PrepU Questions Pediatric Exam #2

The nurse knows that the heads of infants & toddlers are large in proportion to their bodies, placing the at risk for what problem?

Head trauma.

What is ulcerative colitis characterized by?

The disease affecting the intestine(s) in a continuous pattern.

Severe diarrhea could be caused by:

a bacteria or virus.

During the physical examination of a 2 1/2-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed?

-Dramatic increase in head circumference.

A school nurse is trying to prevent poststreptoccoal glomerulonephritis in children. What would be the best way to prevent this?

-Encourage the child to take all the antibiotics if diagnosed with strep throat.

The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse?

-Gathering appropriate equipment & signage for respiratory isolation precautions. -Rationale: Children w/ meningitis are placed on respiratory precautions for 24 hrs after the start of antibiotic therapy to prevent transmission of infection to other family members or HCPs

The nurse is assessing a male neonate & notes that the urethral opening is on the ventral aspect of the penis. Which finding is documented?

-Hypospadias. -Rationale: Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Epispadias is present the the urethral opening is on the dorsal surface the penis. Patent urachus refers to a fistula between the bladder & umbilicus.

A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching?

-Immunosuppression is common after a kidney transplant. -Rationale: A kidney may be transplanted in the child with end stage renal failure as a way of sustaining life & promoting adequate cognitive skills & growth. Because the kidney is a foreign object to the body it can be rejected. To prevent this, immunosuppressants are given, it is extremely important for these medications to be given on schedule.

The nurse is assessing a child following a head injury sustained in a bicycle accident. The child falls asleep frequently unless the parents are talking to the child or the nurse is asking the child questions. How should the nurse document the child's LOC?

-Obtunded. -Rationale: Obtunded is defined as a state in which the child has limited responses to the environment & falls asleep unless stimulation is provided.

The nurse has performed client teaching to a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning occurred?

-"I have to be careful because I am prone to not absorbing nutrients". -Rationale: Chrohn disease typically effects the small intestine more than the large intestine & it's onset is between the ages of 10 to 20 yrs. The cobblestone lesions in the small intestine prevents absorption of nutrients that normally occurs.

The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for?

-"Irritability, fever, & vomiting". -Rationale: Findings associated w/ acute bacterial meningitis may include irritability, fever, & vomiting along w/ seizure activity. Fontanels would be bulging as ICP pressure rises, & Kernigs sign would be present w/ d/t meningeal irritation.

The parent of a 12-year old child with Reye Syndrome approaches the nurse wanting to know how this happened to the child saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent?

-"Sometimes it's hard to tell what products may contain aspirin". -Rationale: Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. Two common medications containing salicylates are bismuth subsalicylate & effervescent heartburn relief anti-acid.

Isabelle age 7, has been complaining of headache, coughing, & an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when Isabelle first said she had a headache, the child's father gave her half an adult aspirin. The mother has heard of Reye syndrome & asks the nurse if her child could get this. Which statement is the best for the nurse to say to this mother?

-"Th might or might not be the problem. Watch Isabelle for signs of lethargy, unusual irritability, confusion or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome". -Rationale: Reye syndrome usually occurs after a viral illness, particularly after an URI or varicella (chicken pox). Administration of aspirin during the viral illness has been implicated as a contributing factor. As a result, the American Academy of Pediatrics recommends that aspirin or aspirin compounds not be given to children w/ viral infections. The symptoms occur w/in 3 to 5 days after the initial illness: The child is recuperating unremarkably when symptoms of severe vomiting, irritability, lethargy, & confusion occurs. Immediate intervention to prevent serious insult to the brain, including respiratory arrest.

The nurse is discussing the treatment of congenital megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?

-"The treatment for the disorder will be a surgical procedure". -Rationale: Treatment of congenital ganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel.

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician?

-Absence of thrill. -Rationale: The nurse should always auscultate the site for the presence of a bruit & palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill. Dialysate without fibrin or cloudiness is normal & used with peritoneal dialysis, not hemodialysis.

What finding is consistent with increased ICP in the child?

-Bulging fontanelle. -Rationale: children w/ increased ICP exhibit bulging fontanels. They typically have decreased appetite, are restless, & have trouble sleeping.

A 4-year-old child is brought to the ED after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing ICP?

-Change in LOC.

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)?

-Cloudy appearance. -Rationale: In the CSF of clients diagnosed w/ bacterial meningitis, the presence is elevated, the appearance is cloudy, & the leukocytes are elevated. A decreased sugar content is noted.

A child is home with the caregivers following a treatment for a head injury. If the child makes which of the following statements, the caregiver should contact the care provider. a) "It will be nice when you will let me take a long nap. I am sleepy." b) "I am glad that my headache is getting better." c) "My stomach is upset. I feel like I might throw up." d) "You look funny. Well, both of you do. I see two of you."

-Correct answer: d) "You look funny. Well, both of you do. I see two of you."

A 10-year-old child in renal failure is on continuous ambulatory peritoneal dialysis. What would be important to teach parents?

-Cramping should not occur with an infusion. -Rationale: Continuous ambulatory peritoneal dialysis is a method which allows mobility for the child. The child should be reassessed for toleration of the fluid volume instilled into the peritoneum. The abdomen pressure should not experience cramping or pain. The dwell time for this type of dialysis is from 3 to 6 hours. The return flow should be clear. A cloudy return flow suggests infection. The dialysate solution will fill from gravity so there is no specified time frame for instillation & will also be affected by the amount of dialysate solution to be instilled.

The nurse is caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is:

-Painless rectal bleeding. -Rationale: With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon.

A nurse is assessing a 3-year old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges?

-Positive Kernig sign.

In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would:

-Prepare the infant for surgery. -Rationale: In pyloric stenosis, the thickened muscle of the pyloric causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy.

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

-Projectile vomiting. -Rationale: During the first few weeks of life, the infant w/ pyloric stenosis often eats well & gains wt & then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency & force, becoming projectile. The child may have constipation, & peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased & urination is infrequent.

The nurse is caring for a 10-year-old boy with end-stage-renal disease (ESRD) with metabolic acidosis. What would the nurse expect to administer if ordered?

-Sodium bicarbonate tablets. -Rationale: Sodium bicarbonate tablets are used for the correction of acidosis.

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools & what looks like fat in the stools. The clinical manifestation this caregiver is describing is:

-Steatorrhea. -Rationale: Celiac disease is an immunologic response to gluten which causes damage to the small intestine. Steattorhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation & nutritional deficiencies.

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

-Tea-colored urine. -Rationale: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as tea or cola colored. Periorbital edema may accompany or precede hematuria.

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care?

-The adolescent will become fatigued easily. -Rationale: Hepatitis A is transmitted via the oral-fecal route; it is water borne & often occurs in areas of poor sanitation. The adolescent with hepatitis A will exhibit flu-like symptoms, a headache, anorexia, & fatigue.

The nurse knows this is a description of peritoneal dialysis when compared to hemodialysis:

-The child can live a more normal lifestyle. -Rationale: The child can live a more normal lifestyle with peritoneal dialysis. This is 7-day-a-week procedure, but there are less diet restrictions & more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

In caring for a child with a seizure disorder. What will be the nurse's primary goal of treatment for this client?

-The child will be free from injury during a seizure.

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would you expect to hear described?

-Vomiting immediately after eating. -With pyloric stenosis the circular muscle pyloric is hypertrophied. This thickness causes gastric outlet obstruction. This condition is seen in younger infants starting at 3 to 6 weeks of age. The infant has projectile non bilious vomiting. It occurs directly after eating & is not related to the feeding position. The infant is hungry shortly after eating. There is weight loss &/or dehydration. The treatment is a pyloromyotomy to reduce the increased size & increase the opening.

An 18-month-old child is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to:

-gastroesophageal reflux. -Rationale: Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus. These refluxed contents may be aspirated into the lungs. The child with GER may present with physical findings of pneumonia or GER-induced asthma.

The nurse is caring for a 12-year-old child with Crohn disease. A primary assessment the nurse would want to make when caring for the child would be to note if:

-the child has a temperature. -Rationale: Crohn disease may affect any area of the digestive tract. It causes acute & chronic inflammation. It may also cause abscesses & fistulas. Inflammation & abscesses can cause increased temperatures. An increasing temperature could be the manifestation of the inflammation worsening or the development of an abscess & subsequent infection.

The student nurse is preparing a presentation on celiac disease. What information should be included?

1.) "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, & dental disorders". 2.) "The only treatment for celiac disease is a strict gluten free-diet." 3.) "Gluten is found in most wheat products, rye, barley & possibly oats".

A mother brings her 2-week-old newborn to the doctor's office because the child has been experiencing gastroesophageal reflux over the past week. Which interventions should the nurse recommend to the mother at this point? Select all that apply.

1.) Feed the infant with thickened rice cereal. 2.) Feed the infant while holding her in an upright position. 3.) Keep the infant upright in an infant chair for 30 minutes after eating.

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness using three parts. What would the nurse assess? Select all that apply.

1.) Motor response. 2.) Eye opening. 3.) Verbal response.

What is full conscious described as?

Fully conscious describes as child who has no neurological changes.

The nurse is assessing a 10-day infant for dehydration. Which finding indicates moderate/moderate dehydration?

Soft & flat fontanels.

When does stupor exist?

Stupor exists when the child only responds to vigorous stimulation.

The nurse is assessing a 10-day infant for dehydration. Which finding indicates severe dehydration?

Tenting of the skin.

Which goal of therapy would be appropriate for a nurse to establishing with a client's family and a client who has a diagnosis of enuresis?

The client remains continent throughout the night.

A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. Which of the following would indicate that the child is regurgitating as opposed to vomiting? a) Is curdled and extremely sour smelling b) Continues until stomach is empty c) Is projected 1 ft away from infant d) Only occurs with feeding

d.) only occurs with feeding.

Currant jelly stools is a sign of:

intussception.