Exam 3

A school-age child diagnosed with classic hemophilia is admitted to the hospital for hemorrhage into the knee joint. Which nursing diagnosis should the nurse use to plan care for this child? 1. Risk for Impaired Physical Mobility related to joint stiffness and contractures 2. Risk for Impaired Tissue Perfusion (cerebral) related to blood loss. 3. Activity Intolerance related to bleeding 4. Disturbed Body Image related to swollen knee

1 (A bleed into the joint can lead to permanent contracture of the joint. Bone changes can result from the immobility associated with the bleed. Bleeding into the knee joint tends to be limited and decreased blood flow to the brain is unlikely. Activity intolerance is not the best diagnosis for this child. Although the knee will be swollen, body image is not the priority diagnosis at this time.)

The nurse is planning a teaching session for the parents of a child who is diagnosed with simple partial seizures. Which causes should the nurse include when teaching the parents? Select all that apply. 1. Lesions 2. Cysts 3. Tumor 4. Brain abscesses 5. Brain trauma

1, 2, 3, and 4 (Lesions are a cause of simple partial seizures. Cysts are a cause of simple partial seizures. Tumors are a cause of simple partial seizures. Brain abscesses are a cause of simple partial seizures. Brain trauma a cause of complex partial seizures.)

A child diagnosed with hemophilia presents to the emergency department (ED) with multiple injuries following a motor vehicle crash. Which injury is the priority when conducting the nursing assessment? 1. Occipital hematoma 2. Radial fracture 3. Dislocated shoulder 4. Abdominal abrasions

1 (A potential intracranial bleed would receive highest priority because of the danger of increased intracranial pressure and potential neurologic damage. Although at risk for bleeding, this would not take priority over a head injury. A dislocation is not at high risk for bleeding or tissue ischemia. Although at risk for bleeding, this would not take priority over a head injury.)

Which menu choices for a child who is diagnosed with renal failure and experiencing hyperkalemia indicate the need for further instruction by the nurse? 1. Carrots and green, leafy vegetables 2. Spaghetti and meat sauce with breadsticks 3. Hamburger on a bun and cherry gelatin 4. Chips, cold cuts, and canned foods

1 (Carrots and green, leafy vegetables are high in potassium. Spaghetti and meat sauce with breadsticks would be acceptable choices for a low-potassium diet. Hamburger on a bun with cherry gelatin would be acceptable choices for a low-potassium diet. Chips, cold cuts, and canned foods are high in sodium but not necessarily in potassium.)

The nurse is providing care to a child diagnosed with hemophilia who states, "I am going to join a bike club at school." Which recommendation should the nurse give to the child? 1. Wear knee pads, elbow pads, and a helmet while bicycling. 2. Consider a swim club instead of the bicycling club. 3. Do not join the club. 4. Participate only in the social activities of the club.

1 (Children with hemophilia should be encouraged to participate in noncontact sports activities. Bicycling is an excellent option, and is recommended, along with swimming. However, the child should always use knee pads, elbow pads, and a helmet when participating in any physical sport. Biking is an acceptable sport as long as protective equipment is worn, and the child should be encouraged to make choices when possible. Discouraging a child from joining a club would not foster growth and development. Participating only in the social aspects of the club would not encourage physical activity.)

The nurse is preparing medication instruction for a child who has undergone a kidney transplant and is prescribed cyclosporine. The parents ask the nurse about the reason for the cyclosporine. Which rationale for this medication should the nurse include in the response? 1. Suppress rejection 2. Decrease pain 3. Improve circulation 4. Boost immunity

1 (Cyclosporine is given to suppress rejection. Cyclosporine does not decrease pain. Cyclosporine does not affect circulation. Cyclosporine does not boost immunity.)

A 9-month-old infant who is not sitting independently has been diagnosed with ataxic cerebral palsy (CP). Which clinical manifestations would the nurse expect to see in the baby? 1. Hypotonia and muscle instability 2. Hypertonia and persistence primitive reflexes 3. Tremors and exaggerated posturing 4. Hemiplegia and hypertonia

1 (Hypotonia in infancy and muscle instability are seen in ataxic CP. Hypertonia and persistent primitive reflexes are seen in spastic CP. Tremors and exaggerated posturing are seen in dyskinetic CP. Hemiplegia and hypertonia are seen in spastic CP.)

Which nursing action is appropriate when treating a school-age child, diagnosed with hemophilia, for a superficial wound above the knee? 1. Applying pressure to the area 2. Applying a warm, moist pack to the area 3. Performing some passive range-of-motion to the affected leg 4. Keeping the affected extremity in a dependent position

1 (If a child with hemophilia experiences a bleeding episode, superficial bleeding should be controlled by applying pressure to the wound. Heat would increase the bleeding by dilating the superficial blood vessels. A cool compress should be applied. The extremity should be immobilized to prevent further bleeding; passive range-of-motion could cause further bleeding at the site. The extremity should be elevated, if possible, to prevent swelling at the site.)

Which is the priority nursing diagnosis when planning care for a pediatric client who is diagnosed with bacterial meningitis? 1. Impaired Gas Exchange 2. Risk for Infection 3. Anxiety (parental) 4. Acute Pain

1 (Impaired gas exchange would be the priority to ensure patent airway and adequate gas exchange. The child already has an infection. The parents will be anxious about the outcome for their child, but this is not the priority diagnosis. Pain management is important but is not the priority.)

Which clinical manifestations should the nurse anticipate when assessing a child who has been admitted to the hospital unit with a diagnosis of minimal change nephrotic syndrome (MCNS)? 1. Massive proteinuria, hypoalbuminemia, and edema 2. Hematuria, bacteriuria, and weight gain 3. Urine specific gravity decreased and urinary output increased 4. Gross hematuria, albuminuria, and fever

1 (Nephrotic syndrome is an alteration in kidney function secondary to increased glomerular basement membrane permeability to plasma protein. It is characterized by massive proteinuria, hypoalbuminemia, and edema. Bacteriuria and fever are associated with a urinary tract infection. Because of the edema, a weight gain, not a weight loss, would be seen. In MCNS, the urine output decreases and the specific gravity of urine increases. Gross hematuria and hypertension are associated with glomerulonephritis.)

The nurse is providing care for a pediatric client in the emergency department (ED) with a diagnosis of decreased level of consciousness (LOC) secondary to increased intracranial pressure (ICP). Which healthcare provider order should the nurse question? 1. Passive range-of-motion exercises to promote hip flexion 2. Oxygen at 2 L nasal cannula to keep saturation above 95% 3. Hourly vital signs and neurologic checks 4. Elevate head of bed 30 degrees

1 (Range-of-motion exercises, especially hip flexion, would not be done. It is imperative to keep the child with increased intracranial pressure quiet, with as little stimulation as possible. Oxygen should be ordered to keep the child's O2 saturation above 95%. Hourly vital signs and neurologic checks are appropriate to watch for changes in this child's condition. The head is elevated 30 degrees to help decrease increased intracranial pressure.)

A preschool-age child is admitted to the hospital with acute postinfectious glomerulonephritis (APIGN) and is admitted to the hospital. Which is the priority nursing diagnosis for this child? 1. Risk for Injury related to hypertension. 2. Altered Growth and Development related to a chronic disease. 3. Risk for Infection related to hypertension. 4. Fluid Volume Excess related to decreased plasma filtration.

1 (The child with APIGN has marked hypertension, which can lead to cardiac failure and cerebral injuries. Growth and development are not normally affected because this is an acute process, not a chronic one. While a risk for infection might be present, it is not related to the hypertension. Although fluid retention occurs, this is not the priority diagnosis.)

Which teaching topic should the nurse include in the discharge instructions for the family of child diagnoses with sickle-cell disease to prevent crisis? 1. Respiratory infection and dehydration 2. Mid-range altitudes 3. Weight loss without dehydration 4. Overhydration

1 (The child with sickle-cell disease is at risk for infection, and dehydration can precipitate crisis. High altitudes with lower oxygen concentrations pose a risk; mid-altitude is not a risk factor. Weight loss is acceptable as long as hydration is maintained. Hydration should be encouraged; risk of overhydration is minimal.)

Which assessment finding for a 4-month-old infant would require further action by the nurse? 1. The posterior fontanel is open. 2. The infant has good head control when held upright. 3. The infant is able to roll only from abdomen to back. 4. The anterior fontanel is open and soft.

1 (The posterior fontanel closes between 2 and 3 months of age. Good head control is expected at 4 months of age. Rolling from abdomen to back is a skill the 4-month-old infant should be learning. An open anterior fontanel, which is soft, is a normal finding at 4 months.)

The nurse is providing care to a child who was treated with aspirin during a viral infection. Which clinical manifestations should cause the nurse concern? 1. Nausea, vomiting, and confusion 2. Headache, vomiting, and seizures 3. Sore throat, moist respirations, and cough 4. Fever, rash, and photophobia

1 (These are the early symptoms of Reye syndrome. These symptoms are associated with a malfunctioning shunt and not the early symptoms of Reye syndrome. These symptoms are more likely to indicate pneumonia, not Reye syndrome. These are not the early symptoms of Reye syndrome.)

The nurse is unsuccessful in inserting a nasogastric tube for a newborn client. The nurse suspects the newborn has esophageal atresia/tracheoesophageal (EA/TE) fistula. Which nursing action is appropriate while waiting for the healthcare provider to further assess the neonate? 1. Position the newborn in semi-Fowler position. 2. Allow the newborn to be taken to the mother's room for bonding. 3. Offer the newborn formula feeding instead of breastfeeding. 4. Wrap the newborn in blankets and place in a crib by the viewing window.

1 (This will reduce stomach juices from being aspirated into the lungs. Because an anomaly is suspected, the newborn should remain under visualization until the diagnosis is confirmed and medical orders determined. If an EA/TE fistula is suspected, the feeding should be withheld until the diagnosis is confirmed or cleared. A newborn wrapped in blankets cannot be observed clearly. The child should be placed in an over-bed warmer.)

Which assessment questions should the nurse include in the psychosocial assessment to determine the effects of chronic renal failure treatments on the growth and development of a school-age child? Select all that apply. 1. "How does it make you feel to have to follow a special diet?" 2. "Do you take your medications every day?" 3. "How does it make you feel to undergo dialysis treatments?" 4. "Do you attend school each day?" 5. "How does it make you feel when your parents come home late from work?"

1 and 3 (While it is important to assess medication use, this question is not appropriate for the psychosocial portion of the assessment. School-age children are often embarrassed about being seen as different from peers. It is appropriate for the nurse to ask the child how it feels to have to undergo dialysis treatments. While it is important to determine if the child attends school every day, this question is not appropriate for the psychosocial portion of the assessment. This question will not help the nurse to determine the effects of the treatments for chronic renal failure on the child's growth and development.)

Which preventative strategies should the nurse include in a teaching session for a mother whose infant is at risk for febrile seizures? Select all that apply. 1. Increasing oral intake of fluids 2. Administering dose-appropriate aspirin 3. Providing a sponge bath with cold water 4. Decreasing oral fluid intake 5. Patting the child dry after a tepid bath

1 and 5 (Fluid intake will help heat loss. Aspirin should be avoided due to the risk for Reye syndrome. Cold water may cause shivering, which will increase the body temperature. Decreasing fluid intake would increase the retention of heat. A tepid bath will bring down the temperature; patting, instead of rubbing, will help keep the child's temperature down.)

Which should the nurse include in the plan of care for a hospitalized school-age child with myelodysplasia? Select all that apply. 1. Implementing interventions for a client of normal intelligence 2. Using latex precautions when providing client care 3. Allowing the client to self-catheterize 4. Ensuring that the client has a low-fiber diet 5. Encouraging the client to shift positions hourly when in the wheelchair

1, 2, 3, and 5 (Many children with myelodysplasia have normal intellect. They should be treated according to their intellectual level rather than their motor development. Children with myelodysplasia are at great risk for latex allergy. It is important to use latex-free products. Self-catheterization fosters independence in this child. It is important to maintain the same schedule as much as possible when this child is hospitalized. Children with myelodysplasia need a high-fiber diet to maintain adequate stool and bowel function. Due to decreased sensation in the buttocks and lower extremities, it is very important for the child to shift positions while in the wheelchair, to prevent pressure sores.)

Which nursing diagnoses should the nurse include in the plan of care for a pediatric client diagnosed with cerebral palsy? Select all that apply. 1. Risk for Constipation 2. Impaired Tissue Integrity 3. Impaired Verbal Communication 4. Acute Pain 5. Risk for Delayed Development

1, 2, 3, and 5 (This is an appropriate nursing diagnosis for a pediatric client diagnosed with cerebral palsy. This is an appropriate nursing diagnosis for a pediatric client diagnosed with cerebral palsy. This is an appropriate nursing diagnosis for a pediatric client diagnosed with cerebral palsy. Chronic, not acute, pain is an acute nursing diagnosis for a pediatric client diagnosed with cerebral palsy. This is an appropriate nursing diagnosis for a pediatric client diagnosed with cerebral palsy.)

A school-age child is admitted to the hospital in a sickle-cell crisis. Which actions should the nurse include in the plan of care to address the child's pain? 1. Administering opioid analgesics, per order 2. Administering nonsteroidal anti-inflammatory drugs (NSAIDs), per order 3. Applying cold packs to affected joints, prn 4. Encouraging oral fluid intake 5. Maintaining bed rest

1, 2, 4, and 5 (Narcotics, such as morphine, are used to control the pain and reduce sickling. NSAIDs may be used in combination with narcotics to control the pain. Cold application is inappropriate in this situation as it would increase the sickling. Oral fluids will help "thin" the blood and reduce sickling. Bed rest will reduce the oxygen requirements of the body and prevent further sickling.)

Which clinical manifestations support the diagnosis of viral meningitis? Select all that apply. 1. Abrupt onset of fever 2. Headache 3. Myalgia 4. Hemorrhagic rash 5. Purpura

1, 2, and 3 (Abrupt onset of fever is a clinical manifestation associated with viral meningitis. Headache is a clinical manifestation associated with viral meningitis. Myalgia is a clinical manifestation associated with viral meningitis. Hemorrhagic rash is a clinical manifestation associated with bacterial, not viral, meningitis. Purpura is a clinical manifestation associated with bacterial, not viral, meningitis.)

Which concepts should the nurse include in the discharge instructions for a child who has undergone a hematopoietic stem cell transplantation (HSCT)? Select all that apply. 1. Keeping the child on a high-calcium diet 2. Practicing good hand washing 3. Avoiding live plants and fresh vegetables 4. Avoiding influenza vaccinations 5. Returning the child to school within 6 weeks

1, 2, and 3 (The child should be placed on calcium supplements to reduce the risk of osteopenia. Hand washing is essential to prevent the spread of infection. Live plants and fresh vegetables can carry bacteria; they should be avoided to decrease the risk of infection.The child cannot return to school for 6 to 12 months after an HSCT. In-hospital or in-home schooling is required. The child and the family should be encouraged to get a yearly influenza vaccination.)

Which nutritional interventions should the nurse include in the plan of care for a pediatric client who is receiving peritoneal dialysis in the treatment of chronic renal failure? Select all that apply. 1. Provide small, frequent meals. 2. Avoid battles over nutritional intake. 3. Administer supplements by tube feedings, if needed. 4. Implement hand hygiene frequently. 5. Perform daily catheter site care.

1, 2, and 3 (The child will feel full with smaller amounts of food because of the dialysate. The child will be more inclined to eat if there is less stress. Adequate nutrition is important for growth and development, and must be supported if oral intake is inadequate. This intervention is appropriate to prevent infection; it is not a nutritional intervention. This intervention is appropriate to prevent infection; it is not a nutritional intervention.)

Which actions should the nurse implement when assessing the physical growth for a child who is diagnosed with chronic renal failure? Select all that apply. 1. Asking the child to step on the scale 2. Measuring the child's height 3. Measuring the child's head circumference 4. Using the Denver II with the child 5. Monitoring the child's blood pressure

1, 2, and 3 (Weight is a physical growth assessment parameter the nurse uses for a child diagnosed with chronic renal failure. Height is a physical growth assessment parameter the nurse uses for a child diagnosed with chronic renal failure. Head circumference is a physical growth assessment parameter the nurse uses for a child diagnosed with chronic renal failure. The Denver II is a developmental assessment tool. It is not used to assess physical growth. Blood pressure is not a criterion used to measure physical growth.)

Which factors in the maternal medical history should cause the nurse concern regarding the development of cleft lip or cleft palate during pregnancy? Select all that apply. 1. Cigarette smoking 2. Alcohol use 3. Excessive folate intake 4. Glucocorticoid use 5. Anticoagulant use

1, 2, and 4 (Cigarette smoking during pregnancy is a risk factor for cleft lip and cleft palate. Alcohol use during pregnancy is a risk factor for cleft lip and cleft palate. Excessive folate intake is not a risk factor for cleft lip and cleft palate. A folate deficiency is often the cause for these disorders. Glucocorticoid use is a risk factor for cleft lip and cleft palate. Anticoagulant use is not a risk factor for cleft lip and cleft palate.)

Which statements should the nurse include in a presentation related to the general function of the gastrointestinal (GI) system for parents of pediatric clients? Select all that apply. 1. "The GI tract is responsible for the ingestion and absorption of food." 2. "Newborns have smaller stomachs but increased peristalsis." 3. "All children require smaller, more frequent feedings." 4. "Infants lack certain digestive enzymes which increases the risk for regurgitation." 5. "By the second year of life a child is able to accommodate three meals each day."

1, 2, and 5 (This statement is correct. The GI system is responsible for the ingestion and absorption of food. This statement is correct. Newborns have smaller stomachs but an increased rate of peristalsis. This statement is false. All children do not require smaller, more frequent feedings. This statement is true for newborns and infants. This statement is false. While infants do lack certain digestive enzymes, this does not increase regurgitation but causes abdominal distention due to gas. This statement is true. By the second year of life children are able to accommodate three meals each day.)

A neonate is born with a bilateral cleft lip that was not detected during the pregnancy. The parents are distressed about the appearance of their infant. Which nursing actions are appropriate to assist the parents to bond with their newborn? Select all that apply. 1. Calling the newborn by the chosen name 2. Keeping the newborn's lower face covered with the blanket 3. Smiling and talking to the newborn in the parents' presence 4. Showing the parents before and after pictures of other children with cleft lips 5. Discussing positive features of the baby

1, 3, 4, and 5 (This behavior humanizes the child to the parents and is appropriate. This indicates that the infant's appearance is distressing. Although the nurse would want to shield the child from a visitor's stare, the nurse would not want to hide the child from her own family. This indicates acceptance of the infant by the nurse. It is usually not appropriate to show before and after pictures as you cannot predict the success of the surgery on this child. But in the case of cleft lip, the improvement will be significant and it is considered acceptable to show before and after pictures. Statements like, "Your baby is the sweetest thing—she never cries," can help the parents recognize positive features about their baby.)

Which risks should the nurse closely assess a pediatric client for during the posttransplant phase of hematopoietic stem cell transplantation (HSCT)? 1. Hemorrhage 2. Thrombosis 3. Pancytopenia 4. Infection 5. Fluid volume overload

1, 3, and 4 (1. Suppression of platelets increases the risk for bleeding. 2. There is no increased risk for thrombosis. 3. It takes 2 to 4 weeks for the bone marrow to begin producing cells; the client will show evidence of suppression until that time. 4. Suppression of white blood cells increases the client's risk for infection. 5. There is no increased risk of excess fluid; the client is at greater risk for dehydration.)

Which nursing actions are appropriate to assess growth and development for an adolescent client diagnosed with chronic renal failure? Select all that apply. 1. Using the Denver II during a health maintenance visit 2. Educating parents on normal milestones 3. Monitoring for delayed sexual maturation 4. Comparing blood pressure values from previous visit 5. Plotting height and weight measurements

1, 3, and 5 (The Denver II is a developmental assessment tool that is appropriate for the nurse to use when assessing growth and development for an adolescent client diagnosed with chronic renal failure. It is appropriate for the nurse to educate the client's parents on normal milestones; however, this is not a nursing assessment. Monitoring for delayed sexual maturation is appropriate when assessing growth and development for an adolescent client diagnosed with chronic renal failure. Blood pressure is not a growth and development parameter. Plotting height and weight measurements is an appropriate nursing action to assess growth and development for an adolescent client diagnosed with chronic renal failure.)

The nurse is teaching a mother of a young child with a newly diagnosed seizure disorder. The child is prescribed valproic acid (Depakote) for control of seizures. Which parental statement indicates the need for further education? 1. "I will not use carbonated beverages to dilute his medication." 2. "I will give his medicine on an empty stomach so he will absorb it better." 3. "I will not let him chew his tablet." 4. "I will bring him to the physician's office for regular blood work to check bleeding times."

2 (Carbonated beverages should never be used to dilute valproic acid. Valproic acid (Depakote) should be given with foods to decrease gastrointestinal irritation. This child should not be allowed to chew a valproic acid tablet. It is appropriate to have periodic blood studies to check bleeding times and platelet count.)

A child who has beta-thalassemia is receiving numerous blood transfusions and deferoxamine (Desferal) therapy. The parents ask how the deferoxamine will help their child. Which response by the nurse is accurate? 1. "It stimulates red blood cell production." 2. "It prevents iron overload." 3. "It provides vitamin supplementation." 4. "It decreases the risk of transfusion reactions."

2 (Desferal does not stimulate red blood cell production. Iron overload can be a side effect of a hypertransfusion therapy. Desferal is an iron-chelating drug that binds excess iron so it can be excreted by the kidneys. It does not prevent blood transfusion reactions, stimulate red blood cell production, or provide vitamin supplementation. Desferal does not provide vitamin supplementation. Desferal does not prevent blood transfusion reactions.)

Which urinalysis result should the nurse anticipate for a child who is admitted with acute glomerulonephritis? 1. Bacteriuria and increased specific gravity 2. Hematuria and proteinuria 3. Proteinuria and decreased specific gravity 4. Bacteriuria and hematuria

2 (Glomerulonephritis is an inflammation of the glomeruli of the kidneys. The clinical manifestation of glomerulonephritis is grossly bloody hematuria with mild to moderate proteinuria, and because the urine is concentrated, the specific gravity is increased. Glomerulonephritis is an inflammation of the glomeruli of the kidneys. Because the urine is concentrated, the specific gravity is increased. Glomerulonephritis is an inflammation of the glomeruli of the kidneys. Bacteriuria is not present.)

An adolescent client reports recurrent abdominal pain with diarrhea and bloody stools. Which type of inflammatory bowel disease does the nurse suspect based on these data? 1. Necrotizing enterocolitis (NEC) 2. Ulcerative colitis (UC) 3. Crohn disease 4. Appendicitis

2 (NEC is usually seen in premature infants and generally not in an adolescent client. Diarrhea and bloody stools are typical symptoms of UC. The teen with Crohn disease might have abdominal pain and diarrhea, but stools usually do not have blood in them. Appendicitis is not associated with bloody stools and usually not with diarrhea.)

Which assessment finding, after the dialysate is drained during peritoneal dialysis for a child experiencing acute renal failure, would warrant further action by the nurse? 1. The dialysate is clear on return. 2. The volume of drained dialysate is less than the volume infused. 3. The child is restless, wanting to get up and play. 4. The child's vital signs are basically the same as were noted on infusion.

2 (This is a normal finding and does not require reporting. This indicates fluids are being retained and is not desirable. The healthcare provider should be notified. This could indicate the child is feeling better. It is a desired effect and does not require reporting to the healthcare provider. This is an expected finding. No dramatic differences in vital signs should be noted.)

Which is the appropriate nursing intervention when providing care to a child, diagnosed with nephrotic syndrome, who is edematous and on bed rest? 1. Monitor blood pressure every 30 minutes. 2. Reposition every 2 hours. 3. Limit visitors. 4. Encourage fluids.

2 (Vital signs are taken every 4 hours. A child with severe edema, on bed rest, is at risk for altered skin integrity. To prevent skin breakdown, the child should be repositioned every 2 hours. The child needs social interaction, so visitors should not be limited. Fluids need to be monitored; they should not be encouraged.)

The nurse is providing care to a newborn client who presents in the pediatric clinic for a 2-week health maintenance visit. The parents of the newborn are concerned, as their baby has "gas all the time." Which responses from the nurse are appropriate? Select all that apply. 1. "Your baby has a relaxed lower esophageal sphincter, which is causing the gas." 2. "Your baby lacks the enzyme amylase, which is causing the gas." 3. "Your baby lacks the enzyme insulin, which is causing the gas." 4. "Your baby has an immature liver, which is causing the gas." 5. "Your baby lacks an enzyme that helps to digest fats, which is causing the gas."

2 and 5 (Newborns and infants do have a relaxed lower esophageal sphincter; however, this is not responsible for gas but for frequent regurgitation of small amounts of oral feedings. Newborns and infants lack several enzymes that assist with the digestive process. One of these enzymes is amylase, which assists with carbohydrate digestion. The lack of this enzyme causes abdominal distention due to gas. Insulin is not an enzyme and is not lacking in the newborn. While newborns and infants do have immature livers, that is not what is causing the gas. Lipase is a digestive enzyme that assists in fat digestion. Infants and newborns do lack this enzyme, which would cause abdominal distention due to gas.)

Which laboratory tests should the nurse prepare to draw when admitting a pediatric client with possible obstructive uropathy? Select all that apply. 1. Platelet count 2. Blood urea nitrogen (BUN) 3. Partial thromboplastin time (PTT) 4. Blood culture 5. Creatinine

2 and 5 (Platelet count is drawn when a bleeding disorder is suspected. BUN is a serum laboratory test for kidney function. Obstructive uropathy is a structural or functional abnormality of the urinary system that interferes with urine flow and results in urine backflow into the kidneys; therefore, the BUN will be elevated. PTT is drawn when a bleeding disorder is suspected. A blood culture is done when an infectious process is suspected. Creatinine is a serum laboratory test for kidney function. Obstructive uropathy is a structural or functional abnormality of the urinary system that interferes with urine flow and results in urine backflow into the kidneys; therefore, the creatinine will be elevated.)

Which statements, made by the adolescent following dietary teaching for Crohn disease, indicate correct understanding of the content presented by the nurse? Select all that apply. 1. "I can promote solid stools by increasing fiber in my diet." 2. "Small, frequent meals are preferred over three meals a day." 3. "I should identify foods that cause distress and eliminate them from my diet." 4. "High-calorie dietary supplement shakes can help me to meet my nutritional requirements." 5. "Socialization during my meal times is important even if my parents do not agree with my food choices."

2, 3, and 4 (Fiber should be decreased, not increased, as diarrhea is one of the symptoms of Crohn disease. This is correct information. This is individualizing the diet and is appropriate. This addition provides an easy way to meet the nutritional needs. Stress should be avoided at mealtimes.)

Which parental statements regarding precipitating factors for sickle-cell disease indicate correct understanding of the discharge information presented by the nurse? Select all that apply. 1. "My child should avoid regular exercise." 2. "We should provide acetaminophen or ibuprofen to treat fever." 3. "Our child needs to drink lots of fluid to avoid dehydration when playing sports." 4. "High altitudes can cause exacerbation and should be avoided." 5. "Fluid restriction is necessary to avoid exacerbations from occurring."

2, 3, and 4 (Regular exercise and increased fluid intake are recommended activities for a child with sickle-cell disease and will not contribute to a sickle-cell crisis. Fever, dehydration, and altitude are all precipitating factors contributing to a sickle-cell crisis. Fever, dehydration, and altitude are all precipitating factors contributing to a sickle-cell crisis. Fever, dehydration, and altitude are all precipitating factors contributing to a sickle-cell crisis. Regular exercise and increased fluid intake are recommended activities for a child with sickle-cell disease and will not contribute to a sickle-cell crisis.)

Which complications should the nurse monitor for when providing care to a child who is having hemodialysis for the treatment of kidney failure? Select all that apply. 1. Migraines 2. Hypotension 3. Infections 4. Fluid overload 5. Shock

2, 3, and 5 (Migraines are not a clinical manifestation associated with hemodialysis. Rapid changes in fluid and electrolyte balance during hemodialysis can lead to hypotension. Infection is another complication that may occur during hemodialysis. Fluid overload is not a clinical manifestation associated with hemodialysis. Rapid changes in fluid and electrolyte balance during hemodialysis can lead to shock.)

Which instructions should be provided to the parents of a 4-year-old girl who has experienced chronic urinary tract infections (UTIs) in the last 2 years? Select all that apply. 1. Wear only nylon underwear for better air flow. 2. Teach the child to wipe from front to back. 3. Encourage the child to take long baths by allowing the child bubbles and toys in the tub. 4. Encourage the child to drink additional fluids throughout the day. 5. Plan potty breaks every 2 hours throughout the day.

2, 4, and 5 (The child should wear cotton underwear. This prevents bacteria from the rectum from being introduced into the urethra. Bubble baths should be avoided. Extra fluids will "wash" bacteria out of the bladder. Children get so involved in playing that they often hold their urine. Voiding every 2 hours will reduce the time for bacteria to grow in the bladder.)

Which assessment data would cause the nurse to suspect that a 3-year-old child has Hirschsprung disease? 1. Clay-colored stools and dark urine 2. History of early passage of meconium in the newborn period 3. History of chronic, progressive constipation and failure to gain weight 4. Continual bouts of foul-smelling diarrhea

3 (Clay-colored stools and dark urine are not associated with Hirschsprung disease. The infant with Hirschsprung disease often has delayed meconium stools. These are symptoms of Hirschsprung disease in an older infant or child. Diarrhea is not typical; obstruction is more likely.)

Which side effect should the nurse include in the parent teaching for a child who is prescribed a baclofen pump for cerebral palsy? 1. Diarrhea 2. Hypertonia 3. Hypotonia 4. Restlessness

3 (Continuous baclofen infusion does not cause diarrhea. Hypertonia is not seen as a side effect of baclofen infusion. Hypotonia is possible if the child is getting too much baclofen. Restlessness is not seen with baclofen; rather, these children can be drowsy and sleepy.)

Which clinical manifestations should the nurse anticipate upon assessment for a preschool-age child with a urinary tract infection (UTI)? 1. Headache, hematuria, and vertigo 2. Foul-smelling urine, elevated blood pressure (BP), and hematuria 3. Urgency, dysuria, and fever 4. Severe flank pain, nausea, and headache

3 (Hematuria might be present, but there will be no complaints of headache or vertigo. While foul-smelling urine and hematuria can be present, there is no elevated BP, headache, or vertigo. Clinical manifestations of UTI in a preschool-age child include fever, urgency, and dysuria. There could be flank pain, although the preschooler might be unable to describe it. There will be no complaints of headache.)

Which parental statement at the end of a teaching session by the nurse indicates correct understanding of colostomy stoma care for the infant client? 1. "We will change the colostomy bag with each wet diaper." 2. "We will expect a moderate amount of bleeding after cleansing the area around the stoma." 3. "We will watch for skin irritation around the stoma." 4. "We will use adhesive enhancers when we change the bag."

3 (Physical or chemical skin irritation can occur if the appliance is changed too frequently, or with each wet diaper. Bleeding is usually attributable to excessive cleaning. Skin irritation around the stoma should be assessed; it could indicate leakage. Adhesive enhancers should be avoided on the skin of infants. Their skin layers are thin, and removal of the appliance can strip off the skin.)

Which is the priority teaching point for the nurse to include in the discharge instructions for the parents of a child who was admitted in a sickle-cell crisis? 1. Rapid weaning of pain medications 2. A diet high in protein 3. Adequate hydration 4. Restriction of activities

3 (Rapid weaning is not necessary; reduction of pain medication should proceed at a rate dictated by the child's pain. A high-protein diet is not necessary; a well-balanced diet should be promoted. Adequate hydration will help prevent further sequestration and crisis. Normal activities are not restricted.)

Which parental action, observed during a home care visit for an infant diagnosed with gastroesophageal reflux, requires intervention by the nurse? 1. The infant's formula has rice cereal added. 2. The mother holds the infant in a high Fowler position while feeding. 3. After feeding, the infant is placed in a car seat. 4. The mother draws up the ranitidine (Zantac) in a syringe for oral administration.

3 (Rice cereal thickens the formula and helps prevent regurgitation. This is appropriate. This position will help prevent regurgitation and is appropriate. Infant seats are not recommended, as they put pressure on the abdomen and may contribute to regurgitation. Since dosing is small, it is appropriate to use a syringe for accurate measurement.)

A toddler is admitted to the surgical unit for a planned closure of a temporary colostomy. Which medical prescription should the nurse question? 1. Clear liquids today. NPO tomorrow 2. Type and cross-match for 1 unit of packed red blood cells. 3. Rectal temperatures every 4 hours 4. Start an intravenous line with D5NS at 20 mL per hour.

3 (This is appropriate in anticipation of surgery. Although not always required during surgery, this would not be inappropriate planning for the surgical procedure. Rectal temperatures are avoided due to the fragile state of the rectum. An IV is appropriate for surgical access.)

The nurse is administering packed red blood cells to a child with sickle-cell disease (SCD). When should the nurse monitor the child closely due to the risk of reaction? 1. Six hours after the transfusion is given. 2. At the end of the administration of the transfusion. 3. The first 20 mL of blood administered. 4. Never; children with SCD do not have reactions.

3 (Transfusion reaction does not occur this long after the transfusion. Reactions generally occur at the onset or during the first 20 minutes of transfusion. Blood reactions can occur as soon as the blood transfusion begins. The nurse should administer the first 20 mL of blood slowly and monitor for a reaction during this time frame. Anyone can have a transfusion reaction during any transfusion.)

Which interventions should the nurse include in the plan of care for a pediatric client who is receiving peritoneal dialysis in the treatment of chronic renal failure to prevent infection? Select all that apply. 1. Provide small, frequent meals. 2. Avoid battles over nutritional intake. 3. Administer supplements by tube feedings, if needed. 4. Implement hand hygiene frequently. 5. Perform daily catheter site care.

3 and 4 (This intervention is appropriate to meet the child's nutritional needs; however, this will not prevent infection. This intervention is appropriate to meet the child's nutritional needs; however, this will not prevent infection. This intervention is appropriate to meet the child's nutritional needs; however, this will not prevent infection. Aseptic technique reduces chance of introducing bacteria into the abdomen. Skin around the catheter site will have fewer organisms that could potentially cause infection.)

Which gastrointestinal defects, often diagnosed shortly after birth, should the nurse include in the assessment process of all newborns? Select all that apply. 1. Pyloric stenosis 2. Biliary atresia 3. Hirschsprung disease 4. Umbilical hernia 5. Diaphragmatic hernia

3 and 5 (Pyloric stenosis is not diagnosed in the newborn nursery, but in the 2- to 4-week-old infant. Symptoms of biliary atresia would not be observable until several weeks of age. Symptoms of Hirschsprung disease may be observable in the newborn nursery. Umbilical hernia cannot be diagnosed at birth. Diaphragmatic hernia will show symptoms immediately after birth due to compression of the lung.)

A young child admitted to the pediatric unit has fever, irritability, and vomiting with suspected bacterial meningitis. Which cerebrospinal fluid (CSF) result should the nurse anticipate based on these data? 1. Decreased protein count 2. Clear, straw-colored fluid 3. Positive for red blood cells (RBCs) 4. Decreased glucose level

4 (Bacterial meningitis causes CSF protein levels to be elevated due to swelling and obstruction of CSF flow. In bacterial meningitis, the fluid is often cloudy with white blood cells (WBCs). The nurse would expect WBCs to be elevated due to the infection. The RBCs may indicate a bloody tap. Glucose levels are low in CSF when a child has bacterial meningitis.)

A neonate with a meningomyelocele is to have surgery in the morning. Which nursing action is appropriate for this neonate? 1. Applying a diaper to prevent contamination of sac 2. Positioning the newborn in a side-lying position 3. Encouraging the mother to hold the newborn because she will not be able to pick him up after surgery 4. Positioning the newborn in a prone position

4 (A diaper is not used because it also puts pressure on the sac. A side-lying position would be contraindicated because it would place pressure on the sac. The mother should not hold the baby because that would put too much pressure on the sac. The newborn should be placed in a prone position to keep pressure off the sac.)

A 4-year-old client with intractable seizures has been on a ketogenic diet for the last 6 months, with a decrease in seizure activity. This child is now admitted to the pediatric unit with left-sided pain. Which possible complication to this diet does the nurse suspect? 1. Appendicitis 2. Bowel obstruction 3. Urinary tract infection 4. Kidney stones

4 (Appendicitis does not occur as a result of the ketogenic diet. The ketogenic diet does not cause a bowel obstruction. Urinary tract infections are not a result of a ketogenic diet. Kidney stones are seen in 5% of children on a ketogenic diet.)

Which is the priority nursing intervention when providing care to a pediatric client who is experiencing disseminated intravascular coagulation (DIC)? 1. Preparing the child for radiographic procedures 2. Implementing the prescribed fluid restriction for the child 3. Encouraging the child to frequently ambulate 4. Monitoring the child's oxygen saturation and vital signs

4 (DIC is not diagnosed with a radiographic examination but by serum laboratory studies. Fluids need to be monitored but will not be restricted. Ambulation places stress on joints and can promote bleeding. The child with DIC should be placed on bed rest. In a child who has a bleeding and clotting disorder, the priority nursing intervention would be monitoring for life-threatening complications.)

The heatlthcare provider prescribes a unit of packed red blood cells for a pediatric client. Which intravenous fluid should the nurse hang during the blood transfusion? 1. D5W 2. D5LR 3. D5 1/4NS 4. NS

4 (Dextrose should not be hung, as it will cause packed cells to clot. D5 lactated Ringer solution also contains dextrose and should not be hung with packed cells. Dextrose is inappropriate no matter what is the other component of the intravenous fluids. Normal saline is appropriate to hang prior to initiating blood.)

The nurse is planning care for a school-age client who is postoperative for the surgical removal of the appendix. In addition to pharmacologic pain management, which should the nurse include in the plan of care to address pain? 1. Applying a warm, moist pack every 4 hours 2. Applying EMLA cream to the incision site prior to ambulation 3. Applying a cold, moist pack every 2 hours 4. Applying a pillow against the abdomen to splint the incision site when coughing

4 (Heat and moisture are not used on the incision area, as they can impair the healing process of the wound. EMLA cream is a medication that requires a prescription. Heat and ice are not used on the incision area, as they can impair the healing process of the wound. A splint pillow placed on the abdomen is a nonpharmacologic strategy to decrease discomfort after an appendectomy.)

Which parental statement indicates understanding of the process involved with a kidney transplant for a child with renal failure? 1. "We are happy our child will not have to take any more medicine after the transplant." 2. "We understand our child will not be at risk anymore for catching colds from other children at school." 3. "We will be glad we will not have to bring our child in to see the doctor again." 4. "We know it is important to see that our child takes prescribed medications after the transplant."

4 (Medications and general health promotion will be necessary. The child will be on immunosuppressing drugs and will be at increased risk for colds and other illnesses. Follow-up appointments will be necessary, as well as medications and general health promotion. It is important that the nurse emphasizes compliance with treatments that will need to be followed after the transplant.)

A child with a history of seizures arrives in the emergency department (ED) in status epilepticus. Which is the priority nursing action? 1. Take vital signs. 2. Establish an intravenous line. 3. Perform rapid neurologic assessment. 4. Maintain patent airway.

4 (Taking vital signs is important, but airway always comes first. Once the airway is secure, securing an IV is vital. A rapid neurologic assessment is appropriate once the airway is secure. Airway is always the priority of care.)

During a natural disaster, a child diagnosed with hemophilia is injured and bleeding internally. Which blood product should the nurse plan to administer if the appropriate factor is not available? 1. Platelets 2. Whole blood 3. Packed cells 4. Fresh or fresh frozen plasma

4 (The child has adequate platelets, and administration of platelets will not promote clotting. Whole blood will increase the blood volume without promoting clotting. A unit of packed cells will provide red blood cells (RBCs) but not the factor needed to clot. Factors are located in the plasma. Fresh or fresh frozen plasma will provide the best source of factor available.)

The nurse is assessing abdominal girth for a pediatric client who presents with abdominal distension. Which nursing action is appropriate? 1. Measuring the girth just below the umbilicus 2. Measuring the girth just below the sternum 3. Measuring the girth just above the pubic bone 4. Measuring the girth around the portion of the stomach

4 (The circumference below the umbilicus would not be an accurate abdominal girth. The circumference just below the sternum would not be an accurate abdominal girth. The circumference just above the pubic bone would not be an accurate abdominal girth. An abdominal girth should be taken around the largest circumference of the abdomen, just above the umbilicus.)

A teacher states to the school nurse, "I have a student who will often just stare at me for 15 seconds after asking a question; then the student blinks and asks me to repeat the question. Should I be concerned?" Which should the nurse include in the response to the teacher? 1. The child has a crush on the teacher. 2. The child has increased intracranial pressure. 3. The child may have had a head injury. 4. The child is experiencing absence seizures.

4 (There are no data to suspect a childhood crush is creating the situation. There is no indication of increased intracranial pressure. There is no indication of a head injury. Absence seizures may cause staring and blinking; they are more common in girls in this age group and often are first noticed by the classroom teacher.)

The parents of an infant diagnosed with sickle-cell disease ask, "How did our child get this disease? Neither one of us has it." Which should the nurse consider when responding to the parents? 1. The father is not the biologic father of the infant. 2. The mother of the child has the trait, but the father does not. 3. The father of the child has the trait, but the mother does not. 4. The mother and the father of the child have the sickle-cell trait.

4 (There is no indication that the father is not the actual parent. Both parents could be carriers of the disorder but unaware of their status. Both parents must have the trait for the child to have a 25% chance of having this disease. Both parents must have the trait for the child to have a 25% chance of having this disease. Sickle-cell disease is an autosomal recessive disorder; both parents must have the trait in order for a child to have a 25% chance of having this disease.)

Which is the priority nursing diagnosis when planning care for a newborn who is born with esophageal atresia and tracheoesophageal fistula? 1. Ineffective Tissue Perfusion 2. Ineffective Infant Feeding Pattern 3. Acute Pain 4. Risk for Aspiration

4 (Tissue perfusion is not a primary problem with this condition. The infant is always kept NPO (nothing by mouth) preoperatively, so ineffective feeding pattern would not apply. Pain is not usually experienced preoperatively with this condition. This is the most common type of esophageal atresia and tracheoesophageal fistula, where the upper segment of the esophagus ends in a blind pouch and a fistula connects the lower segment to the trachea. Preoperatively, there is a risk of aspiration of gastric secretions from the stomach into the trachea because of the fistula that connects the lower segment of the esophagus to the trachea.)

Which clean-catch urinalysis finding should the nurse be most concerned for a child who is admitted to an urgent care center to rule out a urinary tract infection? 1. 2+ white blood cells 2. 1+ red blood cells 3. Urine appearance: cloudy 4. Specific gravity: 1009

4 (White blood cells are expected. Red blood cells are common in the urine of a child with a urinary tract infection. With white blood cells in the urine, this is a common finding. This is a very dilute urine. With white blood cells (WBCs), red blood cells (RBCs), and bacteria in the urine, you would expect the urine to contain more solutes.)

You're assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure? A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." B. "I remember having vision changes, but it didn't last long." C. "I woke up on the floor with my mouth bleeding." D. "After the seizure I was very sleepy, and I had a headache for several hours."

A (The patient will experience an alternation in consciousness (hence the name focal IMPAIRED awareness) AND will perform an action without knowing they are doing it called automatism like lip-smacking, rubbing the hands together etc. With a focal onset AWARE seizure (also called partial simple seizure) the patient is aware and will remember what happens (like vision changes etc.).)

A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication? A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."

A (This medication should NOT be taken with milk products or antacids because it affects absorption. All the other options are correct.)

A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. During administration of this drug, it is important the nurse monitors for: A. Respiratory depression B. Hypertension C. Disseminated intravascular clotting D. Hypotension E. Fever

A and D (This medication stimulates the GABA receptors and helps with inhibitory neurotransmission. It can lead to respiratory depression and hypotension, therefore, it is very important the nurse monitors the patient for this.)

The nurse is ordered to administer Lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby? A. Narcan B. Flumazenil C. Calcium Chloride D. Idarucizumab

B (Flumazenil is the reversal agent for Lorazepam, which is a benzodiazepine.)

TRUE or FALSE: Poststreptococcal glomerulonephritis is a type of NEPHROTIC SYNDROME, which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate. True False

False (Poststreptococcal glomerulonephritis is a type of NEPHRITIC (not nephrOtic) SYNDROME, which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate. In Nephrotic Syndrome, there is only leakage of PROTEIN (not red blood cells) into the filtrate.)

A patient is being tested for sickle cell disease. As the nurse, you know the ________ will assess for abnormal hemoglobin on the red blood cell, but will not differentiate between sickle cell disease and sickle cell trait. Therefore, the patient will need to have what other test to determine this? A. dithionite test; hemoglobin electrophoresis B. hemoglobin electrophoresis; sickledex C. edrophonium test, dithionite test D. sickledex; edrophonium test

a

A 6 year old male is diagnosed with nephrotic syndrome. In your nursing care plan you will include which of the following as a nursing diagnosis for this patient? A. Risk for infection B. Deficient fluid volume C. Constipation D. Overflow urinary incontinence

a (A patient with nephrotic syndrome is at risk for infection due to the potential loss of proteins (immunoglobulins) in the urine that help fight infection. In addition, medication treatment for nephrotic syndrome may include corticosteroids or immune suppressors, which will further suppress the immune system. Option B is wrong because the patient will be experiencing fluid volume overload (not deficient). Option C and D are wrong because constipation and overflow urinary incontinence are not common findings with nephrotic syndrome.)

Which patient below is at MOST RISK for developing acute glomerulonephritis? A. A 3 year old male who has a positive ASO titer. B. A 5 year old male who is recovering from an appendectomy. C. An 18 year old male who is diagnosed with HIV. D. A 6 year old female newly diagnosed with measles.

a (An ASO (antistreptolysin) titer is a test used to diagnose strep infections. Remember strep infections increase, especially in the pediatric population, the risk of developing AGN. Patients in options B, C, and D are not at risk for this.)

An 18 year-old male is taking Hydroxyurea for treatment of sickle cell anemia. Which options below indicate this medication is working successfully? Select all that apply: A. The patient needs fewer blood transfusions. B. The patient experiences diuresis. C. The patient experiences an increase in fetal hemoglobin (Hbg F). D. The patient experiences a decrease in hemoglobin S.

a and c (This medications actually treats cancer, but it will help with SCA in that it will help create fetal hemoglobin hgb F (this helps decrease sickling episodes) and helps with anemia (decreasing the need for so many blood transfusions).)

Which of the following are NOT a sign and symptom of acute glomerulonephritis (poststreptococcal)? SELECT-ALL-THAT-APPLY: A. Hypotension B. Increased Glomerular filtration rate C. Cola-colored urine D. Massive proteinuria E. Elevated BUN and creatinine F. Mild swelling in the face or eyes

a, b, and d (The patient with AGN may experience HYPERtension (not hypotension), DECREASED glomerular filtration rate (NOT increased), MILD (not massive) proteinuria. Massive proteinuria is a classic sign and symptom in Nephrotic Syndrome which doesn't present with hematuria. Options C, E, and F can be present in AGN.)

A 6 year-old is admitted with sickle cell crisis. The patient has a FACE scale rating of 10 and the following vital signs: HR 115, BP 120/82, RR 18, oxygen saturation 91%, temperature 101.4'F. Select all the appropriate nursing interventions for this patient at this time? A. Administer IV Morphine per MD order B. Administer oxygen per MD order C. Keep NPO D. Apply cold compresses E. Start intravenous fluids per MD order F. Administer iron supplement per MD order G. Keep patient on bed rest H. Remove restrictive clothing or objects from the patient

a, b, e, g, and h (When a patient is in sickle cell crisis, the abnormal RBCs are sickling and sticking together, which blocks blood flow. To help alleviate the RBCs from clumping together and sickling, oxygen and hydration are priority. This will help dilute the blood (hence decrease the sticking of RBCs) and help supply oxygen to the RBCs (remember abnormal RBCs with hemoglobin S are very sensitive to low oxygen levels and will sickle when there is low oxygen). In addition, pain needs to be addressed. Opioid medication is the best on a scheduled basis rather than PRN (as needed). Avoid keeping patient NPO unless needed (remember patient needs hydration). Avoid cold compresses (can lead to more sickling) but instead use warm compresses. The patient will need FOLIC ACID supplements to help with RBC creation rather than iron (iron can actually build up in the body and collect in the organs in patients with sickle cell disease). Patients definitely need to be on bedrest, and restrictive clothing or objects (blood pressure cuff etc.) should be removed to help blood flow.)

You're providing education to a group of nursing students about nephrotic syndrome. A student describes the signs and symptoms of this condition. Which signs and symptoms verbalized by the student require you to re-educate the student about this topic? Select-all-that-apply: A. Slight proteinuria B. Hypoalbuminemia C. Edema D. Hyperlipidemia E. Tea-colored urine F. Hypertension

a, e, and f (The patient with nephrotic syndrome will experience massive proteinuria (not slight) along with low albumin in the blood (hypoalbuminemia), edema, and high cholesterol and triglyceride levels. It is not common for the patient to experience tea-colored urine or hypertension (rare) this is very common with acute glomerulonephritis.)

A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will? A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient

b (A normal Phenytoin level is 10 to 20 mcg/mL. The patient's level is low; therefore, the patient is at risk for seizures. The nurse should initiate seizure precautions. Remember a patient being under medicated is a trigger for developing a seizure.)

You're providing care to a 6 year old male patient who is receiving treatment for nephrotic syndrome. Which assessment finding below requires you to notify the physician immediately? A. Frothy, dark urine B. Redden area on the patient's left leg that is swollen and warm C. Elevated lipid level on morning labs D. Urine test results that shows proteinuria

b (Patients with nephrotic syndrome are at risk for hypercoagulability (blood clot formation) due to the loss of proteins in the urine that prevent blood clot formation. Option B represents a possible deep vein thrombosis, which will appear as a redden, warm, and swollen area on the extremity. Options A, C, and D are common findings with nephrotic syndrome, which are expected.)

As the nurse, you know that it is important to implement a low sodium diet for a patient with nephrotic syndrome. However, it is important to implement what other type of diet due to another complication associated with this syndrome? A. Low-phosphate B. Low-fat C. High-carbohydrate D. Low-potassium

b (Patients with nephrotic syndrome can experience hyperlipidemia. Why? Remember that in this condition there will be low amounts of albumin in the blood. This decrease of albumin in the blood causes the liver to make more albumin, BUT while it does this it also makes more cholesterol and triglycerides...hence increasing lipid levels. Therefore, the patient should follow a low-sodium and low-fat diet as well.)

You're providing education to a patient with sickle cell anemia who is taking Hydroxyurea. You will make it priority to tell the patient to? A. Consume foods high in calcium and potassium B. Avoid sick people and maintain strict hand hygiene C. Take this medication with at least 8 oz of water D. Monitor your blood glucose level daily

b (This medication can lower the white blood cell count. Therefore, the nurse should make it priority to tell the patient to avoid infection by avoiding sick people and performing hand hygiene regularly.)

While providing care to a pediatric patient with acute glomerulonephritis, you note the urine output to be 10 mL/hr. The patient weighs 30 lbs. As the nurse, you will want to limit what type of foods from the patient's diet? A. Calcium-rich foods B. Potassium-rich foods C. Purine -rich foods D. None of the above because the patient's urinary output is normal based on the patient's weight.

b (This patient is experiencing OLIGURIA (low urinary output). The patient weighs 30 lbs. which is 13.6 kg (30/2.2= 13.6). Remember a normal urinary output for a pediatric patient should be 1 mL/kg/hr. Based on the patient's weight, their urinary output is 10 mL/hr...it should be 13.6 mL/hr. Therefore, the patient is at high risk for retaining POTASSIUM due to decreased renal function. The nurse should limit foods high in potassium.)

The mother of a child, who was recently diagnosed with nephrotic syndrome, asks how she can identify early signs that her child is experiencing a relapse with the condition. You would tell her to monitor the child for the following: Select-all-that-apply: A. Weight loss B. Protein in the urine using an over-the-counter kit C. Tea-colored urine D. Swelling in the legs, hands, face, or abdomen

b and d (The patient will NOT experience weight loss but weight GAIN as a sign of relapse with this condition. In addition, the urine will appear dark and foamy. Tea-colored urine indicates there is blood in the urine, which is NOT common with nephrotic syndrome.)

A 14 year-old female has sickle cell anemia. Which factors below can increase the patient's risk for developing sickle cell crisis? Select all that apply: A. Shellfish B. Infection C. Dehydration D. Hypoxia E. Low altitudes F. Hemorrhage G. Strenuous exercise

b, c, d, f, and g (Sickle cell crisis can occur when the body experiences low amounts of oxygen in the body (so think about something that increases the body's need for oxygen or affects how oxygen is being transported). Therefore, infection (especially respiratory infections), dehydration, hypoxia, HIGH (not low) altitudes, hemorrhage (blood loss), or strenuous exercise can lead to a sickle cell crisis.)

A 5 year old male is admitted with acute glomerulonephritis. On assessment, you note mild edema predominately in the face and tea-colored urine. The patient's blood pressure is 165/110, heart rate 95, oxygen saturation 98% on room air, and temperature 98.9 'F. In your nursing care plan, what nursing interventions will you include in this patient's plan of care? SELECT-ALL-THAT-APPLY: A. Initiate and maintain a high sodium diet daily. B. Monitor intake and output hourly. C. Encourage patient to ambulate every 2 hours while awake. D. Assess color of urine after every void. E. Weigh patient every daily on a standing scale. F. Encourage the patient to consume 4 L of fluid per day.

b, d, and e (Patients with acute glomerulonephritis experience proteinuria and hematuria. In addition, they may experience mild edema (mainly in the face/eyes), hypertension, and in severe cases renal failure/oliguria. Therefore, it is very important the nurse monitors intake and output every hour, assesses color of urine, and weighs the patient every day on a standing scale. Option A is wrong because the patient should be consuming a LOW (not high) sodium diet. Option C is wrong because the patient should maintain bed rest until recovered due to experiencing hypertension. Option F is wrong because the patient will be on a fluid restriction...4 L is a lot of fluid to consume. It is generally 2 L or less of fluids per day.)

A patient who is experiencing poststreptococcal glomerulonephritis has edema mainly in the face and around the eyes. As the nurse, you know to expect the edema to be more prominent during the? A. Evening B. Afternoon C. Morning D. Bedtime

c (Patients will experience the most prominent swelling in the face in the morning when they awake. This is a common finding with kidney disorders. The skin of the eyes is fragile, folded, and pocketed which makes it easier for fluid to collect around the eyes. In addition, this is where the swelling looks more noticeable.)

Which statement about how sickle cell anemia is passed to offspring is CORRECT? A. This disease is an x-linked recessive disease. B. Sickle cell anemia is an autosomal dominant disease. C. This condition is an autosomal recessive disease. D. Sickle cell anemia is rarely passed to offspring and is an autosomal x-linked dominant disease.

c (SCA is an autosomal recessive disease in that the offspring must receive TWO hemoglobin S genes (one for each parent). The parents usually don't have the disease but are carriers. For the disease to occur in the offspring they must receive both of those genes (Hbg SS). On the contrary, with autosomal dominant the offspring has to only receive an abnormal gene from one parent, who probably has signs and symptoms of the disease too.)

Which type of hemoglobin is present in a patient who has sickle cell anemia? A. Hemoglobin AA B. Hemoglobin AS C. Hemoglobin SS C. Hemoglobin AC

c (SCA is homozygous and the patient must have two abnormal alleles present to have sickle cell anemia. The patient receives each abnormal allele for each parent (hence one from each parent which is Hemoglobin SS). If a patient has Hemoglobin AS (normal allele (A) and abnormal allele (S)) this is known as sickle cell trait, which most patients with this don't present with signs and symptoms of the disease...it's rare because they usually have just enough hemoglobin A to prevent the RBCs from sickling.)

You're collecting a urine sample on a patient who is experiencing proteinuria due to nephrotic syndrome. As the nurse, you know the urine will appear: A. Tea-colored B. Orange and frothy C. Dark and foamy D. Straw-colored

c (The urine will appear dark and foamy due to the high amount of proteins present in the urine. Remember in nephrotic syndrome the patient is losing a massive amount of protein per day (3 grams per day) and this will cause the urine to foam.)

An 8-year-old child, who is not responding to anti-seizure medications, is prescribed to start a ketogenic diet. This diet will include: A. High carbohydrates and high fat B. Low fat, high salt, and high carbohydrates C. High fat and low carbohydrates D. High glucose, high fat, and low carbohydrates

c (This is a type of diet used in the pediatric population with epilepsy whose seizures cannot be controlled by medication. It is a high fat and low carb diet.)

You're providing seminar teaching to a group of nurses about sickle cell anemia. Which of the following is NOT a treatment for this condition? A. Blood transfusion B. Stem cell transplant C. Intravenous fluids D. Iron supplements E. Antibiotics F. Morphine

d (Iron supplements are not prescribed (rather Folic Acid) because this type of anemia is not caused by low iron levels, and patients who take iron supplements with sickle cell disease are at risk for building up too much iron in the body, which will damage the organs.)

During an outpatient well visit with a patient who has sickle cell anemia, you make it PRIORITY to assess the patient's? A. hemoglobin A1C level B. heart rate C. reflexes D. vaccination history

d (Patients will sickle cell anemia are at risk for infection because of spleen compromise. Many patients with SCA experience splenomegaly because blood flow is compromised to the spleen due to sickling of RBCs and the spleen is overworked from recycling the old RBCs (remember a patient with sickle cell anemia does NOT have long-living RBCs...the RBCs tend to die in 20 days rather than 120 days). Therefore, vaccination history is very important. The patient should be up-to-date with the flu, pneumococcal, and meningococcal vaccines.)

Which patient below is NOT at risk for developing nephrotic syndrome? A. An 8 year old male with diabetes mellitus. B. A 5 year old female diagnosed with minimal change disease. C. A 10 year old male with Lupus. D. A 7 year old male recently diagnosed with Goodpasture's Syndrome.

d (The patients in options A-C are all at risk for nephrotic syndrome. The patient in option D is at risk for acute glomerulonephritis.)

Within the past month, the admission rate of patients with poststreptococcal glomerulonephritis has doubled on your unit. You are proving an in-service to your colleagues about this condition. Which statement is CORRECT about this condition? A. "This condition tends to present 6 months after a strep infection of the throat or skin." B. "It is important the patient consumes a diet rich in potassium based foods due to the risk of hypokalemia." C. "Patients are less likely to experience hematuria with this condition." D. "This condition is not caused by the streptococcal bacteria attacking the glomerulus, but by the immune system's response to the bacteria by creating an antigen-antibody complex which inflames the glomerulus."

d (This is the only correct statement. Option A is wrong because this condition tends to present 10-14 days (not 6 months) after a strep infection of the throat or skin. Option B is wrong because the patient is at risk for HYPERkalemia (not HYPOkalemia) especially if low urinary output is present. Option C if wrong because patients with this conditon will experience hematuria which is a hallmark of this condition.)