NR328 Final

An 8-year-old girl was diagnosed and treated for strep throat last week. The parent reports that the child has demonstrated malaise and lethargy for the past 24 hr. The parent states that "her eyes appear puffy." What action should the nurse take first? 1.Assess for periorbital edema 2.Assess the child's upper respiratory tract 3.Obtain a sputum specimen 4.Restrict intake of oral fluids

1 Can be a symptom of Nephrotic Syndrome. - Other symptoms include: proteinuria, hypoalbuminemia, hyperlipidemia, and massive urinary protein loss

A RN is caring for a child who has had watery diarrhea for the past 3 days. Which of the following is an action for the RN to take? 1. Offer chicken broth 2. Initiate oral rehydration therapy 3. Start hypertonic IV solution 4. Keep NPO until the diarrhea subsides

2 is recommended to replace lost electrolytes for children who have diarrhea 1-is avoided bc of its increased sodium and inadequate carbohydrates 3-isotonic iv solutions are recommended 4- this is contraindicated

While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2 and decreased PO2. the nurse suspects that the newborn has: 1. Pulmonary hypertension 2. Patent ductus arteriosus (PDA) 3. Ventricular septal defect -VSD 4. Bronchopulmonary dysplasia

2 the main identifier in the stem is machine-like murmur, which is the hallmark of a PDA

A RN is assessing a child who has Legg-Calve-Perthes dx. Which of the following findings should the RN expect? (Select all that apply) 1.Long affected leg 2.Hip stiffness 3.Back pain 4.Limited ROM 5.Limp with walking

2,3,4,5 1- shortened affected leg

A RN is teaching an adolescent who has DM about manifestations of hypoglycemia. Which of the following findings should the RN include in teaching? (Select all that apply) 1.Increased urination 2.Hunger 3.Poor skin turgor 4.Irritability 5.Sweating and pallor 6.Kussmaul respiration

2,4,5 1,3,6-manifestation of hyperglycemia

A RN is providing teaching to the caregiver of an infant who has a prescription for digoxin. Which of the following instructions should the RN include? 1. Don't offer your baby fluids after giving the medication 2. Digoxin increases your baby's HR 3. Give the correct dose of medication at regularly scheduled times 4. If your baby vomits a dose, you should repeat the dose to ensure that the correct amount is received

3 1-can be given without regard to fluid/foods 2-slows the HR by increasing contractility of the heart 4-it is impossible to determine how much med was lost

The nurse is caring for a child who has undergone a cardiac catheterization. During recover, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to: 1. Call the interventional cardiologist 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site

4 applying direct pressure 1 inch above the puncture site will localize pressure over the vessel site

For a child with type 1 diabetes mellitus, when is it recommended that the urine be tested for ketones? A. During an illness when serum glucose is less than 90 mg/dl B. When serum glucose exceeds 240 mg/dl C. After febrile upper respiratory illnesses D. Before each capillary blood glucose test

B

A nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition? 1. There is a lack of peristalsis in the large intestine and an accumulatio of bowel contents, leading to abdominal distention 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention 3. There is a small-bowel obstruction leading to ribbon-like stools 4. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention

1 in Hirschsprung disease (Also called congenital aganglionic megacolon), a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumulation of bowel content and abdominal distention

A RN is providing teaching about the management of epistaxis to an adolescent. Which of the following positions should the RN instruct the adolescent to take when experiencing a nosebleed? 1. Sit up and lean forward 2. Sit up and tilt the head up 3. Lie in a supine position 4. Lie in a prone position

1 this helps prevent aspiration

A RN is teaching a parent of an infant about GERD. Which of the following should the RN include in the teaching? (Select all that apply) 1. Offer frequent feedings 2. Thicken formula with rice cereal 3. Use a bottle with a one-way valve 4. Position baby upright after feeding 5. Use a wide-base nipple for feedings

1, 2, 4 3, 4-this is used with cleft lip and palate

A 10yo has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain 2. Pulse 3. Hemoglobin and hematocrit levels 4. Catheterization report

2 checking for pulse, especially in the cannulated extremity, would assure perfusion to that extremity and is the priority post procedure

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measure should be taken to stop the bleeding? Select all that apply 1. The extremity should be immobilized 2. The extremity should be elevated 3. Warm moist compress should be applied to decrease pain 4. Passive ROM exercises should be administered to the extremity 5. Factor VIII should be administered

1, 2, 5 - measures are needed to induce vasoconstriction and stop bleeding, including immobilization of extremity, elevating extremity, and cold compression - they have a deficiency in factor VIII which causes a delay in clotting when there is a bleed, therefore they need replacement

A RN is assessing an infant who has hypertrophic pyloric stenosis. Which of the following manifestations should the RN Expect? (Select all that apply) 1.Projectile vomiting 2.Dry mucus membranes 3.Jelly stools 4.Sausage-shaped abdominal mass 5.Constant hunger

1, 2, 5 3 & 4- this is found with pt with intussusception

A RN is providing teaching about epistaxis to the parent of a school-age child. Which of the following should the RN include as an action to take when managing an episode of epistaxis (Select all that apply) 1. Press the nares together for at least 10 minutes 2. Breathe through the nose until bleeding stops 3. Pack cotton or tissue into the naris that is bleeding 4. Apply a warm cloth across the bridge of the nose 5. Insert petroleum into the naris after the bleeding stops

1, 3 2- breathe through the mouth until bleeding stops 4-ice packs across the nose 5- this is done to help decrease incidents of nose bleeds

A RN is caring for a child who has thrombocytopenia (low platlet count). Which of the following actions should the RN take? (Select all that apply) 1. Monitor for manifestations of bleeding 2. Administer routine immunization 3. Obtain rectal temperatures 4. Avoid peripheral venipunctures 5. Limit visitors

1, 4 2-Is at risk for bleeding, avoid skin puncture thus immunizations 3-avoid rectal temperatures could cause tissue injury 5-limiting visiors pis when fyou are preventing infections

A RN is reviewing sick-day management with a parent of child who has type 1DM. Which of the following should the RN include in the teaching? (Select all that apply) 1. Monitor BS q 3hrs 2. Discontinue taking insulin until feeling better 3. Drink 8oz of fruit juice q hour 4. Test urine for ketones 5. Call the provider if BS is >240mg/dL

1, 4, 5

A Rn is caring for a child suspected of having rheumatic fever. Which of the following findings should the RN expect? (Select all that apply) 1. Erythema marginatum rash 2. Continuous joint pain of the digits 3. Tender, subcutaneous nodules 4. Decreased erythrocyte sedimentation rate 5. Elevated CRP

1, 5 2-large joints 3-nontender 4-elevated ESR

The Rn is taking care of a 10yo diagnosed with Graves disease. Which could the RN expect the child to have recently had? 1. Wt gain, excessive thirst, and excessive hunger 2. Wt loss, difficulty sleeping, and heat sensitivity 3. Wt gain, lethargy, and goiter 4. Wt loss, poor skin turgor, and constipation

2 weight loss, increased activity and heat intolerance can be expected when the thyroid gland is hyperfunctions

A RN is caring for a 2yo child who has a heart defect and is scheduled for cardiac catheterization which of the following action should the RN take? 1.Place a NPO status for 12hr prior to procedure 2.Check for iodine or shellfish allergies prior to procedure 3.Elevate the affected extremity following the procedure 4.Limit fluid intake following the procedure

2 1- 4-6 hrs prior 3-straight position after 4-encourage fluids

The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of liquid oral iron supplement. Which instruction should the nurse tell the parents? 1. Administer the iron at mealtime 2. Administer the iron through a straw 3. Milk the iron with cereal to administer 4. Add the iron to formula for easy administration

2 In iron deficiency anemia iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth, because the iron stains the teeth. Should brush or wipe away teeth after administration . It is administered between meals bc absorption is decrease if there is food in the stomach.

The patient of a 5yo states that the child has been having diarrhea for 24 hours, vomited 2x, 2 hrs ago, and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response. 1. " you can offer clear diet soda such as Sprite and ginger ale" 2. "Pedialyte is really the best thing for your child, who, if they are thirsty enough, will eventually drink it" 3. "Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it by offering small amounts in a spoon, medicine cup or syringe" 4. "it really does not matter what your child drinks as long as it is kept down. Try offering small amounts of fluid in medicine cups"

3 Pedialyte is the first choice recommended by the American Academy of Pediatrics as an oral rehydration solution. Offering the child appropriate choices may allow the child to feel empowered and less likely to refuse the Pedialyte. Small frequent amounts are usually better tolerated.

A 4-year-old child with anemia is receiving oral iron supplements. What dietary recommendation would the nurse provide to this family? 1. Administer the iron with a dairy product. 2. Administer the iron with apple juice. 3. Administer the iron with orange juice. 4. Administer the iron prior to breakfast.

3 The intake of citrus juices with the iron will increase the iron's absorption

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1. Diarrhea 2. Metabolic acidosis 3. Metabolic alkalosis 4. Hyperactive bowel sounds

3 vomiting causes the loss of hydrochloric acid and subsequent metabolic alkalosis. 2 - Metabolic acidosis would occur if the child experienced diarrhea bc of loss of bicarb

A RN is teaching a parent of a child who has a Wilms' tumor. Which of the following statements should the RN include in teaching (Select all that apply) 1. Your child will need to have chemotherapy for 12mo 2. Wilms' tumors are typically genetic in nature 3. Surgery is done usually within 48 hours of diagnosis 4. Palpating the tumor could cause the spread of the tumor 5. Further treatment will start immediately after surgery

3, 4, 5 1- chemotherapy tx depends on the stage of the tumor 2-about 2% have a familiar origin

An 18mo male is brought to the clinic by his mother. His height is in the 90th percentile, and weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?' 3. "What does your child eat every day?" 4. "Has the child been given any new medication?" 5. "How much milk does your child drink per day?"

3, 5 - a diet history is necessary to determine the nutritional status of the child and whether the child is getting a sufficient source of iron. - by asking how much milk the child consumes, the nurse can determine whether the child is filling up on milk and not wanting to take food

Which signs best indicate ICP in an infant? Select all that apply 1. Sunken anterior fontanel 2. Complaints of blurred vision 3. High-pitched cry 4. Increased appetite 5. Sleeping more than usual

3, 5 high pitched cry and sleeping more than usual are often indicative of ICP in infants. -fontanel should be bulging, infant cannot complain, and appetite is usually poor

A RN is assessing for a 4mo infant who has meningitis. Which of the following manifestation should the RN expect? 1.Depressed anterior fontanel 2.Constipation 3.Presence of the rooting reflex 4.High-pitched cry

4 - may also have seizures, fever & irritability, bulging fontanel, possible nuchal rigidity, and poor feeding

Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of Developmental Dysplasia of Hip (DDH)? 1.Put socks on the foot pieces of the harness to help stabilize the harness 2.Use lotion or powder on the skin to prevent rubbing of straps 3.Remove harness during diaper changes for ease of cleaning diaper area 4.Check under the straps at least two to three time daily for red area

4 checking prevents skin breakdown 1- socks placed to prevent skin breakdown, but the harness should be stable if fitted correctly 2- lotions and powers are avoided 3- harness should not be removed except in certain conditions

A school age child with type 1 DM has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? 1. Eat 2x the amount normally eaten at lunchtime 2. Take half the amount of prescribed insulin on practice days 3. Take the prescribed insulin at noontime rather than in the morning 4. Eat a small box of raisin or drink a cup of orange juice before soccer practice

4 hypoglycemia is a blood glucose level less than 70 and results from too much insulin , not enough food, or excessive activity. An extra snack of 15-30 g of carbohydrates eaten before activities such as soccer practice would prevent hypoglycemia. 1, 2, 3 - meals should not be doubled, and not instruct to adjust amout or time of insulin admin

A nurse is preparing to care for a child diagnosed with intussusception. The nurse reviews the child's record and expects to note which signs of this disorder documented? 1. Watery diarrhea 2. Ribbon-like stools 3. Profuse projectile vomiting 4. Bright red blood and mucous in the stool

4 intussusception is a telescoping of 1 portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. Child will have severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present but is not projectile. Bright red blood and mucous are passed through the rectum and described as currant jelly-like stool.

A 10yo is being evaluated for possible appendicitis and complains of nausea & sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and blood count has been obtained. The child vomits, finds the pain relieved and calls the RN. Which should be the RN's next action? 1. Cancel the ultrasound, and obtain an order for oral Zofran 2. Cancel the ultrasound, and prepare to admin an IV bolus 3. Prepare for the probably discharge of the patient 4. Immediately notify the physician of the child's status

4 the Dr should be notified immediately, a sudden change or loss of pain often indicates a perforated appendix

A RN is caring for an infant who has a myelomeningocele. Which of the following actions should the RN include in the preoperative plan of care? 1.Assist the caregiver with cuddling the infant 2.Assess the infant's temperature rectally 3.Place the infant in a supine position 4.Apply a sterile, moist dressing on the sac

4 a sterile moist, non-adhering dressing is placed on the sac to keep it moist until surgery. - Myelomeningocele -form of spina bifida (SB Cystica-visible with an external saclike protrusion), sac contains spinal fluid, meninges, and nerves; failure of the neural tube to close causes decreased motor and sensory function. Neurologic deficit occurs in varying degrees in myelomeningocele 1-cuddling could cause pressure on the sac, which could cause it to rupture 2-rectal temp could cause irritation or rectal prolapse 3-placing supine could cause pressure and cause it to prolapse

2.Which is not a motor sign indicative of cerebral palsy? A. Stiff limbs B. Floppy tone C. Straight back D. Head control

A

You're caring for a 2-day-old infant with a large patent ductus arteriosus. The mother of the infant is anxious and asks you to explain her child's condition to her again. Which statement below BEST describes this condition? A. "The vessel connecting the aorta and pulmonary vein has closed prematurely, which is leading to increased blood flow to the lungs." B. "The vessel connecting the aorta and pulmonary artery has failed to close at birth, which is leading to a left-to-right shunt of blood." C. The vessel connecting the aorta and pulmonary vein has failed to close at birth, which is leading to a right-to-left shunt of blood." D. "The vessel connecting the aorta and pulmonary artery has closed prematurely, which is leading to a left-to-right shunt of blood."

B Patent ductus arteriosus (PDA) occurs when the vessel that normally connects the aorta and pulmonary artery in utero has failed to close at birth, which leads to a left-to-right shunting of blood. This shunting of blood will increase blood flow to the lungs and can cause pulmonary hypertension and eventually heart failure (left-sided), especially if the PDA is large.

A child is being admitted with the diagnosis of dehydration. What is the nurse's first responsibility? A. Orient the family to the unit B. Get vital signs C. Weigh the patient D. Start an IV

C