and signs and symptoms of infection

true

Antidiarrheal (which decrease GI motility) medications should be given to a child with diarrhea. NO- determine cause and treat. Infectious diarrhea will get worse if the organism stays longer in the body.

true

Children with fevers may have increase fluid needs

true

Children with latex allergies should avoid bananas, avocados, chestnuts and kiwi as there are allergic cross-reactions.Children with latex allergies should avoid bananas, avocados, chestnuts and kiwi as there are allergic cross-reactions.

true

Clinical manifestations of increased intracranial pressure in an infant include a high pitched cry, elevated fontanel, drowsiness, irritability, dilated scalp veins, and bradycardia.

true

Coughing, sneezing and straining to have a bowel movement all increase intracranial pressure.

true

Hydrocephalus is a common anomaly seen with myelomeningocele (80-90 % incidence)

true

Increased PCO2 causes vasodilation which increases intracranial pressure.

true

Magnesium sulfate may be given to an asthmatic in crisis who is not responding to other treatments.

true

Myelomeningocele is a visible external defect with a protruding sac filled with meninges, spinal fluid and nerves.

true

Neurogenic bladder is a common problem for children born with myelomeningocele.

true

Overhydration can result in respiratory crackles, weight gain and edema.

true

Pancreatic enzymes for a child with cystic fibrosis should be given whole or sprinkled on food before meals or snacks

true

Prevention of otitis media is supported by current immunizations for the child, breastfeeding until the infant is at least 6 months of age and Keeping the child upright before and immediately after feedings.

true

Who would the nurse see first? a.A toddler with a persistent vegetative state and a low grade fever b.An adolescent after a motor vehicle accident who is oriented to person and place c.A preschooler with a head injury and decreasing level of consciousness* d.A school- aged child in a coma with stable vital signs

C

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber (Select all that apply)? a.White rice b.Avocados c.Whole grain breads d.Bran pancakes e.Raw carrots

C, D, E

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care (Select all that apply)? a.Administer antibiotics. b.Administer cough syrup. c.Encourage infant to drink 8 ounces of formula every 4 hours. d.Institute cluster care to encourage adequate rest. e.Place on noninvasive oxygen monitoring.

C, D, E

Which of the following is a clinical manifestation of increased intracranial pressure (ICP) in infants? (Select all that apply.) a. Low-pitched cry b. Sunken fontanel c. Diplopia and blurred vision d. Irritability e. Distended scalp veinsf. Increased blood pressure

C, D, E

The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn's defect? a.Fissure in the spinal column that leaves the meninges and the spinal cord exposed b.Herniation of the brain and meninges through a defect in the skull c.Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements d.Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

D

The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on knowing that: a.Anticonvulsant medications are sometimes useful for controlling spasticity. b.Medications that would be useful in reducing spasticity are too toxic for use with children. c.Many different medications can be highly effective in controlling spasticity. d.Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

D

Which type of dehydration results from water loss in excess of electrolyte loss? a.Isotonic dehydration b.Isosmotic dehydration c.Hypotonic dehydration d.Hypertonic dehydration

D

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? a.They have a widened, shorter airway. b.There is a defect in their sucking ability. c.The gag reflex increases mucus production. d.Mucus and edema obstruct small airways.

D

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is which of the following? a. Discuss with parents the child's previous experiences with pain. b. Discuss with practitioner what analgesia can be safely administered. c. Explain that analgesia is contraindicated with a head injury. d. Explain that analgesia is unnecessary when child is not fully awake and alert.

B

An infant is brought to the emergency department with poor skin turgor, weight loss, lethargy, and tachycardia. This is suggestive of: a.Overhydration. b.Dehydration. c.Sodium excess. d.Calcium excess.

B

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him: a.Prone and tube feed. b.Prone, turn head to side, and nipple feed. c.Supine in infant carrier and nipple feed. d.Supine, with defect supported with rolled blankets, and nipple feed.

B

The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac? a.Open to air b.Covered with a sterile, moist, nonadherent dressing c.Reinforcement of the original dressing if drainage noted d.A diaper secured over the dressing

B

Which of the following should the nurse see first? a.An infant with RSV who has coarse breath sounds and oxygen saturation of 95% b.A lethargic toddler with minimal air movement, grunting and use of accessory muscles to breathe. c.A school aged child with pneumonia who is coughing and deep breathing using the incentive spirometer d.An adolescent who overdosed, had naloxone (Narcan) and is breathing 18 breaths per minute and alert

B

A young child's parents call the nurse after their child was bitten by a raccoon in the woods. The nurse's recommendation should be based on which of the following? a. Child should be hospitalized for close observation. b. No treatment is necessary if thorough wound cleaning is done. c. Antirabies prophylaxis must be initiated. d. Antirabies prophylaxis must be initiated if clinical manifestations appear.

C

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because they may develop: a.Cough. b.Osteoporosis. c.Slowed growth. d.Cushing's syndrome.

C

When caring for a child with probable appendicitis, the nurse should be alert to recognize that a sign of perforation is: a.Bradycardia. b.Anorexia. c.Sudden relief from pain. d.Decreased abdominal distention.

C

A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurse's response should be based on knowledge that this drug is: a.Not indicated. b.Indicated because it slows intestinal motility. c.Indicated because it decreases diarrhea. d.Indicated because it decreases fluid and electrolyte losses.

A

A young boy has just been diagnosed with pseudohypertrophic (Duchenne's) muscular dystrophy. The management plan should include: a.Recommending genetic counseling. b.Explaining that the disease is easily treated. c.Suggesting ways to limit the use of muscles. d.Assisting the family in finding a nursing facility to provide his care.

A

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child will begin with: a.Intravenous fluids. b.Oral rehydration solution (ORS). c.Clear liquids, 1 to 2 ounces at a time. d.Administration of antidiarrheal medication.

A

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a."I should administer all the prescribed medication." b."I should continue medication until the symptoms subside." c."I will immediately stop giving medication if I notice a change in hearing." d."I will stop giving medication if fever is still present in 24 hours."

A

An infant's parents ask the nurse about preventing otitis media (OM). What should the nurse recommend? a.Avoid tobacco smoke. b.Use nasal decongestant. c.Avoid children with OM. d.Bottle-feed or breastfeed in supine position.

A

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a.Diet should be high in carbohydrates and protein. b.Diet should be high in easily digested carbohydrates and fats. c.Most fruits and vegetables are not well tolerated. d.Fats and proteins must be greatly curtailed.

A

Nurses must be alert for increased fluid requirements when a child has: a.Fever. b.Mechanical ventilation. c.Congestive heart failure. d.Increased intracranial pressure (ICP).

A

A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which of the following in the response? a.Medications can be discontinued at this time. b.The child will need to take the drugs for 5 years after the last seizure. c.A step-wise approach will be used to reduce the dosage gradually. d.Seizure disorders are a life-long problem. Medications cannot be discontinued.

C

A current recommendation to prevent neural tube defects is the supplementation of: a.Vitamin A throughout pregnancy. b.Multivitamin preparations as soon as pregnancy is suspected. c.Folic acid for all women of childbearing age. d.Folic acid during the first and second trimesters of pregnancy.

C

A child has a generalized seizure in a classroom. The following nursing actions are prioritized from highest to lowest priority:

Ease the child to the floor, Turn the child to their side, Take vital signs, Allow the child to rest, Integrate the child back into the school environment

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which condition? a.Protein intolerance b.Parasitic infection c.Fat malabsorption d.Bacterial gastroenteritis

D

An infant with pyloric stenosis experiences excessive vomiting that can result in: a.Hyperchloremia. b.Hypernatremia. c.Metabolic acidosis. d.Metabolic alkalosis.

D

Careful hand washing before and after contact can prevent the spread of which condition in day care and school settings? a.Irritable bowel syndrome b.Ulcerative colitis c.Hepatic cirrhosis d.Hepatitis A

D

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a.Bronchoscopy b.Serum calcium c.Urine creatinine d.Sweat chloride test

D

Pancreatic enzymes are administered to the child with CF. Nursing considerations should include which of the following? a.Do not administer pancreatic enzymes if child is receiving antibiotics. b.Decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c.Administer pancreatic enzymes between meals if at all possible. d.Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

D

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on which of the following? a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children.

D