Practice questions

A 1-year-old child is diagnosed with intussusception, and the parent of the child asks the student nurse to describe the disorder. Which statement by the student nurse indicates correct understanding of this disorder?

"It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."

when caring for a child with a tonsillectomy

-observe for continuous swallowing -avoid gargling -put on side or abdomen to facilitate drainage -cold is preferred

Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary? C, D A, E, K A, D, E, K C, folic acid

A, D,E, K

A diagnosis of rheumatic fever is being ruled out for a child. Which laboratory test(s) is/are the most reliable? (Select all that apply.) Additional antistreptoccocal antibody titers Correct C-reactive protein (CRP) Antistreptolysin-O (ASO) titer Correct Elevated white blood cell count (WBC) Erythrocyte sedimentation rate (ESR) Incorrect

Additional antistreptococcal antibody titers Antistreptolysin-O (ASO) titer

An infant is seen in the pediatrician's office for complaints of frequent vomiting and spitting up after feedings. Findings indicate that the infant is not gaining weight, and gastroesophageal reflux is suspected. Which would the nurse anticipate being prescribed initially in the care of this child?

Administer predigested formula and feed small, frequent feedings.

The parents of a child with a cleft palate are concerned and ask the nurse when the palate will be repaired. The nurse would plan to base the response on which information about cleft palate repair?

Repair usually is performed between 6 months and 2 years.

Purpose of PEFR

assess severity of asthma

The nurse would monitor a child with Hirschsprung disease for which associated health problem?

enterocolitis -inflammation of the intesting

The nurse is developing a plan of care for an infant after surgical intervention for imperforate anus. The nurse would include in the plan that which position is the most appropriate one for the infant in the postoperative period?

prone

indications of epiglottitis

sitting upright drooling agitation fro like cough

A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply.) Vomiting Jaundice Swelling of the face Persistent diaper rash Failure to gain weight

vomiting persistent diaper rash failure to gain weight

A toddler is hospitalized with acute renal failure secondary to severe dehydration. The nurse should assess the child for what possible complication? Hypotension Hypokalemia Hypernatremia Water intoxication

water intoxication

A child is scheduled for a tonsillectomy in a day surgical unit. On the day after surgery, the parents call the surgical unit and express concern because the child has a bad mouth odor. Which response is most appropriate?

"Bad mouth odor is normal and may be relieved by drinking more liquids."

An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder?

"Can you describe the type of pain that the child is experiencing?" -s/s: severe colicky pain -screams and draws up knees to chest

The parent of a newborn infant with hypospadias asks the nurse why circumcision cannot be performed. Which is the most appropriate response by the nurse?

"Circumcision has been delayed to save tissue for surgical repair."

A parent brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The parent reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the parent which assessment question to elicit data specific to this condition?

"Does the vomit contain sour, undigested food without bile, and is the infant constipated?"

Which question would the nurse ask the parents of a child suspected of having glomerulonephritis?

"Has the child had a sore throat or a throat infection in the last few weeks?" -strep throat is a cause

A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine whether this child is experiencing a long-term effect of cleft palate, which question would the nurse ask?

"Is the child unresponsive when given directions?" -this indicates hearing loss and they should be routinely checked for this

The clinic nurse is providing instructions to the parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement would the nurse make to the parent?

"The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."

The nurse is caring for an infant after repair of an inguinal hernia. Which of these assessment findings indicates that the surgical repair was effective?

Absence of inguinal swelling with crying

An 18-month-old child is being discharged after surgical repair of hypospadias. Which postoperative nursing care measure would the nurse stress to the parents as they prepare to take their child home?

An 18-month-old child is being discharged after surgical repair of hypospadias. Which postoperative nursing care measure would the nurse stress to the parents as they prepare to take their child home?

A nursing student caring for a 6-month-old infant is asked to collect a sample for urinalysis from the infant. How would the student collect the specimen?

Attaching a urinary collection device to the infant's perineum for collection

The nurse is developing a plan of care for a 6-year-old child diagnosed with acute glomerulonephritis. The nurse would include which priority intervention in the plan of care?

Encourage limited activity and provide safety measures.

A 4-year-old child with acute glomerulonephritis is admitted to the hospital. The nurse identifies which client problem in the plan of care as the priority?

Excessive fluid volume related to decreased plasma filtration

The nurse is caring for a hospitalized infant with a diagnosis of bronchiolitis. In which position would the nurse place the infant?

Head and chest at a 30-degree angle with the neck slightly extended -helps maintain airway and decrease pressure on the diaphragm

The parent of a 3-year-old child arrives at the clinic and reports that the child's bowel movements have changed to a flat ribbon-like appearance and are very foul smelling. The nurse recognizes that this finding could be indicative of which condition?

Hirchsprungs

A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The parents become concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the most appropriate nursing action?

Let one parent hold the child and direct the cool mist over the child's face.

After hydrostatic reduction for intussusception, the nurse would expect to observe which client response?

Passage of barium or water-soluble contrast with stools

The nurse is caring for a child who was brought to the clinic complaining of severe abdominal pain and is suspected of having acute appendicitis. The child is lying on the examining table with the knees pulled up toward the chest. What is the priority nursing action?

Perform a pain assessment using the FACES scale.

Breathing exercises and postural drainage are prescribed for a hospitalized child with cystic fibrosis. What instruction would the nurse include in the client's teaching plan?

Perform the postural drainage first and then the breathing exercises. -postural drainage will mobilize secretions and the breathing exercises will assist getting them out

Which laboratory value for urinalysis is abnormal? pH: 4 Specific gravity: 1.020 Protein level: absent Glucose level: absent

Ph 4 -normal is 4.8-7.8 -normal SG: 1.016-1.022

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions would the nurse include in the plan of care? Select all that apply.

Place the infant in a private room. Wear a mask, gown, and gloves when in contact with the infant. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

The nurse is reviewing the primary health care provider's prescriptions for a child following a tonsillectomy. Which prescription would the nurse question?

Suction the child frequently if coughing. -only suctioned if there is an obstruction

The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse would monitor for which indication that the child may be experiencing airway obstruction?

The child is leaning forward, with the chin thrust out.

Which is considered a mixed cardiac defect? Pulmonic stenosis Atrial septal defect Patent ductus arteriosus Transposition of the great arteries

Transposition of the great arteries -pulmonary stenosis is obstructive -atrial septal defect is increased pulmonary blood flow -patent ductus arteriosus is increased pulmonary blood flow

The nurse is providing discharge teaching to the parents of a child who has recovered from Kawasaki disease. The child received intravenous immunoglobulin (IVIG) and aspirin as part of the treatment plan. Which statement from the parents would indicate a need for further teaching?

We will still plan for my child to receive the MMR vaccine at the doctor's appointment in 2 weeks -joint pain and skin peeling are expected -temperature needs to be taken for first few weeks -no live vaccines for 11 months

group A betahemolytic strep can lead to what if not treated

acute rheumatic fever

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed? Restraining child as necessary Discouraging parents from holding child Doing passive range-of-motion exercises once a day Incorrect Adjusting activities to child's tolerance level

adjusting activities to child's tolerance level

Whenever appendicitis is suspected, the nurse would be aware of the danger of

administering laxatives or enemas or applying heat to the area

management of the child with peptic ulcer often involves

administering proton pump inhibitors

The nurse employed in an emergency department is monitoring a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the chin thrust out. How would the nurse interpret this finding?

airway obstruction -tripod positioning, nasal flaring, tachycardia, high fever, sore throat

What should the nurse recognize as an early clinical sign of compensated shock in a child? Confusion Sleepiness Hypotension Apprehension

apprehension -confusion indicates uncompensated shock -hypotension is a symptom of irreversiible shock

The nurse is preparing to care for an infant who has esophageal atresia with tracheoesophageal fistula. Surgery is scheduled to be performed in 1 hour. Intravenous fluids have been initiated, and a nasogastric (NG) tube has been inserted by the primary health care provider. The nurse plans care, knowing that which intervention is of highest priority during this preoperative period?

aspirate the NG tube Q 5-10 mins

An ambulatory care nurse is preparing a list of instructions for the parents of a child who is being discharged after a tonsillectomy. The nurse would place which instructions on the list? Select all that apply.

avoid hot fluids avoid raw vegetables for 10 days rest in bed or couch for 24 hours avoid milk products

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which would the nurse most likely expect to note?

bacteriuria

The nurse is caring for a child with a diagnosis of a right-to-left cardiac shunt. On review of the child's record, the nurse would expect to note documentation of which most common assessment finding?

bluish discoloration of the skin -present with symptoms in the first weeks of life -dyspneic after feeding, crying and exertion -lower than normal body weight

The nurse reviews the record of a child who is suspected to have glomerulonephritis and expects to note which finding that is associated with this diagnosis?

brown-colored urine -HTN, BUN elevated, high urine specific gravity

The nursing instructor is reviewing the clinical manifestations of gastroesophageal reflux disease (GERD) in children. The nursing instructor determines that the nursing student understands the material if the student identifies which manifestation(s) as associated with GERD? Select all that apply.

chronic cough abdominal pain hoarse voice recurrent pneumonia

The nurse is performing an assessment on a 2-year-old child with Hirschsprung's disease who is accompanied by a parent. Which finding would the nurse expect to note on assessment?

chronic pattern of constipation

The parents of a newborn with a cleft lip are concerned and ask the nurse when the lip will be repaired. With which statement would the nurse respond?

cleft-lip repair is usually performed during the first months of life

A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child would monitor for which sign, knowing that it indicates a worsening of the condition?

decreased wheezing may signal the inability to move air

The nurse is caring for an infant with congenital heart disease. Which, if noted in the infant, would alert the nurse to the early development of heart failure?

diaphoresis during feedings -early s/s of HF: tachypnea, poor feeding, tachycardia during feeding

A child has been tentatively diagnosed with rheumatic fever. The nurse interprets that this diagnosis is consistent with which laboratory result obtained for this child?

elevated antistreptolysin O titer elevated erythrocyte sedimentation rate leukocytosis positive result on C-reactive protein determination presence of group b strep

The parent of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The parent tells the nurse that the child complains of discomfort on the right side and that ibuprofen is ineffective. Which instruction would the nurse provide to the parent?

encourage the kid to lie on his right side

The nurse assesses the neonate immediately after birth. A tracheoesophageal fistula should be suspected if what condition is present? Jaundice Clubfeet Absence of sucking Excessive amount of frothy saliva in the mouth

excessive amount of frothy saliva in mouth

The clinic nurse reviews the record of a child just seen by a primary health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?

exercise intolerance -decreased CO, left ventricular hypertrophy, pulmonary vascular congestion -activity intolerance, chest pain, dizziness when standing for long periods

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome?

generalized edema

The nurse is caring for a 4-year-old child diagnosed with Kawasaki disease. The nurse notices that the child's urinary output is decreasing, the child's heart rate has increased from a baseline of 90 beats per minute at rest to 130 beats per minute at rest, and a new gallop is noted on cardiac auscultation. Which complication would the nurse suspect?

heart failure

The nurse is creating a plan of care for a child admitted with a diagnosis of Kawasaki disease. In developing the initial plan of care, the nurse would include monitoring the child for signs of which condition?

heart failure -increased respiratory rate, dyspnea, crackles and abdominal distension

The nurse is reviewing the pediatrician's orders for a child diagnosed with Hirschsprung's disease. Which diet would the nurse anticipate to be prescribed for the child?

high protein high calories whole grains, fruits and vegetables

A child with a diagnosis of tetralogy of Fallot exhibits an increased depth and rate of respirations. On further assessment, the nurse notes increased hypoxemia. The nurse interprets these findings as indicating which situation?

hypercyanotic episode

The doctor suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent pulmonary infection. right-to-left shunt of blood. decreased workload on left side of heart. increased pulmonary vascular congestion.

increased pulmonary vascular congestion -shunt of blood is from left to right

The nurse is caring for a child who is recovering from a bronchoscopy that was performed to relieve an airway obstruction related to an aspirated foreign body. Which clinical manifestation would prompt the nurse to contact the primary health care provider immediately?

inspiratory stridor -shows laryngeal spasm`

A 4-year-old child presents to the emergency department with sudden acute abdominal pain and red currant jelly-like stool. The nurse recognizes these findings as indicative of which condition?

intussusception

When assessing for hypertension in an infant, the nurse will expect the infant to exhibit which signs? (Select all that apply.) Dizziness Changes in vision Irritability Head rubbing Waking up screaming in the night

irritability head rubbing waking up screaming in the middle of the night

for biliary atresia

liver transplant may be needed -if untreated death by 2

Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The parent of the child is a registered nurse and asks the nurse why the child needs the medication. What is the most appropriate response to the parent about the action of the medication?

maintain adequate CO

The parent of an 18-month-old child tells the clinic nurse that the child has been having some mild diarrhea and describes the child's stools as "mushy." The parent tells the nurse that the child is tolerating fluids and solid foods. The most appropriate suggestion regarding the child's diet would be to give the child which items?

mashed potatoes with baked chicken -foods that are tolerated well: rice, wheat, potatoes, cereals, yogurt with live cultures, cooked veggies, lean meats

Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is a. atrophic changes in the mucosal wall of intestines. b. hypoactivity of the autonomic nervous system. c. hyperactivity of the sweat glands. d. mechanical obstruction caused by increased viscosity of mucous gland secretions.

mechanical obstruction caused by increased viscosity of mucous gland secretions.

The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What would the nurse expect to note as the most likely finding in this infant?

metabolic alkalosis -decreased Na and K+ -increased pH and bicarbonate -decrease chloride

The nurse is caring for a child diagnosed with Kawasaki disease. Keeping the pathophysiology in mind, the nurse carefully monitors the child for which complication?

myocardial infarction

4-year-old girl is brought to the emergency room. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should a. examine her oral pharynx and report to the physician. b. make her lie down and rest quietly. c. auscultate her lungs and make preparations for placement in a mist tent. d. notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

notify the physician immediately and be prepared to assist with a tracheostomy or intubation. -examining oral pharynx can cause obstruction

A mother arrives at the hospital emergency department with her child, in whom a diagnosis of epiglottitis is documented. Which prescription, if written by the primary health care provider, would the nurse question?

obtain a throat culture -stimulation with a tongue depressor or culture swab could cause laryngospasm causing airway obstruction

A 3-year-old child is seen in the health care clinic, and a diagnosis of encopresis is made. The nurse expects to provide teaching about which client problem?

odor -s/s: soiled clothing, scratching or rubbing anal area, fecal odor without apparent awareness by child, social withdraw

Nursing care of the infant or child with congestive heart failure would include forcing fluids appropriate to age. monitoring respirations during active periods. organizing activities to allow for uninterrupted sleep. giving larger feedings less often to conserve energy.

organizing activities to allow for uninterrupted sleep

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of pneumothorax. bronchodilation. carbon dioxide retention. increased viscosity of sputum.

pneumothorax

An infant is seen in the primary health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and seems never to get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child?

prepare family for surgery

A child is scheduled for a tonsillectomy. The nurse plans care, knowing that which condition would be a priority because it presents the highest risk of aspiration during surgery

presence of loose teeth

The nurse is creating a plan of care for a 10-year-old child diagnosed with acute glomerulonephritis. What is the priority nursing intervention?

promoting bed rest -this is required during the acute phase -fluids are not restricted -provide quiet play -limit visitors to allow rest

After a tonsillectomy, a child is brought to the pediatric unit. The nurse would appropriately place the child in which position?

prone or side lying to help facilitate draining of secretions

A child is receiving cyclosporine following a kidney transplant. The nurse should include which information in the teaching plan about this medication? (Select all that apply.) Optimal time to take medication to decrease pain Recommended foods to take with medication to enhance boosting of immunity Purpose of medication is to suppress rejection How to palpate pulses to check for improved circulation Frequent hand washing

purpose of med frequent hand washing

After a patient returns from cardiac catheterization, the nurse assesses that the pulse distal to the catheter insertion site is weaker. The nurse should elevate the affected extremity. record the data on the nurse's notes. notify the physician of the observation. apply warm compresses to the insertion site.

record the data -this is normal for the first few hours -keep insertion site clean and dry

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually is associated with incontinence. urinary obstruction. recurrent kidney infections. infarction of renal vessels.

recurrent kidney infection

The nurse is caring for a 1-year-old child after cleft palate repair. On completion of feeding, the nurse would plan for which appropriate nursing action?

rinsing the mouth with water

The nurse is caring for a newborn infant after surgical intervention for imperforate anus. The nurse would place the infant in which position in the postoperative period?

side lying with legs extended or prone to keep hips elevated

humidified oxygen is used to

smooth inflamed mucus membranes

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is low Fowler's. prone. supine. squatting.

squatting

vomiting, pain, and irreducible mass at the umbilicus are signs of

strangulated hernia

The nurse is caring for a child diagnosed with Kawasaki disease who has been experiencing a fever. Which other clinical manifestations would the nurse expect if this diagnosis is accurate?

strawberry tongue bilateral conjunctiva erythema 2 cervical lymph nodes 2 cm erythema and peeling of soles and hands fever for more than 5 days

following cleft lip repair, the infant would be positioned

supine or on the opposite side the repaire to prevent the suture line from contacting the bed lenins

A parent arrives at the clinic with a 3-year-old child. The parent tells the nurse that the child has had a fever and a cough for the past 2 days and that this morning the child began to wheeze. Viral pneumonia is diagnosed. Based on the diagnosis, the nurse anticipates that which will be a component of the treatment plan?

supportive treatment -if severely ill hospitalized and oxygen

An early sign of congestive heart failure that the nurse should recognize is tachypnea. bradycardia. inability to sweat. increased urine output.

tachypnea -tachycardia at rest, dyspnea, retractions, activity intolerance -may be diaphoretic -decreased urine output

A child is suspected of suffering from intussusception. The nurse would be alert to which clinical manifestation of this condition?

tender distended abdomen

Gastroschisis occurs when

the bowel herniates through a defect in the abdominal wall to the right of the umbilical cord -no membrane covering the exposed bowel

The clinic nurse is assessing jaundice in a child with hepatitis. Which anatomical area would provide the best data regarding the presence of jaundice?

the nail beds -sclera and mucus membranes

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37°C. The nurse suspects croup and should recommend a. controlling fever with acetaminophen and calling if the cough gets worse during the night. b. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. c. trying over-the-counter cough medicine and coming to the clinic in the morning if there is no improvement. d. admitting to the hospital and observing for impending epiglottitis.

trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.

In a non-potty-trained child with nephrotic syndrome, the best way to detect fluid retention is to weigh the child daily. test the urine for hematuria. measure the abdominal girth weekly. count the number of wet diapers.

weigh the child daily

The nurse is reviewing the record of a child diagnosed with nephrotic syndrome. The nurse would expect to note which finding documented in the child's record?

weight gain -urine is dark,foamy and frothy but only microscopic hematuria is present -urine output decreased

A primary health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation would the nurse administer the oxygen to the infant?

when drawing blood for electrolyte testing -give oxygen whenever the child might cry