EXAM 4 PEDS

The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for this child? 1.Soccer 2.Basketball 3.Swimming 4.Field hockey

3.Swimming

The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child? 1.Platelet count 2.Hematocrit level 3.Hemoglobin level 4.Partial thromboplastin time

4.Partial thromboplastin time

A nurse is preparing to administer digoxin to a 6 month old infant. Prior to administering the dose, the nurse listens to the apical heart rate. The nurse should withold the dose if the infant's apical heart rate is less than what rate?

60 or 70

A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement? a. Notify the health care provider. b. Place the child on bed rest. c. Administer a dose of hydrocodone (Vicodin). d. Start O2 per the hospitals protocol.

A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement? a. Notify the health care provider. b. Place the child on bed rest. c. Administer a dose of hydrocodone (Vicodin). d. Start O2 per the hospitals protocol.

A nurse is admitting a child who has leukemia. Which of the following clients should the nurse place in the same room with this child? A. A child who has nephrotic syndrome B. A child recovering from a ruptured appendix C. A child who has rheumatic fever D. A child who has cystic fibrosis

A. A child who has nephrotic syndrome

A nurse is caring for a 17-year-old client who is experiencing a relapse of leukemia and is refusing treatment. The client's mother insists that the client receive treatment. Which of the following actions should the nurse take? A. Initiate the IV per the parent's request. B. Notify the provider of the situation. C. Administer a sedative to calm the client. D. Offer the client and antiemetic.

A. Initiate the IV per the parent's request.B. Notify the provider of the situation.

A nurse is obtaining a health history from a child who has suspected acute rheumatic fever. Which of the following questions should the nurse ask? A.) "Has your son had a sore throat recently?" B.) "Was your son born with a cardiac defect?" C.) "Has your son had an injury recently?" D.) "Have you given your child aspirin in the past 2 weeks?"

A.) "Has your son had a sore throat recently?

A nurse is reviewing data for 4 children. Which of the following children should the nurse assess first? A.) A 10-year-old with sickle cell anemia who reports severe chest pain B.) A 7-year-old who has diabetes insipidus and a specific urine gravity of 1.016 C.) A 1-year-old toddler who has roseola and a temperature of 102.2F D.) A 4-year-old child who has asthma and a PCO2 37 mmHg

A.) A 10-year-old with sickle cell anemia who reports severe chest pain

A nurse is providing teaching about iron deficiency anemia to parents of a toddler. Which of the following should the nurse recommend as a method of preventing iron-deficiency anemia? A.) Avoid a diet that primarily consists of milk B.) Administer fat-soluble vitamins daily C.) Include fluroidated water in toddler's diet D.) Limit intake of high protein foods

A.) Avoid a diet that primarily consists of milk

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

B C E

A nurse is admitting a child who has leukemia and a critically low platelet count. Which of the following precautions should the nurse initiate? A. Neutropenic B. Bleeding C. Contact D. Droplet

B. Bleeding

A nurse is providing discharge instructions to the parent of a 10-year-old child following cardiac catheterization. Which of the following instructions should the nurse include? A.) Keep the child home for 1 week B.) Give the child acetaminophen for discomfort C.) Offer the child clear liquids for the first 24 hours D.) Assist the child to take a tub bath for the first 3 days

B.) Give the child acetaminophen for discomfort

A nurse in a pediatric clinic is caring for a child who has iron deficiency anemia and a new prescription for ferrous sulfate tablets. Which of the following instructions should the nurse provide the parents regarding administration of this medication?A. Give with a 240 mL (8 oz) glass of milk.B. Administer at mealtimes.C. Give with orange juiceD. Administer at bedtime

C. Give with orange juice

A nurse is creating a care plan of care for a child who has sickle cell anemia. Which of following interventions should the nurse include in the plan of care?A.) Discourage a high level of fluid intake B.) Apply a cold press to painful, swollen joints C.) Observe for indications of hypokalemia D.) Administer meperidine every 4 hr for pain

C.) Observe for indications of hypokalemia

A nurse is teaching a parent of a child who has hemophilia how to control a minor bleeding episode. Which of the following statements by the parent indicates a need for further teaching? A. "I will have my child rest." B. "I will elevate the affected part." C. "I will compress the site." D. "I will apply heat."

D. "I will apply heat."

A nurse is planning care for a 5-month-old infant who is scheduled for a lumbar puncture to rule out meningitis. Which of the following actions should the nurse include in the plan of care? A. Keep the infant NPO for 6 hr prior the procedure. B. Apply a eutectic mixture of lidocaine and prilocaine cream topically 15 min prior to the procedure. C. Place the infant in an infant seat for 2 hr following the procedure. D. Hold the infant's chin to his chest and knees to his abdomen during the procedure.

D. Hold the infant's chin to his chest and knees to his abdomen during the procedure.

A nurse is providing teaching to parents of a child with iron deficiency anemia and is taking iron supplements. Which of the following statements by the parents indicates an understanding of the teaching? A.) "The medication should be administered in one large dose every day" B.) "Restricting fiber from our child's diet will help with the absorption of iron" C.) "The medication will be more effective if administered with meals" D.) "Our child's blood count will need to be monitored routinely for several weeks"

D.) "Our child's blood count will need to be monitored routinely for several weeks"

A nurse is reviewing the lab results of four children. Which of the following results should the nurse report to the provider? A.) WBC 10,000 cells/mm3 B.) Lead 2 mcg/dL C.) RBC 4.9 million/mm3 D.) Iron 38 mcg/dL

D.) Iron 38 mcg/dL

which injection should be avoided in a child with hemophilia

IM

A nurse is caring for child who was admitted with suspected rheumatic fever. The provider prescribes an anti-streptolysin O (ASO) titer. The parent asks the nurse the purpose of the test. Which of the following responses should the nurse make?

This test will confirm if your child had a recent streptococcal infection."

When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia? a. 25% b. 50% c. 75% d. 100%

a. 25%

he nurse is caring for a 12-year-old child with b-thalassemia. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Anorexia b. Unexplained fever c. Enlarged spleen or liver d. Bronzed, freckled complexion e. Precocious sexual development

a. Anorexia b. Unexplained fever c. Enlarged spleen or liver d. Bronzed, freckled complexion

In which of the conditions are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

a. Aplastic anemia

A nurse is caring for an 8-year-old child who has acute rheumatic fever. Which of the following assessments is the nurse's priority immediately after admission? a. Ascultating the rate and characteristics of the child's heart sound. b. Using a pain-rating tool to determine the severity of the joint pain. c. Identifying the degree of parental anxiety related to the diagnosis d. Assessing the client's erythematous rash

a. Ascultating the rate and characteristics of the child's heart sound.

What explanation provides the rationale for why iron-deficiency anemia is common during infancy? a. Cows milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by 1 month of age. d. Dietary iron cannot be started until 12 months of age.

a. Cows milk is a poor source of iron.

What pain medication is contraindicated in children with sickle cell disease (SCD)? a. Meperidine (Demerol) b. Hydrocodone (Vicodin) c. Morphine sulfate d. Ketorolac (Toradol)

a. Meperidine (Demerol)

The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron deficiency anemia is common during toddlerhood? a. Milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by age 1 month. d. Dietary iron cannot be started until age 12 months.

a. Milk is a poor source of iron.

Parents of a child with sickle cell anemia ask the nurse, What happens to the hemoglobin in sickle cell anemia? Which statement by the nurse explains the disease process? a. Normal adult hemoglobin is replaced by abnormal hemoglobin. b. There is a lack of cellular hemoglobin being produced. c. There is a deficiency in the production of globulin chains. d. The size and depth of the hemoglobin are affected.

a. Normal adult hemoglobin is replaced by abnormal hemoglobin.

A possible cause of acquired aplastic anemia in children is: a. drugs. b. injury. c. deficient diet. d. congenital defect.

a. drugs.

Meperidine (Demerol) is not recommended for children in sickle cell crisis because it: a. may induce seizures. b. is easily addictive. c. is not adequate for pain relief. d. is given by intramuscular injection.

a. may induce seizures.

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Finger sticks for blood work instead of venipunctures b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene e. Administration of packed red blood cells

b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene

A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan? a. Exercise as a distraction b. Heat to the affected area c. Elevation of the extremity d. Cold compresses to the affected area

b. Heat to the affected area

Care for the child with acute idiopathic thrombocytopenic purpura (ITP) includes which therapeutic intervention? a. Splenectomy b. Intravenous administration of anti-D antibody c. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) d. Helping child participate in sports

b. Intravenous administration of anti-D antibody

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. e. Notify the health care provider if your child begins to develop symptoms of a cold.

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

b. Swimming d. Golf e. Bowling

What statement is descriptive of most cases of hemophilia? a. X-linked recessive deficiency of platelets causing prolonged bleeding b. X-linked recessive inherited disorder in which a blood clotting factor is deficient c. Autosomal dominant deficiency of a factor involved in the blood-clotting reaction d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

b. X-linked recessive inherited disorder in which a blood clotting factor is deficient

A school-age child is admitted in vasoocclusive sickle cell crisis. The child's care should include: a. correction of acidosis. b. adequate hydration and pain management. c. pain management and administration of heparin. d. adequate oxygenation and replacement of factor VIII.

b. adequate hydration and pain management.

Chelation therapy is begun on a child with -thalassemia major. The purpose of this therapy is to: a. treat the disease. b. eliminate excess iron. c. decrease risk of hypoxia. d. manage nausea and vomiting.

b. eliminate excess iron.

Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

c. Adequate dosage will turn the stools a tarry green color.

The nurse is teaching parents of an infant about the causes of iron deficiency anemia. Which statement best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of an infant's emaciated appearance. c. Clinical manifestations are similar regardless of the cause of the anemia. d. Clinical manifestations result from a decreased intake of milk and the premature addition of solid foods.

c. Clinical manifestations are similar regardless of the cause of the anemia.

What condition is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets? a. Aplastic anemia b. Thalassemia major c. Idiopathic thrombocytopenic purpura d. Disseminated intravascular coagulation

c. Idiopathic thrombocytopenic purpura

The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs.

c. Increased red blood cell destruction occurs.

The nurse is teaching the family of a child, age 8 years, with moderate hemophilia about home care. What should the nurse tell the family to do to minimize joint injury? a. Administer nonsteroidal anti-inflammatory drugs (NSAIDs). b. Administer DDAVP (synthetic vasopressin). c. Provide intravenous (IV) infusion of factor VIII concentrates. d. Encourage elevation and application of ice to the involved joint.

c. Provide intravenous (IV) infusion of factor VIII concentrates.

Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon-shaped

c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include to: a. administer with meals. b. administer between meals. c. inject deeply into a large muscle. d. massage injection site for 5 minutes after administration of drug.

c. inject deeply into a large muscle.

A nurse is caring for a child who has Kawasaki disease. Which of the following systems should the nurse monitor in response to the diagnosis? A.) Cardiovascular B.) Gastrointestinal C.) Integumentary D.) Respiratory

cardiovascular

The nurse is conducting a staff in-service on childhood blood disorders. Which describes the pathology of idiopathic thrombocytopenic purpura? a. Bone marrow failure in which all elements are suppressed b. Deficiency in the production rate of globin chains c. Diffuse fibrin deposition in the microvasculature d. An excessive destruction of platelets

d. An excessive destruction of platelets

The nurse is preparing a community outreach program about the prevention of iron-deficiency anemia in infants. What statement should the nurse include in the program? a. Whole milk can be introduced into the infants diet in small amounts at 6 months. b. Iron supplements cannot be given until the infant is older than 1 year of age. c. Iron-fortified cereal should be introduced to the infant at 2 months of age. d. Breast milk or iron-fortified formula should be used for the first 12 months.

d. Breast milk or iron-fortified formula should be used for the first 12 months.

What therapeutic intervention is most appropriate for a child with b-thalassemia major? a. Oxygen therapy b. Supplemental iron c. Adequate hydration d. Frequent blood transfusions

d. Frequent blood transfusions

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested? a. Iron (ferrous sulfate) drops after age 1 month b. Iron-fortified commercial formula by age 4 to 6 months c. Iron-fortified infant cereal by age 2 months d. Iron-fortified infant cereal by age 4 to 6 months

d. Iron-fortified infant cereal by age 4 to 6 months

A nurse is assessing a toddler who has heart failure. Which of the following findings should the nurse expect? a. Weight loss b. Increased urine output c. Bradycardia d. Orthopnea

d. Orthopnea

A child with hemophilia A will have which abnormal laboratory result? a. PT (ProTime) b. Platelet count c. Fibrinogen level d. PTT (partial thromboplastin time)

d. PTT (partial thromboplastin time)

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

d. Painful swelling of hands and feet; painful joints

The nurse is caring for a child with hemophilia A. The childs activity is as tolerated. What activity is contraindicated for this child? a. Ambulating to the cafeteria b. Active range of motion c. Ambulating to the playroom d. Passive range of motion exercises

d. Passive range of motion exercises

how do you diagnose sickle cell anemia

hemoglobin electrophoresis (main one) new cord blood screening newborn screening genetic testing

a nurse is providing discharge teaching to the parents of a child who has sickle cell anemia and was hospitalized after experiencing a vasoocclusive crisis. what instructions should the nurse include in the teaching

increase your child's intake of oral fluids

a nurse is admitting a child who has bacterial meningitis, what actions should the nurse take first

initiate antibiotic therapy for the child

a nurse is caring for a child who has bacterial meningitis, what action should the nurse take

initiate seizure precaution

a nurse is caring for a toddler who drinks 950mL (32oz) of milk per day and has poor appetite, the nurse should identify that the toddler is at risk for

iron deficiency anemia

what is an expected finding when taking oral iron

it turns the stool to tarry green or black which is a normal finding it should be given with orange juice it should be given with straw because it may stain the teeth they can brush teeth after administration

Which of the following is the priority intervention a nurse should take when caring for a child who just experienced a febrile seizure?

keep in side lying position

What activity should the school nurse recommend for a child with hemophilia A? (Select all that apply.) a. Golf b. Soccer c. Rugby d. Jogging e. Swimming

non contact sport a. Golf d. Jogging e. Swimming

What is sickle cell anemia?

normal Hgb is replaces by partly or completely abnormal Hgb

a nurse is assessing a child who has sickle cell anemia and is experiencing a vasoocclusive crisis, what manifestations should the nurse expect

pain

a nurse is developing a plan of care for a 4yr old who has hemophilia and is experiencing acute hemarthrosis, what interventions should the nurse include in the plan

place ice packs on the affected joints

a nurse is caring for a school-age child who has hemophilia and reports increased bruising, what lab values provides an explanation for the finding

plt count 120,000

a nurse is caring for a child who has cancer and is receiving chemo, the parent tells the nurse that she wants to d/c treatment and take the child home, what responses should the nurse make

tell me more about your reasons for making this decision today

how do you know that a child is not complaint with iron supplement

the stool does not turn tarry green or black black may be brown