STAY FOCUSED PED Exam 4

The nurse is teaching a couple about X-linked disorders. They are concerned that they might pass on hemophilia to their children. Which of the following responses indicates the need for further teaching?

"If the father doesn't have it, then his kids won't either."

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another?

"Keep in mind that the signs of leukemia are often subtle and difficult to recognize."

Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?

"Kids can usually be managed with an oral agent, meal planning, and exercise."

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority?

Calling the doctor if the child gets a sore throat

Which of the following would lead the nurse to suspect that an adolescent has bulimia?

Calluses on back of knuckles

The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which of the following responses from his mother indicates a need for further teaching?

"A product's label indicates whether it is latex-free."

While providing care to a 5-month-old girl whose family has a history of food allergies, the nurse instructs the parents about foods to be avoided in the first year of life. Which response by the parents indicates a need for further teaching?

"Any kind of fruit is acceptable"

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system.

Which of the following would the nurse include when teaching an adolescent about tinea pedis?

"Dry the area between your toes really well."

The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching?

"I can have the nurse administer the chelation therapy if I am uncomfortable."

The nurse is caring for a 2-year old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required?

"I know it will be important for me to catheterize my child for the rest of her life."

The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate?

"I will help you become comfortable in caring for your daughter."

The parents of a 6-year-old male with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response?

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

A nurse is caring for a 12-year-old girl with a severe peanut allergy. The girl's parents are upset because the school does not permit her to carry her EpiPen with her. It must remain in the school's office per school regulations. Which response by the nurse would be most appropriate?

"She is allowed by law to carry her EpiPen with her; I will talk to school authorities."

The nurse is teaching a couple about the pros and cons of genetic testing. Which of the following statements best describes the capabilities of genetic testing?

"Some genetic tests can give a probability for developing a disorder."

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching?

"We will place the liquid in the front of her gums, just below her teeth."

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?

"We'll need to have a match with a donor."

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning?

"Will you show me how you walk across the room?"

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation?

"You will feel pressure on your hip from the needle."

a nurse is caring for a toddler who has hip dysplasia and has been placed in a hip spica cast. the child's guardian asks the nurse why a Pavlik harness is not being used. which of the following responses should the nurse make?

"the Pavlik harness is used for infants less than 6 months of age"

The nurse is caring for a child experiencing a cardiac arrest. The nurse has administered IV epinephrine at 1315. At what time can the nurse administer another dose of epinephrine?

1320

A child who weighs 53 lb is receiving fluid volume replacement as part of the treatment for shock. The nurse is evaluating the child's hourly urinary output to determine if the child's condition is improving. Which output would the nurse interpret as most indicative of improvement?

30 mL

An adolescent weighing 55 kg is admitted to the hospital experiencing a sickle cell crisis. Intravenous fluid therapy as well as increased oral fluids are ordered as part of his treatment plan. Based on the understanding of the amount of fluids needed to promote hemodilution, the nurse would expect the adolescent to receive how much total fluid in 24 hours? __________ mL

8,250 mL

A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control?

8.2%

The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which of the following findings would help confirm this diagnosis?

A distinct "clunk" is heard with Barlow and Ortolani maneuvers.

The nurse is caring for a child who is having an anaphylactic reaction with bronchospasm. The nurse would expect to administer which of the following for bronchospasm as ordered?

ALBUTEROL

A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. Which of the following would the nurse do first?

ASSES FOR PATENT AIRWAY

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform?

Administer broad-spectrum antibiotics intravenously.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?

Administering the measles, mumps, rubella (MMR) vaccine

A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test?

Checking with the parents for any allergies

The nurse working in a pediatric mental health clinic is assessing a 4-year-old child who has suffered from physical abuse. Which type of therapy does the nurse anticipate will be most helpful in developing a trusting relationship as well as assisting in determining the patient's current emotional state?

PLAY THERAPY

The nurse is providing care to a child who is intubated and the child's condition is deteriorating. What would the nurse do first?

Assess for displacement of the tracheal tube

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis?

Bone marrow aspiration

Which mechanism is central to cancers in children?

CELLULAR GROWTH

The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. Which of the following would the nurse include as a major congenital anomaly?

CLEFT PALATE

A 4-year-old is brought to the emergency department with a burn. Which of the following would alert the nurse to the possibility of child abuse?

Clear delineations are noted between burned and unburned skin areas

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock?

Confusion and somnolence

The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a violaceous color with discharge and a foul odor. The nurse suspects which of the following infections?

INVASIVE BURN CELLULITIS

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered?

IV immune globulin

When teaching a group of new parents about newborn care and development, which immunoglobulin would the nurse explain as being primarily responsible for the passive immunity exhibited by newborns?

IgG

When teaching about primary and secondary humoral responses, what should the nurse identify as the immunoglobin that is first to appear in the serum?

IgM

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. Which of the following would the nurse most likely identify as the priority nursing diagnosis?

Deficient fluid volume related to dehydration

The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. Which of the following would the nurse identify as the initial goal for the teaching plan?

Developing management and decision-making skills

How will the nurse teach the client to mix her insulins when administering 30 units regular insulin and 70 units NPH insulin in the morning?

Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.

Which of the following would the nurse expect to find in a male infant with Wiskott-Aldrich syndrome?

ECZEMA

Administration of which medication reverses the histamine release and hypotension that are seen in anaphylaxis?

EPINEPHRINE

A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would anticipate preparing the girl for which diagnostic tests as ordered?

Electrocardiographic monitoring

The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. Which of the following will be the priority nursing diagnosis?

Imbalanced nutrition, less than body requirements related to the effects of hypotonia

A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. Which of the following would be the priority?

Ensuring a patent airway

The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. Which of the following would the nurse include in the plan?

Explaining about the radioactive iodine procedure

A group of students are working on a presentation for a local health fair about safety for children. When developing this presentation, the students would address what cause as the most common in pediatric injury?

FALLS

The nurse is caring for an adolescent girl with anorexia nervosa. Which of the following findings would indicate to the nurse that the girl requires hospitalization?

FOOD REFUSAL

The nurse is assessing a child with suspected thalassemia. Which of the following would the nurse expect to assess

FRONTAL BOSSING

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?

Following guidelines for protective isolation

A group of students are reviewing information about the various types of insulin used to treat type 1 diabetes. The students demonstrate understanding of the information when they identify which insulin listed below as having the longest duration?

GLARGINE

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. Which of the following would the nurse do next?

Give 10 to 15 grams of a simple carbohydrate

The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely?

Grieving related to the child's poor prognosis

A group of nursing students are reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify what as the primary function of this system?

HORMONAL SECRETION

The nurse is reviewing the laboratory test results of a child with Addison disease. Which of the following would the nurse expect to find?

HYPERKALEMIA

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?

Have the parent bring the child to the pediatric oncology clinic as soon as possible.

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching?

He can resume participation in football in 2 weeks."

The nurse is assessing a 9-year-old girl with a history of tuberculosis at age 6 years. She has been losing weight and has no appetite. The nurse suspects Addison disease based on which of the following assessment findings?

Hyperpigmentation and hypotension

After teaching a group of nursing students about shock in children, the instructor determines that the teaching was successful when the students identify which type of shock as most common?

Hypovolemic

A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find?

Impulsivity

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management?

Initiate pain assessment with a standardized pain scale.

The nurse is assessing a 4-year-old boy whose mother was 40 years old when he was born. Which of the following findings suggests this child has a genetic disorder?

Inspection reveals low-set ears with lobe creases.

A child is diagnosed with hyperthyroidism. Which agent would the nurse expect the physician to prescribe?

METHIMAZOLE

When assessing the adolescent with anorexia, which of the following would the nurse expect to find?

MURMUR

The nurse is caring for a child who has undergone stem cell transplantation for severe combined immune deficiency. Which of the following would the nurse interpret as indicative of graft-versus-host disease?

Maculopapular rash

The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform?

Make sure patient eats by 5 PM.

When caring for an 8-year-old boy injured in an automobile accident, the nurse demonstrates understanding of the principles of Pediatric Advanced Life Support (PALS) by which action?

Managing compensated shock to prevent decompensated shock

A nurse is reviewing an article about genetic disorders and patterns of inheritance. The nurse demonstrates understanding of the information by identifying which of the following as an example of an autosomal dominant genetic disorder?

Neurofibromatosis

A 3-year-old child has sustained significant severe burns and is ordered to receive 100% oxygen. Which of the following would the nurse use to administer the oxygen?

Non-rebreather mask

A nurse is caring for a 5-year-old in Buck traction. When conducting a skin examination for signs of pressure ulcers, the nurse pays particular attention to which area?

OCCIPUT

A hospice nurse is providing at-home care to a child with end-stage cancer. The nurse is developing a plan of care to manage the child's pain. Which medications will the nurse likely include?

OPIOIDS

The nurse is caring for an adolescent girl with a suspected anxiety disorder. The girl states that she is constantly double-checking that she has unplugged her curling iron and must make sure that everything is in perfect order in her room before she leaves the house. The nurse interprets these findings as indicating which of the following?

Obsessive-compulsive disorder

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia?

Pernicious anemia

The nurse is caring for a child with idiopathic thrombocytopenic purpura with a platelet count of 24,000 mm3. Which health care provider prescription will the nurse question?

Provide ibuprofen as needed for pain

The nurse is providing care to a child experiencing shock. Which intravenous solution would the nurse expect to administer?

RINGER LACTATE

When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority?

RISK FOR INJURY

A nursing instructor is preparing a class discussion on the benefits and drawbacks associated with genetic advances and the Human Genome Project. Which of the following would the instructor address as a potential problem?

RISK PROFILING

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 g/dL. Which action would the nurse expect to happen next?

Repeat testing within 2 days and prepare to begin chelation therapy as ordered

A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis would best apply to him during therapy?

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy

: The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion?

SPOONED NAILS

The nurse is caring for a 5-year-old. The child's mother reports that he is extremely sensitive to sounds that most people do not notice and that he prefers complete silence. She explains that the boy is resisting going to school due to the noise and commotion. Additionally, the mother states that he will only wear 100% cotton clothing with all of the tags cut out. The nurse interprets these findings as indicating which of the following?

Sensory integration dysfunction

A nurse is providing an in-service program on child abuse for a group of newly hired nurses. When evaluating the effectiveness of the teaching, the nurse determines a need for additional review when the group identifies which of the following as an indicator of possible child abuse?

Sexual behavior that correlates with the child's developmental age

A child with hypogammaglobulinemia is to receive intravenous immunoglobulin (IVIG). Which of the following would be least appropriate for the nurse to do?

Shake the vial after reconstituting it

The nurse is assessing a 6-week-old infant in the home setting. The nurse notes the infant has a regular breathing pattern with brief periods of apnea followed by a respiratory rate of 40. What would the nurse further assess in the infant?

Skin color and heart rate

The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. Which of the following would the nurse include?

Soaking the catheter in a vinegar and water solution to sterilize

A group of nursing students are reviewing information about humoral and cellular immunity. The students demonstrate understanding of this material when they identify what as being involved in cellular immunity?

T CELLS

When assessing a young child who is experiencing decompensated shock, what would the nurse expect to find?

TACHYPNEA

The nurse is caring for a couple who have just learned that their infant has a genetic disorder. Which of the following would be least appropriate for the nurse to do at this time?

Teaching the parents about the child's medical needs

The nurse is caring for an 8-year-old girl with an endocrine disorder involving the posterior pituitary gland. Which of the following would the nurse expect to implement?

Teaching the parents how to administer the desmopressin acetate

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately?

Temperature of 101° F (38.3° C) or greater

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following?

The child has mild to moderate iron deficiency.

The nurse is obtaining the health history for a 15-month-old boy from the parents. The child is not yet speaking. Which finding would be eliminated as a risk factor for a possible genetic disorder?

The child is male and Caucasian

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. Which of the following would the nurse correlate with disorder?

The parents report that their son "can't drink enough water."

The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful?

The process occurs in a head-to-toe fashion.

The physician orders an alkylating agent for a child's chemotherapy. Which best describes an action produced by these types of agents?

They are cell cycle-nonspecific, destroying both resting and dividing cells.

The school nurse is providing information to parents of adolescents about prevention of cervical cancer. Which information is included in the teaching?

Vaccine against human papilloma virus

Which of the following would lead the nurse to suspect that a child has Turner syndrome?

Webbed neck

Which of the following would the nurse expect to assess in a child with hypothyroidism?

Weight gain

The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the physician to order?

antifungals

a nurse is caring for an infant who has myelomeningocele. which of the following actions should the nurse include in the preoperative plan of care?

apply a sterile, moist dressing on the sac

The nurse is administering 10 units of NPH insulin to a child at 8 a.m. The nurse would expect this insulin to begin acting at which time?

b/w 9-11 AM

A group of nursing students are reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state:

infants have difficulty balancing glucose and electrolytes.

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to:

kill enough cancerous cells to induce remission.

A nurse is caring for a 5-year-old girl with depression. The girl is having difficulty coping with her feelings of sadness and fear, which stem from her parents' separation and recent divorce. The girl has been prescribed antidepressant medication but the mother thinks the girl would benefit from therapy. The nurse anticipates a referral to a therapist specializing in which type of therapy?

play therapy

The nurse is administering intravenous immune globulin (IVIG). The nurse assesses vital signs and for adverse reactions every 15 minutes for the first hour of administration. After the first hour, the nurse most likely would continue to assess the child at which frequency?

q. 60 minutes

A group of students are reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material when they identify this disorder as due to which of the following?

x-linked recessive inheritance