PEDs Test 4 Practice Questions

The nurse is assessing the neurovascular status of a child in Russell's traction. Which finding should the nurse report to the healthcare provider?

Pale bluish coloration of the toes Rationale: Russell's skin traction is used for fractures of the femur in young children and adolescents whose growth plates remain open and is applied to the lower leg using moleskin and elastic wrap bandages, which can compress the peroneal nerve and arteries that supply the foot. Assessment of adequate circulation, movement, and sensation of the toes and skin distal to the application is made to identify compromised blood flow, so cyanosis of the toes should be reported immediately.

The nurse is assessing a 13-year-old girl with suspected hyperthyroidism. Which question is most important for the nurse to ask her during the admission interview?

"Are you experiencing any type of nervousness?" Rationale:Assessing the client's psychophysiologic state upon admission is a priority, and nervousness, apprehension, hyperexcitability, and palpitations are signs of hyperthyroidism. Weight loss (even with a hearty appetite) occurs in those with hyperthyroidism, but assessing the client's neurological state has a higher priority.

A 12-year-old male client tells the nurse that he is happy to be taking growth hormones because now he can expect to grow and be just as tall as all of his friends. What response is best for the nurse to provide?

"Being taller is important to you and taking your injections will help achieve that goal." Rationale: It is important to validate his feelings and reinforce the fact that injections are the only way he can get the medication and achieve growth in height. He will have to take injections three times a week for years.

The nurse is giving preoperative instructions to a 14-year-old female client who is scheduled for surgery to correct a spinal curvature. Which statement by the client best demonstrates that learning has taken place?

"I understand that I will be in a body cast and I will show you how you taught me to turn." Rationale:Outcome of learning is best demonstrated when the client not only verbalizes an understanding, but can also provide a correct return demonstration.

The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply. 1. Time the seizure. 2. Restrain the child. 3. Stay with the child. 4. Place the child in a prone position. 5. Move furniture away from the child. 6. Insert a padded tongue blade in the child's mouth

1. Time the seizure. 3. Stay with the child 5. Move furniture away from the child.

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? 1. Test the urine for protein. 2. Reposition the infant frequently. 3. Provide a stimulating environment. 4. Assess blood pressure every 15 minutes.

2. Reposition the infant frequently.

A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? 1. Eat twice the amount normally eaten at lunchtime. 2. Take half the amount of prescribed insulin on practice days. 3. Take the prescribed insulin at noontime rather than in the morning. 4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.

4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.

An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? 1. Sweating and tremors 2. Hunger and hypertension 3. Cold, clammy skin and irritability 4. Fruity breath odor and decreasing level of consciousness

4. Fruity breath odor and decreasing level of consciousness

A child is diagnosed with Reye's syndrome. The nurse creates a nursing care plan for the child and should include which intervention in the plan? 1. Assessing hearing loss 2. Monitoring urine output 3. Changing body position every 2 hours 4. Providing a quiet atmosphere with dimmed lighting

4. Providing a quiet atmosphere with dimmed lighting

The nurse is caring for a female client with scoliosis who has a posterior spinal fusion and is in a body jacket cast. Which assessment finding indicated to the nurse the client is developing cast syndrome?

Abdominal distension Rationale: Case syndrome occurs when the cast is applied too tightly and is compressing the superior mesenteric artery against the duodenum

The nurse is caring for a 12-year-old with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication?

Changes in level of consciousness. Rationale:The child must be monitored for signs and symptoms of hyponatremia, which creates secondary central nervous system alterations such as changes in level of consciousness, seizure, and coma.

When taking the health history of a child, the nurse knows that which finding is an early indication of hypothyroidism in children?

Cessation of growth in a child that had been normal. Rationale:Since the thyroid gland is responsible for metabolism, cessation of growth which was previously within normal range, is the most common sign for hypothyroidism in children.

An infant with developmental dysplasia of the hip is placed in a Pavlik harness. What instructions should the nurse include in a teaching plan for the parents?

Check for red areas under the straps three times a day. Rationale: The Pavlik harness, which maintains the hips in abduction, is the most widely used device for developmental dysplasia of the hip. An infant who continuously wears a Pavlik harness is at risk for skin breakdown, so parents should be instructed to check two to three times a day for red areas under clothing and harness straps. To avoid direct contact with the skin, clothing and diapers should be placed under the straps.

The mother of a preschool-aged child asks the nurse if it is all right to administer bismuth subsalicylate (Pepto Bismol, Bismylate) to her son when he "has a tummy ache." After reminding the mother to check the label of all over-the-counter drugs for the presence of aspirin, which instruction should the nurse include when replying to this mother's question?

Do not give if the child has chickenpox, the flu, or any other viral illness. Rationale: Pepto Bismol, Bismylate contains subsalicylate and if used in the presence of a viral illness, there is the potential of developing Reye's syndrome, a sometimes fatal condition for children.

The nurse is assessing the coping behaviors of the parents whose child has been recently diagnosed with a chronic illness. What reaction by the parents is a positive step in the ability to cope with this new situation?

Endowing the illness with meaning. Rationale: Coping mechanisms are behaviors directed at reducing the tension elicited by a crisis. Approach behaviors are coping mechanisms resulting in movement toward adjustment and resolution of the crisis. The parents' ability to assign the illness meaning within an existing medical, scientific, or spiritual philosophy of life is a long-term coping strategy significantly related to successful family functioning

Which neurological test should the nurse implement to assess cerebellar function in a 5-year-old with symptoms of hyperactivity?

Finger-to-nose. Rationale: The cerebellum controls balance and coordination and is significant in children with symptoms of hyperactivity or learning difficulty, so difficulty in performing a "finger-to-nose" test indicates poor sense of position (especially with the eyes closed) and incoordination (especially with the eyes opened).

The nurse is teaching a 12-year-old male adolescent and his family about taking injections of growth hormone for idiopathic hypopituitarism. Which adverse symptoms, commonly associated with growth hormone therapy, should the nurse plan to describe to the child and his family?

Polyuria and polydipsia. Rationale:Signs and symptoms of diabetes or hyperglycemia need to be reported. Clients who are receiving growth hormones should be monitored to detect elevated blood sugars and glucose intolerance.

The nurse is assessing a child for neurological "soft" signs. Which finding is most likely demonstrated in the child's behavior?

Poor coordination and sense of position Rationale: there is a gray area in neurologic assessment known as "soft signs", which are findings that are normal in a young child but disappear in the normal course of maturation.

The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect? 1. Meningitis 2. Spinal cord injury 3. Intracranial bleeding 4. Decreased cerebral blood flow

1. Meningitis

The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? Select all that apply. 1. Use the fingertips to lift the cast while it is drying. 2. Keep small toys and sharp objects away from the cast. 3. Use a padded ruler or another padded object to scratch the skin under the cast if it itches. 4. Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold. 5. Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling. 6. Contact the health care provider (HCP) if the child complains of numbness or tingling in the extremity

2. Keep small toys and sharp objects away from the cast. 5. Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling. 6. Contact the health care provider (HCP) if the child complains of numbness or tingling in the extremity

Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? 1. "Treatment needs to be started as soon as possible." 2. "I realize my infant will require follow-up care until fully grown." 3. "I need to bring my infant back to the clinic in 1 month for a new cast." 4. "I need to come to the clinic everyweek with my infant for the casting."

3. "I need to bring my infant back to the clinic in 1 month for a new cast."

The parents of a child recently diagnosed with cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophysiological process? 1. An infectiousdiseaseofthe centralnervoussystem 2. An inflammation of the brain as a result of a viral illness 3. A chronic disability characterized by impaired muscle movement and posture 4. A congenital condition that results in moderate to severe intellectual disabilities

3. A chronic disability characterized by impaired muscle movement and posture

A mother arrives at the emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia

4. Bradycardia

The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside? 1. Emergency cart 2. Tracheotomy set 3. Padded tongue blade 4. Suctioning equipment and oxygen

4. Suctioning equipment and oxygen

An 8-year-old boy who is recently diagnosed with diabetes mellitus is admitted to the intensive care unit with diabetic ketoacidosis (DKA). Which nursing action has the highest priority?

Initiate an intravenous infusion. Rationale: The priority for a child with DKA, an emergency life-threatening situation, is to obtain venous access for administration of fluids, electrolytes, and insulin. The child should be placed on a cardiac monitor and have serum electrolytes and glucose levels obtained, but not before initiating venous access.

A 4-year-old boy was admitted to the emergency room with a fractured right ulna and a short arm cast was applied. When preparing the parents to take the child home, which discharge instruction has the highest priority?

"Call the healthcare provider immediately if his nail beds appear blue." Rationale:Cyanosis indicates impaired circulation to fingers and should be reported immediately.

A 4-year-old child sustains a fall at home. After an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast.Which statement by the parents indicates a need for further instruction? 1. "The cast may feel warm as the cast dries." 2. "I can use lotion or powder around the cast edges to relieve itching." 3. "Asmall amount ofwhite shoe polish can touch up a soiled white cast." 4. "If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast."

2. "I can use lotion or powder around the cast edges to relieve itching."

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? 1. Clear CSF, decreased pressure, and elevated protein level 2. Clear CSF, elevated protein, and decreased glucose levels 3. Cloudy CSF, elevated protein, and decreased glucose levels 4. Cloudy CSF, decreased protein, and decreased glucose levels

3. Cloudy CSF, elevated protein, and decreased glucose levels

The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? 1. Hold the next dose of insulin. 2. Come to the clinic immediately. 3. Encourage the child to drink liquids. 4. Administer an additional dose of regular insulin

3. Encourage the child to drink liquids

The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellituswho has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply. 1. Administer regular insulin. 2. Encourage the child to ambulate. 3. Give the child a teaspoon of honey. 4. Provide electrolyte replacement therapy intravenously. 5. Wait 30 minutes and confirm the blood glucose reading. 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs

3. Give the child a teaspoon of honey. 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs

The nurse is assigned to care for an 8-year-old child with a diagnosis of a basilar skull fracture. The nurse reviews the health care provider's (HCP's) prescriptions and should contact the HCP to question which prescription? 1. Obtain daily weight. 2. Provide clear liquid intake. 3. Nasotracheal suction as needed. 4. Maintain a patent intravenous line.

3. Nasotracheal suction as needed.

A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention? 1. Ensure that all ropes are outside the pulleys. 2. Ensure that the weights are resting lightly on the floor. 3. Restrict diversional and play activities until the child is out of traction. 4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied

4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care? 1. Maintain enteric precautions. 2. Maintain neutropenic precautions. 3. No precautions are required as long as antibiotics have been started. 4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.

4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.

In developing a teaching plan for a 5-year-old child with diabetes, which component of diabetic management should the nurse plan for the child to manage first?

Process of glucose testing. Rationale:Developmentally, a 5-year-old has the cognitive and psychomotor skills to use a glucometer and to read the number (it is especially helpful if the nurse presents this activity as a game).

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? 1. "Iwill encouragemy child to perform prescribed exercises." 2. "I will have my child wear soft fabric clothing under the brace." 3. "I should apply lotion under the brace to prevent skin breakdown." 4. "I should avoid the use of powder because it will cake under the brace."

3. "I should apply lotion under the brace to prevent skin breakdown."

A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? 1. Potassium infusion 2. NPH insulin infusion 3. 5% dextrose infusion 4. Normal saline infusion

4. Normal saline infusion

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. Administer an analgesic. 2. Release the skin traction. 3. Apply ice to the extremity. 4. Notify the health care provider (HCP).

4. Notify the health care provider (HCP).

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 1. Administer an antiemetic. 2. Increase the intravenous fluids. 3. Place the child in a Sims' position. 4. Notify the health care provider (HCP).

4. Notify the health care provider (HCP).

A 14-year-old is brought to the emergency room after a biking accident. How should the nurse interact with the adolescent?

Provide clear explanations while encouraging questions Rationale: adolescents are capable of abstract thinking and understand explanations, so the opportunity to ask questions should be provided

A 14-year-old returns to the pediatric unit after corrective surgery for scoliosis. In the immediate postoperative period, the nurse should include which action(s) in this client's plan of care? (Select all that apply.)

1. Assess bowel sounds every 4 hours. 2. Initiate a logrolling schedule every 2 hours. 3. Give morphine sulfate 2 mg IV every 4 hours PRN. Rationale: Recording intake and output and assessing bowel sounds are critical when determining if the body systems are recovering from the effects of anesthesia. Turning the client using a logrolling technique maintains spinal alignment postoperatively and prevents complications of immobility. Since this is a painful surgery, the nurse should maintain pain control as prescribed. The pain associated is not just due to the incisions of surgery, but due to the manipulation and placement of the spinal hardware and possible muscular pain as the involved muscles adjust to the corrective realignment of the spine. Following corrective surgery for scoliosis, a client should be immobilized without spinal flexion for 24 to 48 hours, and then ambulated by the physical therapist.

The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing? 1. Flaccid paralysis of all extremities 2. Adduction of the arms at the shoulders 3. Rigid extension and pronation of the arms and legs 4. Abnormal flexion of the upper extremities and extension and adduction of the lower extremities

3. Rigid extension and pronation of the arms and legs

The nurse notices that the hem of a skirt on a pre-adolescent girl is uneven when she comes to the clinic. What procedure should the nurse follow to examine the girl for scoliosis? (Arrange the examination process from first on top to last on the bottom.) 1. Instruct the girl to bend at the waist so back is parallel to the floor. 2. Look for asymmetry in the hip area. 3. Examine for scapular prominence. 4. Ask the girl to remove her shirt but leave on her bra or swimsuit top.

1. Ask the girl to remove her shirt but leave on her bra or swimsuit top. 2. Look for asymmetry in the hip area. 3. Instruct the girl to bend at the waist so back is parallel to the floor. 4. Examine for scapular prominence. Rationale: To screen for scoliosis, the girl should first be asked to remove her shirt, wear her bra, or wear a swimsuit top. Then, as she stands erect, observe for asymmetry of the shoulders, back and hips while standing behind the girl. Next, ask her to bend forward so that the back is parallel to the floor, and finally observe from the side and the back, noting asymmetry or prominence of the rib cage and scapulae.

What is the priority nursing intervention for a 12-year-old client newly diagnosed with bacterial meningitis?

Administer broad-spectrum antibiotics before results of culture and sensitivity tests are returned. Rationale: Although culture and sensitivity results identify the most effective treatment, prescribed broad spectrum antibiotic therapy should be initiated once the culture is obtained to provide an immediate antiinfectant regimen against the risk of mortality due to bacterial meningitis.

The nurse is developing the plan of care for a school-aged boy with a chronic disability. The child frequently cries about being different from his siblings and wants others to do things for him that he is capable of doing for himself. To assist the family in coping with this child's chronic illness, which intervention is most important for the nurse to implement?

Recommend the use of consistent discipline and reward for acceptable behavior. Rationale: Focusing on the child, and not the condition, is essential in assisting the child to adapt to a chronic disability or illness. Consistent family rules should be used with a chronically ill child, such as setting boundaries for acceptable behavior, requiring participation in household activities, and fulfilling school responsibilities.