Notes from practice questions in book

The pediatric nurse educator is providing a teaching session to nursing staff about hemophilia. Which statement would the nurse educator include?

"Affected prepubescent girls need to be counseled concerning menorrhagia, which may be life-threatening." -Rationale:The female offspring of an affected male and a carrier female is at risk for hemorrhage once puberty is attained and menstrual cycles begin, and depending on the severity of the hemophilia, a hysterectomy or ablation may be performed. The remaining options are incorrect statements. Aspirin is not routinely given to young children and would not be given to a child with a bleeding disorder because of its effects on platelet aggregation. Hemarthrosis is the result of bleeding into the joint cavity, not of aspiration. Seventy-two hours is too long for the joint to be rested because maintenance of mobility is a primary concern once the bleeding episode has been arrested.

The nurse is preparing to administer an MMR (measles, mumps, and rubella) vaccine to a 15-month-old child. Before administering the vaccine, which question would the nurse ask the parent of the child?

"Is the child allergic to any antibiotics?" -before the administration of MMR vaccine, a thorough health history needs to be obtained. MMR is used with caution in a child with a history of an allergy to gelatin, eggs, or neomycin because the live measles vaccine is produced by chick embryo cell culture and because MMR also contains a small amount of the antibiotic neomycin.

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

"Can you describe the type of pain that the child is experiencing?" -A report of severe colicky abdominal pain in a healthy, thriving child between 3 and 17 months of age is the classic presentation of intussusception. Typical behavior includes screaming and drawing the knees up to the chest. The remaining options are important aspects of a health history but are not specific to the diagnosis of intussusception.

The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information?

"The child does not experience pain at the primary tumor site." -Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor.

A woman who is 6 weeks' pregnant tells the nurse that she is worried that the baby might have spina bifida because of a family history. The nurse's BEST response is

"The concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally."

The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse would use which most appropriate method to assess the urine output? 1. Weighing the diapers 2. Inserting a urinary catheter 3. Comparing intake with output 4. Measuring the amount of water added to formula

1

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse would plan to implement which measure? 1. Restrict fluids as prescribed. 2. Care for the arteriovenous fistula. 3. Encourage foods high in potassium.

1 -Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis).

A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding would be noted in this condition? 1. Limited range of motion in the affected hip 2. An apparent lengthened femur on the affected side 3. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed 4. Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table

1 -In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical and restricted abduction of the affected hip when the child is placed supine with the knees and hips flexed would be an assessment finding in developmental dysplasia of the hip in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.

The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect? 1. Meningitis 2. Spinal cord injury 3. Intracranial bleeding 4. Decreased cerebral blood flow

1 -Meningitis is an infectious process of the central nervous system caused by bacteria and viruses. The inability to extend the leg when the thigh is flexed anteriorly at the hip is a positive Kernig's sign, noted in meningitis. Kernig's sign is not seen specifically with spinal cord injury, intracranial bleeding, or decreased cerebral blood flow.

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings would the nurse expect to observe? Select all that apply. 1.Pallor 2.Edema 3.Anorexia 4.Proteinuria 5.Weight loss 6.Decreased serum lipids

1,2,3,4 -Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.

The nurse is monitoring the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse prepares to implement bleeding precautions if the child becomes thrombocytopenic and the platelet count is less than how many cells/mm3?

150,000 mm3 (150 × 109/L)

A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child would monitor for which sign, knowing that it indicates a worsening of the condition? 1. Warm, dry skin 2. Decreased wheezing 3. Pulse rate of 90 beats per minute 4. Respirations of 18 breaths per minute

2 -Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving. Warm, dry skin indicates an improvement in the child's condition, because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats per minute. The normal respiratory rate in a 10-year-old is 16 to 20 breaths per minute.

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? 1. Test the urine for protein. 2. Reposition the infant frequently. 3. Provide a stimulating environment. 4. Assess blood pressure every 15 minutes.

2 -Hydrocephalus occurs as a result of an imbalance of cerebrospinal fluid absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased intracranial pressure (ICP). In infants with hydrocephalus, the head grows at an abnormal rate, and if the infant is not repositioned frequently, pressure ulcers can occur on the back and side of the head. An egg crate mattress under the head is also a nursing intervention that can help prevent skin breakdown. Proteinuria is not specific to hydrocephalus. Stimulus needs to be kept at a minimum because of the increase in ICP. It is not necessary to check the blood pressure every 15 minutes.

The nurse is assigned to care for an 8-year-old child with a diagnosis of a basilar skull fracture. The nurse reviews the pediatrician's prescriptions and would contact the pediatrician to question which prescription? 1. Obtain daily weight. 2. Provide clear liquid intake. 3. Nasotracheal suction as needed. 4. Maintain a patent intravenous line.

3

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse would assess the infant for which early sign of HF? 1. Pallor 2. Cough 3. Tachycardia 4. Slow and shallow breathing

3

The nurse is reviewing the record of a child with increased intracranial pressure from a head injury and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing? 1. Flaccid paralysis of all extremities 2. Adduction of the arms at the shoulders 3. Rigid extension and pronation of the arms and legs 4. Abnormal flexion of the upper extremities and extension and adduction of the lower extremities

3

The parents of a child recently diagnosed with cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophysiological process? 1. An infectious disease of the central nervous system 2. An inflammation of the brain as a result of a viral illness 3. A chronic disability characterized by impaired muscle movement and posture 4. A congenital condition that results in moderate to severe intellectual disabilities

3 -Cerebral palsy is a chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system. Meningitis is an infectious process of the central nervous system. Encephalitis is an inflammation of the brain that occurs as a result of viral illness or central nervous system infection. Down's syndrome is an example of a congenital condition that results in moderate to severe intellectual disabilities.

Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? 1. "Treatment needs to be started as soon as possible." 2. "I realize my infant will require follow-up care until fully grown." 3. "I need to bring my infant back to the clinic in 1 month for a new cast." 4. "I need to come to the clinic every week with my infant for the casting."

3 -Clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus; the defect may be unilateral or bilateral. Treatment for clubfoot is started as soon as possible after birth. Serial manipulation and casting are performed at least weekly. If sufficient correction is not achieved in 3 to 6 months, surgery usually is indicated. Because clubfoot can recur, all children with clubfoot require long-term interval follow-up until they reach skeletal maturity to ensure an optimal outcome

The nurse is assisting a primary health care provider (PHCP) in the examination of a 3-week-old infant with developmental dysplasia of the hip. What test or sign would the nurse expect the PHCP to assess? 1. Babinski's sign 2. The Moro reflex 3. Ortolani's maneuver 4. The palmar-plantar grasp

3 -In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Ortolani's maneuver is a test to assess for hip instability and can be done only before 4 weeks of age. The examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. A "clicking" sensation indicates a dislocated femoral head moving into the acetabulum. Babinski's sign is abnormal in anyone older than 2 years of age and indicates central nervous system abnormality. The Moro reflex is normally present at birth but is absent by 6 months; if still present at 6 months, there is an indication of neurological abnormality. The palmar-plantar grasp is present at birth and lessens within 8 months.

The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse would make which response? 1. "Avoid all exercise during painful periods." 2. "Range-of-motion exercises must be performed every day." 3. "Have the child perform simple isometric exercises during this time." 4. "Administer additional pain medication before performing range-of-motion exercises."

3 -Juvenile idiopathic arthritis is an autoimmune inflammatory disease affecting the joints and other tissues, such as articular cartilage. During painful episodes of juvenile idiopathic arthritis, hot or cold packs and splinting and positioning the affected joint in a neutral position help reduce the pain. Although resting the extremity is appropriate, beginning simple isometric or tensing exercises as soon as the child is able is important. These exercises do not involve joint movement.

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? 1. Clear CSF, decreased pressure, and elevated protein level 2. Clear CSF, elevated protein, and decreased glucose levels 3. Cloudy CSF, elevated protein, and decreased glucose levels 4. Cloudy CSF, decreased protein, and decreased glucose levels

3 -Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. Meningitis is diagnosed by testing CSF obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure; turbid or cloudy CSF; and elevated leukocyte, elevated protein, and decreased glucose levels.

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1. Cracked lips 2. Normal appearance 3. Conjunctival hyperemia 4. Desquamation of the skin

3 Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an acute systemic inflammatory illness. In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal, but signs of inflammation may be present.

A 5-year-old child arrives at the emergency department, and the child's parents state that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia

4

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention would be included in the plan of care? 1. Maintain enteric precautions. 2. Maintain neutropenic precautions. 3. No precautions are required as long as antibiotics have been started. 4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.

4 -Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. A major priority of nursing care for a child suspected to have meningitis is to administer the prescribed antibiotic as soon as a culture is obtained. The child also is placed on respiratory isolation precautions for at least 24 hours while culture results are obtained and the antibiotic is having an effect. Enteric precautions and neutropenic precautions are not associated with the mode of transmission of meningitis. Enteric precautions are instituted when the mode of transmission is through the gastrointestinal tract. Neutropenic precautions are instituted when a child has a low neutrophil count.

The parent of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The parent tells the nurse that the child complains of discomfort on the right side and that ibuprofen is ineffective. Which instruction would the nurse provide to the parent? 1. Increase the dose of ibuprofen. 2. Increase the frequency of ibuprofen. 3. Encourage the child to lie on the left side. 4. Encourage the child to lie on the right side.

4 -Pneumonia is an inflammation of the pulmonary parenchyma or alveoli, or both, caused by a virus, mycoplasmal agents, bacteria, or aspiration of foreign substances. Splinting of the affected side by lying on that side may decrease discomfort. It would be inappropriate to advise the parent to increase the dose or frequency of the ibuprofen. Lying on the left side would not be helpful in alleviating discomfort.

A child is diagnosed with Reye's syndrome. The nurse creates a nursing care plan for the child and would include which intervention in the plan? 1. Assessing hearing loss 2. Monitoring urine output 3. Changing body position every 2 hours 4. Providing a quiet atmosphere with dimmed lighting

4 -Reye's syndrome is an acute encephalopathy that follows a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver. In Reye's syndrome, supportive care is directed toward monitoring and managing cerebral edema. Decreasing stimuli in the environment by providing a quiet environment with dimmed lighting would decrease the stress on the cerebral tissue and neuron responses. Hearing and urine output are not affected. Changing the body position every 2 hours would not affect the cerebral edema directly. The child needs to be positioned with the head elevated to decrease the progression of the cerebral edema and promote drainage of cerebrospinal fluid.

when to hold a digoxin for infants

<90 bpm

A 7-year-old child is hospitalized with a fracture of the femur and is placed in traction. In meeting the psychosocial needs of the child, the nurse most appropriately selects which play activity for the child?

A board game -The school-age child becomes organized with more direction with play activities. Such activities include collections, drawing, construction, dolls, pets, guessing games, board and computer games, riddles, hobbies, competitive games, and listening to the radio or television.

The nurse employed in a neonatal intensive care nursery receives a telephone call from the delivery room and is told that a newborn with spina bifida (myelomeningocele type) will be transported to the nursery. The maternity nurse prepares for the arrival of the newborn and places which priority item at the newborn's bedside?

A bottle of sterile normal saline

The nurse is caring for a hospitalized child who is receiving a continuous infusion of intravenous potassium for the treatment of dehydration. Which assessment finding requires the need to notify the primary health care provider?

A decrease in urine output to 0.5 mL/kg/hr -The priority assessment is to assess the status of urine output. Potassium would never be administered in the presence of oliguria or anuria. If urine output is less than 1 to 2 mL/kg/hr, potassium would not be administered. A slight elevation in temperature would be expected in a child with dehydration. A weight increase of 0.5 kg is relatively insignificant. A blood pressure that is unchanged is a positive indicator unless the baseline was abnormal. However, there is no information in the question to support such data.

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

Administer predigested formula and feed small, frequent feedings.

The nurse is caring for a child with a diagnosis of hemophilia, and hemarthrosis is suspected because the child is complaining of pain in the joints. Which measure would the nurse expect to be prescribed for the child?

Application of a bivalved cast for joint immobilization -In an acute period, immobilization of the joint would be prescribed. Range-of-motion exercise during the acute period can increase the bleeding and would be avoided at this time. Heat will increase blood flow to the area, so it would promote increased bleeding to the area. Nonsteroidal anti-inflammatory drugs (NSAIDs) can prolong bleeding time and would not be prescribed for the child.

The nurse is creating a plan of care for a newborn infant with spina bifida (myelomeningocele type). The nurse includes assessment measures in the plan to monitor for increased intracranial pressure. Which assessment technique would be performed that will best detect the presence of an increase in intracranial pressure?

Assess anterior fontanel for bulging. -A bulging or taut anterior fontanel would indicate the presence of increased intracranial pressure. Urine concentrating ability is not well developed at the newborn stage of development. Monitoring for signs of dehydration will not provide data related to increased intracranial pressure. Blood pressure is difficult to assess during the newborn period and is not the best indicator of intracranial pressure.

A child with sickle cell anemia who is in vaso-occlusive crisis is admitted to the hospital. Which primary health care provider prescription would assist in reversing the vaso-occlusive crisis?

Begin intravenous fluids.

A child is brought to the emergency department after falling from a high swing and landing on the back. The nurse notes that the client also has hemophilia. Based on the client's history and the nature of the injury, which would the nurse assess for first?

Blood in the urine -Because the kidneys are located in the flank region of the body, trauma to the back area can cause hematuria, particularly in the child with hemophilia. The nurse would be most concerned about the child's airway and respiratory rate if the child sustained an injury to the neck region. Headache and slurred speech are associated with head trauma.

The nursing student is assigned to care for a child with hemophilia. The nursing instructor reviews the plan of care with the student and intervenes if which intervention on the student-written plan of care is noted?

Blood transfusion of packed red blood cells. -Hemophilia is a lifelong hereditary blood disorder associated with deficiency of clotting factors. It is inherited in a recessive manner via a genetic defect on the X chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX. Blood product transfusion is not the treatment of choice over administering recombinant factors intravenously. Measuring circumference of injured joints is appropriate to assess for enlarging hematomas or bleeding under the skin. The nurse would avoid taking rectal temperatures to decrease the risk for injury.

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

Bluish discoloration of the skin

Cerebral palsy (CP) is suspected in an infant, and the parents ask the nurse about the potential warning signs of CP. The nurse would provide which information? Select all that apply.

Cerebral palsy (CP) is a term applied to a disorder that impairs movement and posture. The effects on perception, language, and intellect are determined by the type that is diagnosed. Stiff, rigid arms and legs, low birth weight, poor sucking and swallowing, and inability to crawl properly are potential warning signs of CP. By 8 months of age, if the infant cannot sit up without support, this needs to be considered a potential warning sign because this developmental task would be completed by this time. The infant with a potential diagnosis of CP has poor head control by 3 months of age, when head control would be strong.

A school-age child with Down's syndrome is brought to the ambulatory care center by the parent. The child has bruising all over the body. To work most effectively with this child, the nurse first addresses which complication associated with Down's syndrome?

Children with Down's syndrome are more likely to develop acute leukemia than the average child.

The nurse is providing home care instructions to the parent of a child who is recovering from Reye's syndrome. Which instruction would the nurse provide to the parent?

Check the skin and eyes every day for a yellow discoloration. -Checking for jaundice will assist in identifying the presence of liver complications, which are characteristic of Reye's syndrome. Decreasing stimuli and providing rest decrease stress on the brain tissue. If vomiting occurs in Reye's syndrome, it is caused by cerebral edema and is a sign of intracranial pressure.

The nurse is reviewing the pediatrician's documentation in the record of a child admitted with a diagnosis of intussusception. The nurse expects to note that the pediatrician has documented which manifestation?

Currant jelly-like stools -In the child with intussusception, bright red blood and mucus are passed through the rectum, resulting in what is commonly described as currant jelly stools. The child classically presents with severe abdominal pain that is crampy and intermittent, causing the child to draw the knees in to the chest. Vomiting may be present but not projectile. Scleral jaundice and pale-colored, hard stools are not manifestations of this disorder.

The nurse is monitoring a 3-month-old infant with hydrocephalus for signs of increased intracranial pressure. On palpation of the fontanels, the nurse notes that the anterior fontanel is soft and flat. On the basis of this finding, which nursing action is most appropriate?

Document the finding.

The nurse is caring for an infant with spina bifida (myelomeningocele type) who had the sac on the back containing cerebrospinal fluid, the meninges, and the nerves (gibbus) surgically removed. The nursing plan of care for the postoperative period would include which action to maintain the infant's safety?

Elevating the head with the infant in the prone position -Elevating the head will decrease the chance that cerebrospinal fluid will accumulate in the cranial cavity. The infant needs to be prone or side-lying to decrease the pressure on the surgical site on the back. Binders and a baby seat would not be used because of the pressure they would exert on the surgical site.

An emergency department nurse is caring for a child with suspected acute epiglottitis. Which nursing interventions apply in the care of this child? Select all that apply.

Ensure patent airway Obtain a pediatric-size tracheostomy tray. Prepare the child for a chest radiographic study. Place the child on an oxygen saturation monitor. -Acute epiglottitis is a serious obstructive inflammatory process that requires immediate intervention. The nurse immediately ensures a patent airway. To reduce respiratory distress, the child needs to sit upright. Examining the throat with a tongue depressor or attempting to obtain a throat culture is contraindicated because it could precipitate further obstruction. A complete blood count is obtained, and the child is placed on an oxygen saturation monitor. Lateral neck and chest radiographic films are obtained to determine the degree of obstruction, if present. A pediatric-size tracheostomy tray needs to be readily available, and intubation may be necessary if respiratory distress is severe.

An infant is born to a postpartum client with hepatitis B. The nurse plans for which prophylactic measure for the infant?

Hepatitis B immune globulin (HBIG) and hepatitis B vaccine given within 12 hours after birth

The nurse is caring for a 4-year-old child with human immunodeficiency virus (HIV) infection. The nurse would expect which statement that is aligned with the psychosocial expectations of this age? "Being sick is scary." 2"I know it hurts to die." 3"I know I will be healthy soon." 4"I know I am different than other kids."

I know it hurts to die. -A preschool-age child begins to conceptualize the death process as involving physical harm. An adolescent expresses fear, withdrawal, and denial, noted in option 1. A child from birth to 2 years of age is unable to grasp the concept of illness and death, which is reflected in the statement in option 3. A school-age child begins to understand that something is wrong, which is noted in option 4.

A child who is 4 years old is seen for a well-child checkup. The child has been regularly receiving immunizations. Which immunizations would the child receive at this visit? Select all that apply.

IPV Varicella DTap MMR

The nurse is developing a plan of care for a 5-week-old infant being admitted with hypertrophic pyloric stenosis who is scheduled for pyloromyotomy. In the preoperative period, the nurse would place the infant in which best position?

In an infant seat placed in the crib

The nurse is asked to prepare for the admission of a child to the pediatric unit with a diagnosis of Wilms' tumor. The nurse is creating a plan of care for the child and would include which intervention in the plan?

Inspect the urine for the presence of hematuria at each voiding. -If Wilms' tumor is suspected, the tumor mass would not be palpated. Excessive manipulation can cause seeding of the tumor and cause spread of the cancerous cells. Fever (not hypothermia), hematuria, and hypertension (not hypotension) are clinical manifestations associated with Wilms' tumor.

A 10-year-old child with hemophilia A has slipped on the ice and bumped the knee. The nurse would prepare to administer which prescription?

Intravenous infusion of factor VIII

A parent brings their child to the well-child clinic and expresses concern to the nurse because the child has been playing with another child diagnosed with hepatitis. The nurse prepares to perform an assessment on the child, knowing that which finding would be of least concern for hepatitis?

Left upper abdominal quadrant pain -Assessment findings in a child with hepatitis include right upper quadrant tenderness and hepatomegaly. The stools will be pale and clay-colored, and urine will be dark and frothy. Jaundice may be present and will be best assessed in the sclerae, nail beds, and mucous membranes.

A nurse is assigned to care for a 6-year-old child with Legg-Calves-Perthes disease, and the parent asks about treatments that may be used. Which treatments may be prescribed? Select all that apply.

Legg-Calve-Perthes disease occurs from avascular necrosis of the femoral head from a disturbance of blood circulation to the femoral capital epiphysis. The bone weakens and gradually breaks apart. The cause is unknown. Abduction braces or casting may be used for containment of the femoral head. Traction may be used to stretch adductor muscles and improve the containment of the femoral head. Physical therapy helps maintain range of motion in the hip joint, reduce inflammation and pain, and protect the joint as it heals. Since weight-bearing is limited, crutches are helpful. An arm sling is not helpful since the upper extremities are not affected in this condition.

The nurse is reviewing the pediatrician's orders for a child with Legg-Calve-Perthes disease. Which orders(s) would the nurse expect to note written in the medical record? Select all that apply.

Legg-Calve-Perthes disease occurs from avascular necrosis of the femoral head from a disturbance of blood circulation to the femoral capital epiphysis. The bone weakens and gradually breaks apart. The cause is unknown. Limiting weight-bearing activities decreases discomfort and stress on the bone. Ibuprofen is a nonsteroidal anti-inflammatory drug and reduces inflammation. Traction is applied to stretch tight abductor muscles and strengthen containment of the femoral head; traction also helps to relieve pain. Bracing or casting may be also be used for containment.

When assessing a 2-year-old child, the nurse notes the child is limping, especially with increased activity. The nurse recognizes this finding as indicative of which condition?

Legg-Calves-Perthes disease

The nurse is assessing a client with fragile X syndrome. The nurse anticipates noting which physical assessment finding?

Long, narrow face with a prominent jaw -Fragile X syndrome is a genetic condition that causes developmental problems, including learning disabilities and cognitive impairment. Physical assessment findings of fragile X syndrome include long, wide, and/or protruding ears; a long, narrow face with a prominent jaw; and large testes. Therefore, the descriptions in the remaining options are incorrect.

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

Mashed potatoes with baked chicken -The continued feeding of a normal diet can prevent dehydration, reduce stool frequency and volume, and hasten recovery. Common foods that are especially well tolerated during diarrhea are bland but nutritional foods, including complex carbohydrates (rice, wheat, potatoes, cereals), yogurt containing live cultures, cooked vegetables, and lean meats. Oral rehydration solutions are also helpful. The foods in options 1 and 3 may worsen the diarrhea. Fluids only will affect nutritional status.

A child admitted to the hospital with a diagnosis of gastroenteritis and dehydration weighs 17 lb 2 oz (7.8 kg). The parents state that his preadmission weight was 18 lb 4 oz (8.3 kg). Based on weight alone, what type of dehydration does the nurse expect?

Moderate dehydration -Mild dehydration is a weight loss less than 5%; moderate dehydration is 5% to 10%; severe dehydration is greater than 10% weight loss. All types of dehydration are acute situations. The answer can be determined by calculating the percent of weight loss in dehydration. Because the math calculation determines more than a 5% weight loss but less than 10% weight loss, the correct answer is moderate dehydration. By calculating the percent of weight loss, the correct answer can be determined.

The nurse is reviewing a chart for a child with a head injury. The nurse notes that the level of consciousness has been documented as obtunded. Which finding would the nurse expect to note on assessment of the child?

Not easily arousable and limited interaction

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?

Partial thromboplastin time

A parent brings their child to the emergency department. Based on the child's sitting position, drooling, and apparent respiratory distress, a diagnosis of epiglottitis is suspected. In anticipation of the primary health care provider's prescriptions, in which order of priority would the nurse implement the actions? Arrange the actions in the order that they would be performed. All options must be used.

Patent Airway Assess breath sounds by auscultation. Obtain an oxygen saturation level using pulse oximetry. Insert an intravenous line for fluid administration. Obtain an axillary temperature. Administer an antipyretic.

Assessment findings of an infant admitted to the hospital reveal a machinery-like murmur on auscultation of the heart and signs of heart failure. The nurse reviews congenital cardiac anomalies and identifies the infant's condition as which disorder? Refer to figure (the circled area) to determine the condition.

Patent ductus arteriosis

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

Perform a pain assessment using the FACES scale. -A pain assessment is the priority to assess for increased or reduced pain, which can indicate peritonitis. A reported sudden relief from pain may indicate perforation. If perforation occurs, increasing pain then ensues. Perforation can lead to peritonitis, an urgent condition to be treated immediately. Computed tomography has become the imaging technique of choice, although ultrasonography may also be helpful in diagnosing appendicitis. Urinalysis is analyzed to rule out a urinary tract infection but is not the priority of care. A white blood cell count above 10,000 mm3 (10 × 109/L) is an expected finding in appendicitis.

A 12-year-old child is admitted to the hospital with suspected appendicitis. What nursing interventions would be implemented preoperatively?

Placing the child in a fetal position, side-lying with legs drawn up to chest -A child with appendicitis is more comfortable when lying in what is traditionally known as the fetal position, with the legs drawn up toward the chest. This flexed positioning assists in decreasing the pain that comes with appendicitis by decreasing the pressure on the abdominal area. A heating pad is contraindicated because heat can lead to a ruptured appendix. Pain medications are not given to the client with acute appendicitis because they may mask the symptoms that accompany a ruptured appendix. A nasogastric tube may be necessary postoperatively for gastric decompression or preoperatively if perforation occurs. There are no data in the question that support perforation.

The emergency department nurse is caring for a child with suspected epiglottitis and has ensured that the child has a patent airway. Which action is the next priority in the care of this child?

Prepare the child for a chest radiograph -If epiglottitis is suspected, the priorities are to maintain a patent airway and obtain a chest radiograph to confirm the diagnosis. If epiglottitis is present, the child is taken promptly to the operating room for tracheal intubation or immediate placement of a surgical airway. Epinephrine is not used in the treatment of epiglottitis.

A child is brought to the emergency department after being accidentally struck in the lower back region with a baseball bat. When gathering assessment data, the nurse discovers that the child has hemophilia. The nurse would immediately assess for which data?

Presence of hematuria

The nurse is caring for a child with hemophilia and is reviewing the results that were sent from the laboratory. Which result would the nurse expect in this child?

Prolonged PTT

The nurse is admitting a newborn infant to the nursery and notes that the primary health care provider (PHCP) has documented that the newborn has an omphalocele and will require a surgical procedure. Preoperative nursing care would include which nursing interventions? Select all that apply.

Protect defect from trauma. Maintain a thermoneutral environment. Assess for associated birth defects such as cleft palate.

The nurse is assessing for Kernig's sign in a child with a suspected diagnosis of meningitis. Which action would the nurse perform for this test?

Raise the child's leg with the knee flexed and then extend the leg at the knee and assess for pain.

A 6-year-old girl born with a myelomeningocele has a neurogenic bladder disorder. Her parents have been performing clean intermittent catheterization. The nurse's MOST appropriate action is to

teach the child to do self-catheterization

The nurse is reviewing a primary health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record would the nurse question? Select all that apply.

Restrict fluid intake. Give meperidine, 25 mg intravenously, every 4 hours for pain. -Sickle cell anemia is one of a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell; insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. Oral and intravenous fluids are an important part of treatment. Meperidine is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would question the prescription for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-calorie and high-protein diet are also important parts of the treatment plan.

A 4-year-old child diagnosed with Legg-Calves-Perthes disease underwent magnetic resonance imaging (MRI), and radiographic findings showed aseptic necrosis of the femoral capital epiphysis with degenerative changes. The nurse recognizes this finding as indicative of which stage?

Stage I

The clinic nurse prepares to administer a measles, mumps, and rubella (MMR) vaccine to a 5-year-old child. The nurse would administer this vaccine by which method?

Subcutaneously in the outer aspect of the upper arm

In caring for a child diagnosed with Hodgkin's disease, which oncological emergency would the nurse be most concerned about?

Superior vena cava syndrome

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

Tender, distended abdomen

The nurse is performing a pain assessment on a nonverbal, neurologically impaired child. Which pain scale would be most appropriate in this situation?

The revised FLACC (r-FLACC) scale -The revised FLACC (r-FLACC) scale is used for nonverbal clients, such as young children who have not yet learned to speak or those who are nonverbal related to an underlying etiology. The r-FLACC scale consists of five categories, including face, legs, activity, crying, and consolability, with scores ranging from 0 to 2 in each category; the scale has a maximum score of 10. Therefore, option 4 is the correct answer. The CRIES scale is generally used for infants 6 months of age and younger. The Wong-Baker FACES scale uses visual representations of pain with different drawn-out facial expressions. While useful for young children, this scale would not be the most appropriate to use for a nonverbal, neurologically impaired child. The numerical pain scale uses a scale from 0 to 10 and would be inappropriate in this situation.

The nurse is teaching a client with nephrotic syndrome about managing the disorder. What would the nurse instruct the client to adjust according to the amount of edema present?

activity level -The client is taught to adjust the activity level according to the amount of edema. As edema decreases, activity can increase. Correspondingly, as edema increases, the client needs to increase rest periods and limit activity. Bed rest is recommended during periods of severe edema. The client with nephrotic syndrome usually has a standard limit set on sodium intake. Fluids are not restricted unless the client also is hyponatremic. Diuretics are prescribed on a specific schedule, and doses are not titrated according to the level of edema.

An adolescent with diabetes receives 30 units of Humulin N insulin at 7:00 a.m. The nurse would monitor for a hypoglycemic episode at what time?

before supper -Humulin N insulin is an intermediate-acting insulin that peaks in approximately 6 to 12 hours. It would peak before supper if given at 7:00 a.m. Short-acting insulin would peak after breakfast or midmorning. Long-acting insulins would peak at bedtime.

The nurse is caring for a client diagnosed with a hydrocephalus. Which would the nurse anticipate as being the cause of this disorder?

closure of cranial suture

The nurse is performing an assessment on a child with a head injury. The nurse notes an abnormal flexion of the upper extremities and an extension of the lower extremities. What would the nurse document that the child is experiencing?

decorticate flexion

The nurse is collecting data on a 9-year-old child suspected of having a brain tumor. Which question would the nurse ask to elicit data related to the classic symptoms of a brain tumor?

do you throw uo in the morning? -The classic symptoms of children with brain tumors are headache and morning vomiting related to the child getting out of bed. Headaches worsen on arising but improve during the day. Fatigue may occur but is a vague symptom. Visual changes may occur, including nystagmus, diplopia, and strabismus, but these signs are not the hallmark symptoms with a brain tumor.`

The nurse is caring for a child after surgical removal of a brain tumor. The nurse would assess the child for which sign that would indicate that brainstem involvement occurred during the surgical procedure?

elevated temp

The parents of a 6-year-old child who has type 1 diabetes mellitus call a clinic nurse and tell the nurse that the child has been sick. The parents report that the child's urine is positive for ketones. The nurse would instruct the parents to take which action?

encourage child to drink fluids

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

exercise intolerance -exercise intolerance, chest pain, and dizziness when standing for long periods.

The nurse would plan to place a child who had a medulloblastoma brain tumor (infratentorial) removed in which position postoperatively?

flat on either side -If an infratentorial tumor has been removed, the child is positioned flat on either side. The pillow is placed behind the child's back for comfort and for maintaining the position. The pillow is not placed behind the head because when the pillow is behind the head, proper alignment is not maintained, and this misalignment can impair circulation. The child would never be placed in a Trendelenburg's position (head down) because this position increases intracranial pressure. The head is elevated when the tumor is a supratentorial one. Remember, though, that the surgeon's prescription for positioning is always followed.

The clinic nurse is assessing a child suspected of having juvenile rheumatoid arthritis (JRA). Which assessment findings would the nurse expect to note in a child who has been diagnosed with JRA?

intermittent joint pain that lasts longer than 6 weeks and painful, stiff, and swollen joints that are warm to the touch, with limited range of motion. The child will complain of morning stiffness and may protect the affected joint or refuse to walk. Systemic symptoms include malaise, fatigue, lethargy, anorexia, weight loss, and growth problems. A history of a late-afternoon fever with temperature spiking up to 105° F (40.6° C) will also be part of the clinical manifestations.

The nurse is caring for an infant with a diagnosis of tetralogy of Fallot. The infant suddenly becomes cyanotic, and the nurse recognizes that the infant is experiencing a hypercyanotic spell (blue or tet spell). The nurse immediately places the infant in what position?

knee to chest

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

maintains adequate CO

The nurse is caring for a hospitalized child with a diagnosis of measles (rubeola). In preparing to care for the child, which supplies would the nurse plan to bring to the child's room to prevent transmission of the virus?

mask and gloves -droplet precautions

An important nursing intervention when caring for a child with myelomeningocele in the postoperative stage is to

measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.

The nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle crash for signs of increased intracranial pressure (ICP). The nurse would assess the child frequently for which early sign of increased ICP?

nausea -Nausea is an early sign of increased ICP. Late signs of increased ICP include a significant decrease in level of consciousness, Cushing's triad (increased systolic blood pressure and widened pulse pressure, bradycardia, and irregular respirations), and fixed and dilated pupils. Other late signs include decreased motor response to command, decreased sensory response to painful stimuli, posturing, Cheyne-Stokes respirations, and papilledema.

A child with type 1 diabetes mellitus is brought to the emergency department by the parents, who state that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion?

normal saline infusion

The clinic nurse is assessing a child for dehydration. The nurse determines that the child is moderately dehydrated if which finding is noted on assessment?

oliguria -In moderate dehydration, the fontanels would be slightly sunken, the mucous membranes would be dry, and the skin color would be dusky. Also, oliguria would be present.

The nurse is caring for an infant with gastroenteritis who is being treated for dehydration. The nurse reviews the health record and notes that the primary health care provider has documented that the infant is mildly dehydrated. Which assessment finding would the nurse expect to note in mild dehydration?

pale skin color -In mild dehydration, the skin color is pale. Anuria and sunken fontanels are assessment characteristics of severe dehydration. Dry mucous membranes are an assessment characteristic of moderate dehydration.

s/s of vaso occlusive crisis with sickle cell

pallor fever painful swelling of joints, hands, and feet abdominal pain

Cerebral palsy may result from a variety of causes. It is now known that the most common cause of cerebral palsy is

prenatal brain abnormalities.

A child is admitted to the pediatric unit with a diagnosis of acute stage Kawasaki disease. Which assessment findings by the nurse are characteristic of this disorder?

red throat Conjunctival hyperemia Enlargement of the cervical lymph nodes -Kawasaki disease is known as mucocutaneous lymph node syndrome and is an acute systemic inflammatory disease. Assessment findings in the acute stage include fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. Desquamation of the skin, cracking lips, joint pain, cardiac manifestations, and thrombocytosis are characteristics of the subacute stage.

in. a preschooler, play is...

simple and imaginative, and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh.

A 3-year-old male child has cerebral palsy and is currently hospitalized for orthopedic surgery. His mother says that he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. The MOST appropriate nursing action related to feeding this child is to

stabilize his jaw with one hand (either from a front or side position) to facilitate swallowing

early signs of HF

tachypnea, poor feeding, and diaphoresis during feeding.

in mild dehydration...

the skin color is pale. -Anuria and sunken fontanels are assessment characteristics of severe dehydration. Dry mucous membranes are an assessment characteristic of moderate dehydration.