Peds Unit 6. Chapters 32, 34, 35
A 5-year-old child has enuresis. Which medication regime does the nurse educate the parents on related to this diagnosis? A. Imipramine (Tofranil), 10 mg before bed B. Imipramine (Tofranil), 25 mg before bed C. Oxybutynin chloride (Ditropan), 5 mg once daily D. Oxybutynin chloride (Ditropan), 50 mg once daily
ANSWER: C Both medications are used in this condition. Tofranil cannot be used in children under the age of 6. The dose of Ditropan is 5 mg once daily and can be titrated upward to a maximum dose of 20 mg/day.
A mother reports that her 2-year-old child experiences constipation frequently. The nurse would recommend to the mother to include what food in the child's diet? a. Cooked vegetables b. Pretzels c. Whole-grain cereal d. Yogurt
ANSWER: C Dietary modifications for constipation include eating more high-roughage foods such as whole-grain breads and cereals.
The nurse explains that the function of an insulin pump is to: a. release insulin as blood glucose rises. b. provide continuous infusion of insulin. c. decrease need for painful glucose monitoring. d. deliver a prescribed amount of insulin twice a day.
ANSWER: B The insulin pump that is attached to a subcutaneous tube releases a continuous infusion of insulin.
A child is receiving hemodialysis. The parents ask why hypotension is a possible complication. Which response by the nurse is the most appropriate? A. "It could be from the anticoagulant we use." B. "Kidney disease can often cause hypotension." C. "The treatment is removing fluid from his body." D. "Your child is critically ill and is unstable."
ANSWER: C Hemodialysis removes fluid from the child's body, sometimes at a rate that causes hemodynamic instability, including hypotension. The other answers are not accurate.
A practicing nurse explains to a nursing student that which is the most common cause of acute renal failure in children? A. Congenital renal problems B. Glomerulonephritis C. Hemolytic uremic syndrome D. Tylenol (acetaminophen) overdose
ANSWER: C Hemolytic uremic syndrome is most often associated with children eating undercooked meat and is the most common cause of acute renal failure in the pediatric population. Tylenol overdose is associated with liver failure.
Parents ask the nurse how their infant developed a Meckel's diverticulum. The nurse's response is based on the knowledge that this condition occurs when: a. the yolk sac remains connected to the intestine. b. there is inflammation of the ileocecal valve. c. a pouch forms when the vitelline duct fails to disappear. d. there is a weakness in the abdominal wall.
ANSWER: C If the vitelline duct fails to disappear completely after birth, a blind pouch may form.
The nurse is aware that rapid respirations are a possible cause of dehydration because they: a. prevent the child from drinking. b. increase circulation, thus increasing urine production. c. cause evaporation of fluid on the mucous membranes. d. often lead to vomiting.
ANSWER: C Rapid respirations cause increased insensible fluid loss.
The nurse explains that the treatment of choice for a child with intussusception is: a. a barium enema. b. immediate surgery. c. IV fluids until the spasms subside. d. gastric lavage.
ANSWER: A A barium enema is the treatment of choice for intussusception because the passage of the barium frequently "un-telescopes" the bowel. Surgery is scheduled only if reduction is not achieved
An appropriate intervention for a 3-month-old infant who has gastroesophageal reflux is to: a. position the infant in the crib on his or her abdomen, with the head elevated. b. administer medication as ordered to stimulate the pyloric sphincter. c. give thin rice cereal with formula before feeding solid foods. d. place the infant in an infant seat after feedings.
ANSWER: A After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure.
Intussusception would be suspected when parents describe the child's stools as: a. currant jelly. b. black and tarry. c. green liquid. d. greasy and foul-smelling.
ANSWER: A Bowel movements of blood and mucus that contain no feces ("currant jelly" stools) are common about 12 hours after the onset of the obstruction.
A nurse is assigned to care for four children who have acute kidney injury (AKI). Which child should the nurse see first after obtaining the handoff report? A. Anuric B. Oliguric C. Has deep, rapid respirations D. Having in-room dialysis
ANSWER: A Children with AKI generally are not anuric unless a catastrophic event has occurred. The nurse needs to see this child first. Oliguria (low urine output) is an expected finding unless the child is in the diuretic phase (high-output phase) of AKI. Deep rapid respirations (Kussmaul's respirations) are also expected as a compensatory response to the metabolic acidosis of AKI. A child receiving dialysis in the room is being attended to by a dialysis nurse.
A child is prescribed gentamycin (Garamycin) and develops acute kidney injury. Which etiology is the most likely cause of the child's acute kidney injury? A. Intrarenal B. Postrenal C. Prerenal D. Streptococcal
ANSWER: A Gentamycin is one of the aminoglycoside antibiotics, which are known to be nephrotoxic, leading to intrarenal kidney injury. Prerenal kidney injury is due to decreased perfusion. Postrenal kidney injury is obstructive in nature. Strep infections can cause damage to body systems, but there is no indication this child had a strep infection. Gentamycin is directly related to an intrarenal injury.
A child has acute kidney injury following a serious motor vehicle crash. Which intervention takes priority? A. Administer IV fluids and blood products. B. Insert an indwelling urinary catheter. C. Monitor hourly urine output measurements. D. Place the child on a low-sodium diet.
ANSWER: A Hypovolemia, blood loss, and shock all can lead to prerenal kidney injury. The priority interventions include administering fluids and blood products if needed. An indwelling urinary catheter will be important for hourly urine output measurements, but this will not actively help the problem. A low-sodium diet may or may not be appropriate.
A child has acute kidney injury (AKI). Which primary acid-base balance does the nurse assess the child for? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
ANSWER: A In AKI there is insufficient hydrogen ion excretion and poor bicarbonate reabsorption, leading to metabolic acidosis.
An adolescent patient with acute kidney injury (AKI) asks why she is taking Tums (calcium carbonate). Which response by the nurse is the most appropriate? A. Gets rid of phosphorus B. Prevents Curling ulcers C. Prevents gastric reflux D. Provides calcium
ANSWER: A In AKI, phosphorus is high, and patients are given phosphorus binders, such as Tums. They are not used to prevent reflux or Curling ulcers (seen in burns), or to provide calcium.
The instruction the nurse would give to parents about preventing the spread and reinfection of pinworms is to: a. keep children's nails short. b. dress child in loose-fitting underwear. c. clean the bathroom with bleach solution. d. wash bed linens in cold water.
ANSWER: A One intervention to prevent the further spread of pinworms is to keep the child's fingernails short. Pinworms are not spread from person to person.
An adolescent on the cross-country track team had a urinalysis during a school physical that showed proteinuria. Which action by the nurse is the most appropriate? A. Advise the teen not to run for 48 hours and repeat the test. B. Collaborate with the provider to order kidney imaging tests. C. Explain the finding is insignificant and does not need follow-up. D. Take the teen's blood pressure on three separate occasions.
ANSWER: A Proteinuria can be a benign finding, especially if it is noted after heavy exercise or fever. The teen should avoid exercise for 48 hours and repeat the test. At this point, further testing is not warranted.
A child is being treated for nephrotic syndrome. Which assessment finding indicates that an important goal for this child is being met? A. Decreased abdominal girth B. Diminished urine output C. Improved rash D. Increased weight over a week
ANSWER: A The combination of fluid retention and protein loss through the urine produces ascites, or a swollen belly. Decreasing abdominal girth signifies that the disease is being successfully treated. Urine output is already diminished in nephrotic syndrome. There is no rash. Increasing weight means increased fluid retention, which would not be an improvement.
The pediatric clinic nurse calls a parent to report urinalysis findings for her child including microscopic hematuria. Which question by the nurse is most appropriate? A. "Has your child recently had strep throat?" B. "Has your child been in a bike or car crash?" C. "Has your child started menstruating yet?" D. "Has your child taken lots of bubble baths?"
ANSWER: A The most common causes of microscopic hematuria include UTI, poststreptococcal glomerulonephritis, hypercalciuria, and structural abnormalities. Trauma would more likely cause gross hematuria. The other two questions are appropriate depending on the age and sex of the child, but do not assess for the most common reasons for this finding.
A child is brought to the pediatric clinic, where the parent reports that the child has tea-colored urine and puffy eyes. Which diagnostic test does the nurse prepare the parent and child for based on the assessment findings? A. BUN and creatinine B. Intravenous pyelogram C. Suprapubic aspiration D. Voiding cystourethrogram
ANSWER: A This child has manifestations of possible glomerulonephritis. To assess kidney function, the patient needs a BUN and creatinine. A pyelogram is used when kidney stones are suspected. Suprapubic aspiration is one way of collecting a sterile urine sample, but is very invasive. A voiding cystourethrogram is used to assess for reflux.
On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment? a. Weight loss of 4 ounces b. Dry mucous membranes c. Decreased skin turgor d. Depressed fontanelle
ANSWER: A Weight loss is the most significant indicator of dehydration because an infant's weight is comprised of 77% water.
A mother reports that her child has been scratching the anal area and complaining of itching. Based on this information, the nurse might suspect this child has: a. pinworms. b. giardiasis. c. ringworm. d. roundworm
ANSWER: A With pinworms, the nurse or parent may notice that the child scratches the anal area and complains of itchiness. The other choices do not cause this reaction
The student learns that which hormones are regulated by the kidneys? (Select all that apply.) A. Calcitriol B. Creatinine C. Estradiol D. Erythropoietin E. Renin
ANSWER: A, B, E Hormones released by the kidneys include calcitriol, erythropoietin, and renin. Creatinine is a laboratory value that measures kidney function. Estradiol is a hormone but is not released by the kidneys.
Following a closed head injury, the unconscious 10-year-old child begins to excrete copious amounts of pale urine with an attendant drop in blood pressure (BP). Based on these symptoms, the nurse suspects the development of: a. diabetes insipidus. b. diabetes mellitus. c. hypothyroidism. d. hyperthyroidism
ANSWER: A Diabetes insipidus can be acquired as the result of a head injury or tumor, and suppression of the posterior pituitary causes copious urine output with an attendant drop in BP. The child can become dehydrated very quickly if some remedy is not applied.
The laboratory result indicating good metabolic control for a child with type 1 diabetes mellitus is: a. glycosylated hemoglobin value of 8%. b. fasting blood glucose level less than 140 mg/dL. c. glucose tolerance test result of 190 mg/dL. d. no glucose or ketones present in the urine.
ANSWER: A Glycosylated hemoglobin reflects glycemic levels over a period of months. Levels of 6% to 9% represent good metabolic control.
The statement made by a 7-year-old child with type 1 diabetes mellitus that indicates a need for more teaching is: a. "My pancreas is sick and needs insulin until it is well." b. "I will need to take my insulin every day." c. "I need to keep a piece of candy in my pocket in case I start to feel shaky." d. "My mom has to give me insulin shots twice a day."
ANSWER: A The child with type 1 diabetes mellitus has an insulin deficiency and will require lifelong management of this disease. Insulin does not cure the pancreas.
The nurse discussed treatment of hypoglycemia with an adolescent. The nurse determined the adolescent understood the instructions when she verbalized that if her blood glucose is low or if she begins to feel hungry and weak, she will: a. eat six LifeSavers. b. give herself Lispro insulin. c. have a slice of cheese. d. drink a diet soda
ANSWER: A The immediate treatment of hypoglycemia consists of administering sugar in some form such as orange juice, hard candy, or a commercial product. Cheese will eventually raise the blood glucose, but not as quickly as candy.
A mother reports that her 4-month-old infant is lethargic, sleeps 18 hours a day, and snores. The nurse recognizes that these signs are characteristic of: a. hypothyroidism. b. hyperthyroidism. c. type 1 diabetes mellitus. d. Tay-Sachs disease.
ANSWER: A The infant with hypothyroidism will appear sluggish, and the tongue will be enlarged, causing noisy respiration.
The nurse planning to teach a family about Tay-Sachs disease understands the pattern of inheritance for inborn errors of metabolism is usually: a. autosomal recessive. b. autosomal dominant. c. X-linked recessive. d. multifactorial.
ANSWER: A The pattern of inheritance is generally autosomal recessive.
The nurse caring for a child with a new diagnosis of type 1 diabetes mellitus plans the care based on the understanding that: a. there is an absolute deficiency of insulin. b. insufficient quantities of insulin are produced by the pancreas. c. oral hypoglycemic agents can control it. d. insulin deficiency is caused by another disease affecting the pancreas.
ANSWER: A Type 1 insulin-dependent diabetes mellitus is characterized by an absolute or complete deficiency of insulin.
The nurse is planning discharge teaching for a child who just had a kidney transplant. Which information does the nurse provide regarding signs of rejection? (Select all that apply.) A. Decreased urine output B. Edema C. Fever D. Pain over the kidney E. Weight loss
ANSWER: A, B, C, D Decreased urine output, edema, fever, and pain over the donor kidney site are all signs of possible rejection. The child would have a weight gain related to the edema.
The student studying the renal system learns that the kidneys have several functions. Which options are functions of the kidneys? (Select all that apply.) A. Filtering the blood B. Maintaining electrolyte balance C. Regulating acid-base balance D. Removing waste products E. Suppressing hormone release
ANSWER: A, B, C, D Functions of the kidneys include filtering the blood, removing waste products from the blood, regulating both fluid and electrolyte and acid-base balance, and releasing hormones.
A faculty member is explaining complications of hemodialysis to a group of students. Which complications does the faculty member include in the discussion with the students? (Select all that apply.) A. Bleeding B. Febrile reactions C. Hypotension D. Infection E. Pulmonary embolism
ANSWER: A, B, C, D There are many complications associated with hemodialysis, including bleeding, febrile reactions, hypotension, and infection. Although any ill child can develop a pulmonary embolism, this is not a specific complication of this therapy.
The nurse warns that keeping diabetes in control in an adolescent is made difficult by what? Select all that apply. a. Hormonal changes b. Developmental conflicts c. Preference for fast food d. Growth spurts e. Denial of disease
ANSWER: A, B, C, D, E The adolescent who is in a growth spurt and filled with raging hormones resents and denies the need to be dependent on a medication. Medication schedules and diet restrictions do not correlate well with the adolescent's lifestyle of eating fast foods.
The nurse explains that the endocrine system is primarily responsible for controlling which process(es)? Select all that apply. a. Maturation b. Reproduction c. Stress response d. Sexual identity e. Growth
ANSWER: A, B, C, E The endocrine system governs maturation, reproduction, stress response, and sexual maturity. Sexual identity is a psychosocial response.
The nurse reminds the adolescent with diabetes that soluble fiber in the diet can reduce what? Select all that apply. a. Blood glucose b. Serum cholesterol c. Incidence of infections d. Absorption of sugar e. Insulin requirements
ANSWER: A, B, D, E Soluble fiber can reduce blood glucose, serum cholesterol, absorption of sugar, and insulin requirements. It has no effect on infections.
The home health nurse is monitoring an 8-month-old child with hypothyroidism taking levothyroxine (Synthroid). The nurse recognizes signs of overdose when the assessment reveals which symptom(s)? Select all that apply. a. Tachycardia b. Irritability c. Vomiting d. Weight gain e. Diaphoresis
ANSWER: A, B, E All the options with the exception of weight gain and vomiting are indications of overdose of Synthroid. Weight loss is a symptom of overdose, however.
A new mother asks the nurse why babies are more prone to dehydration than adults. Which rationales from the nurse best answer this mother's question? (Select all that apply.) A. A greater body surface area than adults B. Higher percentage of total body water C. Improved ability of kidneys to concentrate urine D. Kidneys too efficient in excreting waste E. More fluids losses through GI tract and skin
ANSWER: A, B, E There are several reasons children are more prone to dehydration than adults, including: a greater body surface area from which to lose fluids, a higher percentage of total body water, more losses from the GI tract and skin, a decreased ability of the kidneys to concentrate urine, and immature kidneys that are not good at excreting waste products.
A nurse is providing teaching on toilet training to a parent education group. Which signs of training readiness does the nurse explain to the parents? (Select all that apply.) A. Can stay dry for at least 2 hours B. Gets up by self at night for toileting C. Showing interest in toileting D. Tells parent of need to use toilet E. Wants to hold urine and not void
ANSWER: A, C, D There are several "readiness" signs to watch for when planning toilet training. These include being able to stay dry for a specific amount of time, showing interest in toileting, and being able to tell the parent or caretaker of the need to use the toilet. Getting up by oneself and wanting to hold the urine are not signs.
Which food sources are high in soluble fiber? Select all that apply. a. Raw fruits b. Cooked vegetables c. Beans d. Lean meat e. Bran cereal
ANSWER: A, C, E
The nurse is explaining the RIFLE classification of kidney injury to a student. Which options are included in this system? (Select all that apply.) A. End-stage kidney disease B. Failure to concentrate urine C. Injury to the kidney D. Loss of protein in the urine E. Risk of renal dysfunction
ANSWER: A, C, E RIFLE stands for risk of renal dysfunction, injury to the kidney, failure of the kidney, loss of kidney function, and end-stage kidney disease.
The finding in a newborn suggestive of tracheoesophageal fistula is: a. failure to pass meconium in 24 hours. b. choking on the first feeding. c. palpable mass in the sternal area. d. visible peristalsis across abdomen.
ANSWER: B After birth, a newborn with tracheoesophageal fistula will vomit and choke when the first feeding is introduced.
A child has just returned to the pediatric intensive care unit after having a kidney transplant. Which assessment takes priority for this child? A. Level of consciousness B. Hourly urine output C. Pain D. Vital signs
ANSWER: B All assessments are important in a postoperative patient. However, because the child had a kidney transplant, assessment of renal function takes priority.
A child is admitted to the hospital with suspected hemolytic uremic syndrome (HUS). Laboratory results indicate elevated BUN, creatinine, and potassium. Which action by the nurse takes priority? A. Administer antibiotics. B. Apply cardiac monitoring. C. Insert a urinary catheter. D. Obtain a stool sample.
ANSWER: B An elevated potassium can cause serious, even fatal, dysrhythmias. The nurse applies cardiac monitoring first for patient safety. Inserting a urinary catheter and sending a stool sample are appropriate but do not take priority. Antibiotics are not given in HUS because they exacerbate the condition.
The parents of a child with chronic kidney disease ask the nurse why the child is prescribed epoetin alfa (Epogen). Which response by the nurse is the most accurate? A. "It binds with and removes phosphorus." B. "It will help his body to make more red blood cells." C. "It will help to boost his white blood cell count." D. "It will help his body to make more platelets so he doesn't bleed."
ANSWER: B Anemia is common with chronic kidney disease due to reduced erythropoeitin, which is vital for making red blood cells. The other answers are incorrect.
An acutely ill child is admitted for a suspected severe urinary tract infection (UTI). Which is the priority action by the nurse? A. Administer broad-spectrum antibiotics as ordered. B. Obtain a urine sample for culture and sensitivity. C. Start an IV line for aggressive fluid resuscitation. D. Teach the parents how to prevent future UTIs.
ANSWER: B Antibiotics need to be started as soon as possible, but it is imperative to obtain a urine sample for a culture and sensitivity to guide medication choices first. While awaiting the results, the nurse will administer a broad-spectrum antibiotic. The child does need an IV, but there is no indication that the child needs aggressive fluid resuscitation. Teaching is always an important task, but does not take priority over obtaining the sample for urinalysis.
A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). After gastric lavage is completed, the nurse might expect this child to receive: a. activated charcoal. b. N-acetylcysteine. c. vitamin K. d. syrup of ipecac.
ANSWER: B Gastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen.
A child is in the emergency department following a car crash. Which finding noted by the nurse warrants immediate intervention? A. Complains "I hurt all over." B. Grey-Turner's sign C. Increased WBCs D. Tachycardia
ANSWER: B Grey-Turner's sign is bruising in the flank area and can indicate a renal injury. The other signs would be expected after a traumatic event.
An infant has poor feeding, fever, and malodorous urine. The parents do not want the nurse to catheterize the child. Which response by the nurse is the most appropriate? A. Apply a urine collection bag on the baby. B. Explain how this procedure obtains the best results. C. Give the baby acetaminophen (Tylenol) for fever. D. Inform the health-care provider of the refusal.
ANSWER: B Parents can be understandably distraught at the thought of their baby having an invasive procedure. The nurse should ensure that the parents understand why the catheterized urine sample or a suprapubic aspirated urine sample is the best choice for obtaining the most accurate urinalysis results. If the parents still refuse, the nurse should document their refusal, inform the provider, and apply a collection bag. The nurse should also treat the baby's fever with acetaminophen, but this option is not directly related to the question.
A child presents to the pediatric clinic, where the parent reports that the child has had bloody diarrhea and joint pain. Which diagnostic test does the nurse prepare the child and parent for first? A. Echocardiogram B. Skin assessment C. Serum renal studies D. Urinalysis
ANSWER: B The classic signs of Henoch-Schönlein purpura are rash, gastrointestinal complaints (often bloody diarrhea), hematuria, and arthritis. The nurse needs to assess the child's skin for a rash. The diagnosis is usually made by clinical findings, as there is no specific diagnostic test.
A school-age child has renal disease and the parent wants to know how this could cause the child's hypertension. Which response by the nurse is the most appropriate? A. "The high blood pressure caused the kidney disease." B. "The kidneys regulate renin, which controls blood pressure." C. "The medication your child takes often raises blood pressure." D. "The renal diet includes a lot of sodium, which raises blood pressure."
ANSWER: B The kidneys regulate renin, a hormone that controls blood pressure. Kidney abnormalities often affect renin, leading to hypertension. In a child this young, the kidney disease most likely came first; in adults, long-standing hypertension is a frequent cause of renal disease. Medications are not the reason. The typical renal diet is low in sodium.
An infant appears dehydrated. Laboratory results indicate a serum sodium of 143 mEq/L. Which fluid would the nurse use for IV replacement? A. 0.45% normal saline B. 0.9% normal saline C. 3% normal saline D. D5W with 20 mEq KCL
ANSWER: B This child has an isotonic dehydration, in which fluids and solutes are lost in balanced proportions, as evidenced by the normal serum sodium level. The child needs an isotonic IV solution, which would be 0.9% normal saline. The 0.45% normal saline ("half normal saline") is hypotonic, as is D5W, with or without potassium. The 3% normal saline is hypertonic.
The nurse interviewing parents of an infant with pyloric stenosis would expect the parents to report if the infant has had: a. diarrhea. b. projectile vomiting. c. poor appetite. d. constipation.
ANSWER: B Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting.
A child receives a combination of regular and NPH insulin at 8:00 AM At 8:45 AM, when the breakfast trays have not yet arrived from the kitchen, the nurse should: a. notify the charge nurse. b. give the patient a snack of graham crackers and milk. c. ambulate the patient in the hall for a short time. d. give the patient more insulin according to the sliding scale.
ANSWER: B A child who receives regular insulin before meals may have an insulin reaction if food is not eaten within 20 minutes. A snack of graham crackers and milk will prevent an episode of hypoglycemia
The condition the nurse suspects when a child with type 1 diabetes mellitus has hyperglycemia, diaphoresis, and headaches in the morning is: a. dawn phenomenon. b. Somogyi phenomenon. c. honeymoon effect. d. ketoacidosis.
ANSWER: B The Somogyi phenomenon (rebound hyperglycemia) occurs when the blood glucose level is lowered to the point at which the body's counter-regulatory hormones are released, producing the symptoms described.
The general dietary measure to include in a teaching plan for the child with type 1 diabetes mellitus is to: a. control intake of carbohydrates and consume fewer calories. b. focus on complex carbohydrates and eat foods high in fiber. c. obtain most calories from proteins and fats. d. eat a diet low in fat and low in complex carbohydrates.
ANSWER: B The nutritional needs of a child with diabetes mellitus are essentially the same as those of the nondiabetic child with the exception of the elimination of concentrated carbohydrates such as sugar. Fiber has been shown to reduce blood glucose levels.
The parents of a child newly diagnosed with diabetes mellitus tell the nurse, "Our son's body is resistant to insulin." The nurse recognizes this description as consistent with: a. type 1, insulin-dependent diabetes mellitus. b. type 2, non-insulin-dependent diabetes mellitus. c. maturity-onset diabetes of youth. d. drug-induced diabetes.
ANSWER: B Type 2, non-insulin-dependent diabetes mellitus is caused by insulin resistance or failure of the body to use the insulin.
The nurse explains that because of an inadequate secretion of insulin: a. protein synthesis is increased. b. increased fat breakdown leads to ketonemia. c. serum glucose levels are markedly decreased. d. more rapid conversion and storage of carbohydrates to glucose occurs.
ANSWER: B When insulin is deficient, the body cannot metabolize carbohydrates for energy. The body is also unable to store and use fat properly. Incomplete fat metabolism produces ketone bodies that accumulate in the blood.
A nurse is explaining to a group of students that there are certain criteria that are met before a child starts renal replacement therapy. Which of the following criteria does the nurse include in the discussion with the students? (Select all that apply.) A. Acidosis with pH < 7.2 or rising rapidly B. BUN > 150 mg/dL, or lower if rising rapidly C. Mental status changes from uremia D. Potassium > 6.5 mEq/L despite treatment E. Presence of dialyzable toxins or poisons
ANSWER: B, C, D, E There are several criteria for beginning renal replacement therapy, including those listed here. Acidosis with a pH of greater than 7.2 or HCO3 greater than 10 mEq/L are also criteria, but if the pH is rising (normalizing) quickly, that would not be an indication to begin therapy.
A nurse is caring for a child who is scheduled for a kidney biopsy. The prebiopsy laboratory results indicate a platelet count of 88,000, pH of 7.28, and potassium of 5.8 mEq/L. Based on these laboratory results, which action by the nurse is the most appropriate? A. Ensure signed consent is on the chart. B. Document the findings in the chart. C. Notify the provider immediately. D. Prepare to administer Kayexalate (sodium polystyrene).
ANSWER: C A platelet count this low is too low to perform an invasive procedure, such as a kidney biopsy. The nurse should notify the provider immediately. Documentation should be done and consent should be on the chart prior to a procedure, but in this case, the biopsy may be postponed. The potassium level is slightly high and probably does not warrant Kayexalate, but in any event, notifying the provider takes priority.
A nurse is caring for a child with acute kidney injury (AKI) at home. The child's laboratory work is as follows: serum albumen 2.8 g/dL and serum protein 4 g/dL. Which action by the nurse is the most appropriate? A. Assess the child for edema. B. Document findings in the chart. C. Facilitate a dietitian referral. D. Weigh and measure the child.
ANSWER: C All interventions are appropriate for a child with AKI. However the child's laboratory results indicate malnutrition, and with the dietary restrictions the child must follow, ensuring adequate nutrition is difficult. A referral to a dietitian is most important.
A school-age boy is in the emergency department with testicular torsion. Which action by the nurse takes priority for this patient? A. Administer prophylactic antibiotics. B. Assess and treat the child's pain. C. Ensure surgical consent is on the chart. D. Ice and elevate the scrotum.
ANSWER: C Testicular torsion is a surgical emergency, and the nurse's priorities are to facilitate surgery. The nurse must ensure a signed consent is on the chart. Treating pain is important too, but the consent is a legal requirement. Prophylactic antibiotics may or may not be given. Ice and elevation may be helpful as a comfort measure, but do not take priority over the consent.
The nurse that is teaching a parent about pyrvinium (Povan) would include the information that the drug will cause: a. diarrhea. b. skin rash. c. red stool. d. metallic taste.
ANSWER: C The nurse should advise parents that pyrvinium stains clothing and turns stools red.
The comment made by a school-age child indicating that he needs more teaching about diabetes mellitus and exercise is: a. "I carry a piece of hard candy with me in case I start to feel shaky." b. "I make sure I have emergency money when I have soccer practice or a game." c. "Sometimes I skip my breakfast when I have a game in the morning." d. "I play in soccer games that are scheduled after dinner."
ANSWER: C Blood glucose is high after meals. The child with type 1 diabetes mellitus who skips a meal before exercise is at risk for hypoglycemia.
When teaching a 12-year-old how to administer insulin, the nurse instructs the child to: a. make sure injection sites are 6 inches apart. b. select an injection site that was recently exercised. c. inject the needle at a 90-degree angle. d. give the injection deep into the muscle.
ANSWER: C Children often find it easier to learn to inject the needle at a 90-degree angle.
A child with diabetes is brought to the emergency department. He is flushed and drowsy, and his skin is dry. His father states that the child has been feeling progressively worse since the morning. This child is most likely experiencing: a. Somogyi phenomenon. b. dawn syndrome. c. ketoacidosis. d. water intoxication.
ANSWER: C In ketoacidosis, the child's skin is dry, and the face is flushed. Patients appear dehydrated. They may perspire and be restless. The breath has a fruity odor, and there is no rest period between inspiration and expiration.
An important consideration for the school-age child taking DDAVP for diabetes insipidus would be: a. observing for signs of water deprivation. b. restricting his physical education program. c. arranging for the child to use the bathroom when needed. d. limiting fluid intake other than during the lunch period.
ANSWER: C The child with diabetes insipidus needs liberal access to bathrooms and water fountains. Arrangements may have to be made with the school to allow access.
Although the child with type 1 diabetes had her prescribed insulin at 7:30 AM, the child is complaining of hunger and thirst and is drowsy at 10:30 AM. The nurse should first: a. walk the patient in the hall for 10 minutes. b. allow the patient a short nap. c. give her a cup of orange juice. d. test her blood with a glucometer and give insulin according to the sliding scale.
ANSWER: C The immediate remedy is to give orange juice to raise the blood glucose. Giving more sugar will increase the blood glucose in a hyperglycemic child. Walking exercise will use up even more glucose. The treatment for hyperglycemia is to give the patient more insulin.
The nurse is assisting a 12-year-old kidney transplant recipient to select items from the hospital menu. Which meal indicates an appropriate understanding of dietary restrictions? A. Chicken alfredo, breadstick B. Cheese pizza, fruit cocktail C. Lasagna, salad, breadstick D. Pasta with tomato sauce, salad
ANSWER: D A kidney transplant recipient is placed on a protein-restricted diet. Pasta with plain tomato sauce is the lowest-protein menu item listed. The other meals are high in protein. Sodium may be limited too.
An adolescent male patient had an orchiopexy for cryptorchidism as an infant. Which health promotion activity does the nurse educate this patient about? A. Annual digital prostate exam B. Fertility testing C. Genetic screening D. Testicular self-exam monthly
ANSWER: D After orchiopexy, the teen still has a high risk for testicular cancer and should perform testicular self-exams each month. The other actions are not warranted for this condition
A school-age female child has a urinary tract infection (UTI). The culture has come back positive for Escherichia coli. Which teaching measure is most important for the nurse to include in the teaching plan? A. Avoid bubble baths and nylon panties. B. Offer the child fluids frequently. C. Place the child on a voiding schedule. D. Teach the child to wipe from front to back.
ANSWER: D All items are appropriate to teach when a child has a UTI. However, E. coli infection stems from contamination with fecal material. The female child should be taught to wipe from front to back to prevent this cross-contamination.
A student nurse wants to know why a bruit is heard and a thrill palpated at the site of an AV fistula used for dialysis. Which response by the nephrology nurse is the most appropriate? A. Abnormal findings signaling complications B. Flapping of the AV valve during circulation C. Small blood clots blocking some blood flow D. Turbulent blood flow through the fistula
ANSWER: D Blood flowing through an AV fistula goes from a high-pressure system into a low-pressure system during circulation, leading to turbulent flow. It is a normal finding and not caused by the AV valve or small blood clots.
A child is receiving home peritoneal dialysis. When the visiting nurse assesses the patient, he finds the outflow from the dialysis to be cloudy. Which action by the nurse is the most appropriate? A. Call 911 and send the child to the hospital. B. Call the nephrology clinic to make an appointment. C. Review teaching with the child on the process. D. Take a full set of vitals and notify the provider.
ANSWER: D Cloudy outflow could indicate peritonitis, a serious complication of peritoneal dialysis. The nurse should take a full set of vitals to assess for infection and call the provider. The child does not need 911. Teaching can be done later. The child should not wait for an appointment.
A nurse is obtaining a bagged urine collection on an infant. Which action by the nurse is most important? A. Clean and powder the skin prior to bagging. B. Remove the bag as soon as it contains urine. C. Send the sample to the laboratory as soon as possible. D. Use universal precautions, including gloves.
ANSWER: D For infection control, the nurse uses universal precautions, including wearing gloves when collecting urine samples. The baby's skin should be clean and dry; powder will cause the bag to not adhere. The other answers are appropriate, but infection control and safety come first.
A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. An acid-base imbalance that the nurse would expect to occur from this persistent vomiting is: a. hyperkalemia. b. hypernatremia. c. acidosis. d. alkalosis.
ANSWER: D Hydrochloric acid and sodium chloride from the stomach are lost from persistent vomiting. This results in alkalosis
A child has glomerulonephritis and hypertension. Which dietary modification is most appropriate for the nurse to suggest? A. High fiber B. High potassium C. Low saturated fat D. Low sodium
ANSWER: D Hypertension in glomerulonephritis is usually due to fluid overload, and a sodium-restricted diet can help this problem. If the patient is on loop diuretics (often prescribed for hypertension in these patients), potassium is important. High fiber and low saturated fat are healthy diets for nearly everyone.
An infant is born with exstrophy of the bladder but otherwise appears healthy. Which nursing diagnosis is the priority for this infant? A. Altered family processes B. Fluid volume deficit C. Hypothermia D. Risk for infection
ANSWER: D In this condition, the bladder is open on the abdominal wall, and priority interventions revolve around preventing infection. There is no indication that the child has fluid volume deficit or hypothermia. Altered family processes might be a diagnosis, but physical diagnoses take priority over psychosocial ones.
A child is hospitalized with acute kidney injury (AKI) and has a critical hyperkalemia. Which order would the nurse question as inappropriate for this child? A. Calcium gluconate B. Dextrose and insulin C. Emergent dialysis D. Kayexalate (sodium polystyrene) enema
ANSWER: D Kayexalate enemas can take up to 4 hours to work. With critical hyperkalemia, the drug of choice needs to work faster than this. The other options would all work faster.
An infant is admitted to the hospital with severe isotonic dehydration. In planning the infant's care, the nurse is aware the infant is at risk for: a. metabolic alkalosis. b. hypocalcemia. c. sepsis. d. shock.
ANSWER: D Shock is the greatest threat to life in isotonic dehydration.
The nurse instructs the 11-year-old diabetic child to use the side of the finger for blood testing because the side of the finger: a. has fewer capillaries. b. is easier to puncture. c. is less likely to become infected. d. has fewer nerve endings.
ANSWER: D The sides of the finger have fewer nerve endings and more capillaries but are not easier to puncture than the fingertip. The risk for infection is remote for either site.
A nurse is preparing to administer gentamicin (Garamycin), IV, to a hospitalized child. Before administering the medication, the nurse checks the drug trough level, which is 13 µg/mL. Which action by the nurse is the priority for this child? A. Administer the medication. B. Document the findings. C. Have the laboratory re-run the specimen. D. Notify the health-care provider.
ANSWER: D This trough level is too high (normal is 2 µg/mL). Because this drug is nephrotoxic, care must be given to avoid causing acute kidney injury. The nurse notifies the health-care provider about the results and does not administer the medication. Documentation should occur, but is not the priority. Asking the laboratory to re-run the specimen is not warranted.
The nurse teaching parents of a child with diabetes insipidus about water intoxication would tell the parents to be alert for: a. polyuria. b. cough. c. weight loss. d. lethargy.
ANSWER: D Signs of water intoxication include edema, lethargy, nausea, and central nervous system signs.
The nurse determines a parent is administering levothyroxine (Synthroid) correctly when she states: a. "I stopped giving the medication because my daughter was losing her hair." b. "I am using a different brand now because it costs less money." c. "I don't give the medication on the weekends." d. "I give the medication at 8:00 AM every day."
ANSWER: D Synthroid should be given at the same time each day, preferably in the morning.
What would be the most appropriate nursing response to a woman who says, "My sister had a child with Tay-Sachs disease, and I want to know if I could have a child with this condition." a. "The disease is rare. It is unlikely that you would have a child with Tay-Sachs disease." b. "A screening test can be done to determine if you are a carrier of the gene." c. "The gene for Tay-Sachs disease is transmitted by the father." d. "The cause of Tay-Sachs disease is thought to be an autoimmune response to a virus."
ANSWER:: B Carriers can be identified by screening tests. Tay-Sachs disease has an autosomal recessive pattern of transmission.
