Pediatrics Exam 3 (Chapters 27-29)

A child is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment finding indicates a possible complication? A. Crackles in lung bases B. Decreased urine output C. Low serum sodium level D. Nausea and vomiting

A Because of fluid retention, heart failure is a potential complication and would manifest with lung congestion. The nurse would hear rales or crackles in the child's lungs. The other assessment findings are expected in the child with SIADH.

An infant is suspected of having diabetes insipidus (DI) and is having diagnostic testing. Which action by the nurse is most important? A. Apply a urine collection bag. B. Facilitate DNA testing. C. Insert an indwelling urinary catheter. D. Start two large-bore IVs.

C Infants are tested for DI with desmopressin (DDAVP) instead of a water deprivation test. After administering the medication, urine osmolality is tested at baseline and every 30 minutes for the next 2 hours. The nurse must collect the urine. An indwelling catheter is needed to obtain samples so frequently. A urine collection bag collects the urine but the infant may not void every 30 minutes. If no increase is seen in the osmolality, the infant may have hereditary nephrogenic DI, which can be confirmed by subsequent DNA testing. Because the child is not deprived of water, there is no need for an IV.

A child's chart indicates he has leukocoria and a hyphema in the right eye. Which teaching does the nurse implement for the child and parents? A. Application of antibiotic ointment and eye patch B. Possibility of other children having this genetic disorder C. Surgery, possible enucleation, possible chemotherapy D. Wearing appropriate eye protection during sports

C Leukocoria (cat's eye reflex) and hyphema (blood in the anterior chamber of the eye) are manifestations of retinoblastoma, a rare and aggressive tumor of the retina. Treatment is vigorous and may include surgery (including enucleation), radiation, chemotherapy, laser, or cryotherapy.

A new nurse is caring for a child who had a ventriculoperitoneal shunt placed 2 days ago for hydrocephalus. Which action by the new nurse causes the experienced nurse to intervene? A. Administers IV antibiotics B. Asks for medication to treat nausea C. Palpates the shunt tract with assessments D. Raises the head of the bed to 30°

B Peritonitis is a complication of this procedure and manifestations of this include rebound tenderness, abdominal muscle rigidity, nausea, and vomiting. The new nurse should conduct a more thorough abdominal assessment instead of asking for anti-nausea medication. The other actions are appropriate and do not require the experienced nurse to intervene.

The pediatric nurse caring for patients in a trauma center examines a patient who has increased intracranial pressure as a result of a motor vehicle crash. The nurse is aware that secondary brain injuries can result from which factor? A. Acidosis B. Ischemia C. Infections D. Reduced oxygen

B Primary brain injury is irreversible, immediate, and can result from traumatic injuries (e.g., a blow to the head) or nontraumatic injuries (e.g., a tumor or infection). Secondary brain injuries include ischemia from hypoxia, hypercapnia, hypotension, acidosis, and reduced oxygen delivery.

The nurse gave a diabetic child an injection of Humalog insulin at 0700. At what time would it be most important to check on the child? A. 0715 B. 0800 C. 0930 D. 1200

B The peak action of humalog insulin is in 55 minutes, so the most appropriate time to check on the child is at 0800.

A nurse is caring for four teenagers with diabetic ketoacidosis. Which patient should the nurse see first? A. pH: 7.22 B. Potassium: 7.2 mEq/L C. Sodium: 128 mEq/L D. White blood cell count: 17,250 mm3

B This potassium is critically high and can lead to fatal dysrhythmias. The nurse should see this patient first. All of the other children have abnormal laboratory values too, but this takes priority.

A child is prescribed baclofen (Lioresal) via intrathecal pump to treat severe muscle spasms related to cerebral palsy. What teaching does the nurse provide the child and parents? A. Do not let this prescription run out. B. The medication may cause gingival hyperplasia. C. Periodic serum drug levels are needed. D. Watch for excessive facial hair growth.

A Abrupt discontinuation of intrathecal baclofen can cause drastic effects, such as high fever, altered mental status, and exaggerated rebound spasticity and muscle rigidity. The parents should ensure there is a supply of this drug on hand at all times to avoid these effects. Gingival hyperplasia and hirsutism are side effects of phenytoin (Dilantin). Serum drug levels are not obtained with an intrathecal medication.

A child is 4 hours postoperative after a total parathyroidectomy. Which assessment takes priority? A. Airway B. Dressing C. IV site D. Pain

A All assessments listed are important for this child; however, airway is always the priority assessment.

What would the nurse assess for in a child with a disturbance in the basal ganglia? A. Ataxia B. Hyperthermia C. Hypotension D. Incontinence

A Ataxia, or uncoordinated movements, may been seen in a child with a problem of the basal ganglia, which controls movement. Changes in temperature and blood pressure are more likely related to problems with the hypothalamus, and incontinence could signify a spinal cord problem.

A child has been diagnosed with diabetic ketoacidosis (DKA) and is in the pediatric intensive care unit. Which nursing diagnosis does the nurse direct interventions toward as the priority? A. Fluid volume deficit B. Ineffective breathing patterns C. Knowledge deficit D. Risk for infection

A Because the child with DKA can be severely dehydrated, priority interventions are directed toward the goal of rehydration. Breathing patterns for the child in DKA may consist of Kussmaul respirations, which are actually the body's way of trying to compensate for the acidosis. As the glucose decreases, this will self-correct. Knowledge deficit can be addressed when the child's condition is stable. Risk for infection is always a potential diagnosis, and the nurse ensures proper technique to prevent this from occurring. But because the dehydration is so severe, this takes priority.

A nurse is preparing to discharge a 10-year-old child who was diagnosed with bacterial meningitis. Which action by the nurse takes priority? A. Arrange home health-care visits for antibiotic infusions. B. Consult with physical therapy about a home exercise plan. C. Ensure the parents can plan high-protein meals. D. Make a social work referral for long-term care placement.

A Children with bacterial meningitis are often discharged with a PICC line in place for home IV antibiotic infusions. Depending on the needs of the child, the other options may or may not be appropriate.

A woman is considering a second pregnancy, but tells the nurse she is not sure she wants to get pregnant again because her first child was born with spina bifida. She is taking folic acid on the advice of her health-care provider. Which information can the nurse provide this woman? A. Alpha-fetoprotein testing can be done in pregnancy. B. Genetic testing is available for this condition. C. It is rare for two children in one family to be affected. D. Usually spina bifida affects only female children.

A During pregnancy, testing of maternal blood for elevated alpha-fetoprotein is available for an early indication of spina bifida. The other options are incorrect.

A health-care provider administers edrophonium (Tensilon) to a school-age child with new onset of muscle weakness. The child is able to hold her eyes open for the duration of the drug's half-life. Which information does the nurse plan to teach the child and parents? A. Muscle weakness will progress in an ascending fashion. B. Pain control will be an important aspect of the child's care. C. This disease is a result of a previous viral infection. D. Weakness and fatigue will probably be worse during the day.

D A positive result to a Tensilon test is diagnostic for myasthenia gravis, an autoimmune disease uncommon in children. Muscle weakness is the main symptom, and the weakness is particularly pronounced in muscles used for eye movement, chewing, swallowing, and breathing. Weakness is usually worse during the day or during times of stress. It is not painful, muscle weakness does not progress in ascending fashion as in Guillain-Barré syndrome, and the cause is unknown.

A child diagnosed with hyperaldosteronism needs a diuretic. Which diuretic does the nurse anticipate administering? A. Bumetanide (Bumex) B. Furosemide (Lasix) C. Hydrocholorthiazide (Hydrodiuril) D. Spironolactone (Aldactone)

D Aldactone is a potassium-sparing diuretic, which is important because children with hyperaldosteronism have low potassium levels. The other three diuretics are potassium wasting.

A hospitalized child is having a seizure. Which action by the nurse takes priority? A. Apply oxygen and oximeter. B. Give anti-seizure medications. C. Pad the side rails of the bed. D. Turn the child on his or her side.

D All actions are appropriate when a patient has a seizure. The priority, however, is on maintaining the child's airway. Placing the child in a side-lying position decreases the risk of aspiration and airway obstruction.

The student nurse studying anatomy and physiology understands which of the following to be the function of axons? A. Bringing information to the brain B. Maintaining myelin sheaths on nerves C. Protecting sensory and motor pathways D. Taking information away from the brain

D Axons take information away from the brain.

A nurse is caring for a child and notes Battle's sign during the assessment. Which action by the nurse is the most appropriate? A. Assist with obtaining laboratory studies. B. Document the findings in the child's chart. C. Measure the child's abdominal girth. D. Notify the provider and facilitate a CT or an MRI.

D Battle's sign is indicative of a basilar skull fracture. The child will need a head CT or an MRI. The other actions are not needed as a result of this finding.

A nurse is caring for a 45-kg (99-lb) child undergoing a water deprivation test. At a routine assessment during the test, the nurse notes the child's weight at 42 kg. Which action by the nurse takes priority? A. Allows the child to have clear liquids, like broth B. Documents the findings and continues to monitor C. Increases the rate of the IV fluid infusion by 5% D. Notifies the health-care provider immediately

D During a water deprivation test, the child's weight is not allowed to decrease by more than 2-5%. This child's weight has dropped by more than 5%, so the health-care provider must be notified immediately and the test stopped. Broth contains high levels of sodium, which is already high in the dehydrated child. The child's IV fluid rate may need to be increased, but not without the provider's order. Documenting the findings is important, but does not take priority over notifying the provider.

The pediatric nurse caring for a patient with encephalitis explains to the parents that the most common origin of encephalitis is which of the following? A. Bacterial B. Fungal C. Parasitic D. Viral

D Encephalitis is usually viral in origin and occurs with an acute febrile illness that is characterized by cerebral edema and infection of surrounding meninges. Less common etiologies are fungal, bacterial, and parasitic infections; exposure to toxins or drugs; and cancer.

A neonate receives a diagnosis of hydrocephalus. The pediatric nurse assesses for congenital anomalies related to this condition. Which condition is inconsistent with the nurse's knowledge of hydrocephalus? A. Aqueductal stenosis B. Chiari I and II malformations C. Dandy-Walker malformation D. Folic acid deficiency

D Hydrocephalus develops when an impedance to cerebrospinal fluid (CSF) flow or absorption is present. It rarely occurs as a result of the overproduction of CSF. Congenital anomalies, including Chiari I and II malformations, Dandy-Walker malformation, and aqueductal stenosis, are the most common causes of hydrocephalus during the neonatal and early infancy periods. Acquired hydrocephalus occurs after birth and in infancy, usually resulting from intraventricular hemorrhage due to prematurity. Folic acid deficiency is related to neural tube deficits.

A nurse is teaching a parent group about caring for their infants and toddlers. What does the nurse teach to prevent a serious neurological problem in infants? A. Always treat any temperature elevation to prevent seizures. B. Avoid vaccinations with live, attenuated viruses. C. Do not use artificial sweeteners in your baby's food. D. Never give honey to a child less than 1 year of age.

D Infant botulism can be caused by feeding honey to a child less than 12 months of age, so the nurse teaches parents to avoid this. The other statements are inaccurate.

The pediatric nurse explains to the parents of a comatose child that which structure controls the child's level of consciousness? A. Basal ganglia B. Brainstem C. Central nervous system D. Reticular activating system

D Level of consciousness is controlled by the reticular activating system and the cerebral hemispheres of the brain. Cognitive cerebral function cannot occur without an active reticular activating system.

A parent calls the clinic nurse to report that his child, who takes methimazole (MTZ), is running a high fever, seems agitated, and is nauseated. Which response by the nurse is the most appropriate? A. "Bring your child to the clinic this afternoon for a checkup." B. "Double the methimazole dose for 2 days or until the fever is gone." C. "Give your child acetaminophen (Tylenol) every 4 hours for the fever." D. "Take your child to the nearest emergency department right away."

D Methimazole is used to treat hyperthyroidism. With fever, nausea and vomiting, and agitation, the child is demonstrating manifestations of thyroid storm, which is a medical emergency. The parent should take the child to the emergency department.

The nurse in an endocrine clinic is assessing an 8-year-old girl who has not yet started menstruating and is Tanner stage II. Which statement by the nurse to the parent is most appropriate? A. "Bring her back when she starts menstruating." B. "She may have a deficiency of luteinizing hormone." C. "Your child's development is appropriate for her age." D. "We will test her for levels of the female hormones."

D Precocious puberty in a female is suspected when any secondary sex characteristics begin to develop before the age of 9 years. A child who is assessed at Tanner stage II has some breast development, pubic hair development, or both.

A pediatric nurse reads the diagnosis "SCIWORA" on a child's chart. Which assessment finding does the nurse anticipate to correlate with this condition? A. Altered level of consciousness B. Diplopia and visual disturbances C. Inability to hold his head up D. Weakness/paralysis of muscles

D SCIWORA stands for "spinal cord injury without radiographic abnormality." Common manifestations of spinal cord injury include increased muscle tone, loss of normal bowel and bladder function, numbness, sensory changes, pain, and weakness or paralysis of muscles.

The pediatric nurse carefully monitors a patient's status by assessing the child's level of consciousness. The nurse understands that the Glasgow Coma Scale provides clues to which of the following? A. Encephalitis B. Irreversible coma C. Neurological impairment D. Neurological status

D The child's level of consciousness and the use of the Pediatric Glasgow Coma Scale, pupil response, and overall activity provide clues to the child's neurological status

A patient has a serum sodium level of 119 mEq/L, a blood glucose level of 52 mg/dL, and a cortisol level of 1.1 mg/dL. What does the nurse add to this patient's plan of care? A. Demonstrate proper technique to check blood glucose. B. Encourage the child to take salt tablets with each meal. C. Teach parents and child about desmopressin acetate (DDVAP). D. Teach parents and child about solumedrol (Solu-Cortef).

D These laboratory values are indicative of Addison's disease. The drug used to treat this disorder is solumedrol. DDVAP is used for diabetes insipidus. Blood sugar and sodium levels should normalize during treatment.

During assessment of a 6-year-old child with meningitis, the nurse places the child supine and attempts to put the child's chin on her chest. The child cries out in pain and flexes her knees. How does the nurse document this assessment finding in the medical record? A. Absent Moro reflex B. Exaggerated Grey-Turner sign C. Negative Kernig sign D. Positive Brudzinski sign

D Two assessment tests are used in evaluating a patient with meningitis: the Kernig sign and the Brudzinski sign. The nurse has demonstrated a positive Brudzinski sign. The Kernig sign is elicited by placing the patient supine with hips flexed and raising and straightening the leg. Pain behind the knee and resistance are abnormal findings possibly indicative of meningitis. The Moro reflex is done on infants. The Grey-Turner sign is bruising of the flanks, often accompanying pancreatitis.

A child is taking methimazole (MTZ). What does the nurse teach parents to report immediately? (Select all that apply.) A. Brittle hair B. Dry skin C. Headache D. Jaundice E. Pink or red urine

D, E Methimazole has some side effects that can be serious. Jaundice can signal hepatic failure and pink/red urine can be a manifestation of glomerulonephritis, and so both should be reported without delay. The other manifestations are not due to side effects of this drug.

A nurse is caring for four patients in the pediatric intensive care unit with head injuries or brain infections. Which child should the nurse see first? A. Blood pressure change from 110/58 to 134/40 mm Hg in a child with brain injury B. Child with brain injury who has vomited twice in 12 hours, now sleeping C. Child with meningitis who is irritable, complaining of a "bad" headache D. Oral temperature of 100.4°F (38°C) in a child with meningitis

A Hypertension (with widening pulse pressure), bradycardia, and changes in respiratory pattern are components of Cushing's triad, a late sign of increased intracranial pressure, indicative of impending herniation. The change in the child's blood pressure, including the widened pulse pressure (difference between systolic and diastolic pressures), is worrisome. A child with a head injury and minimal vomiting is not alarming. A child with a brain infection who is irritable with a headache needs attention, but not over the child with possible herniation. An oral temperature of 100°F would be expected in a child with a brain infection.

An ophthalmologist examining the eyes of a patient explains to the nurse that the patient has an irregular curvature or uneven contour of the eye, resulting in impaired light refraction that causes blurred vision at all distances. Which condition does the nurse inform the parents about? A. Astigmatism B. Hyperopia C. Myopia D. Strabismus

A In myopia, light rays do not reach the retina, causing blurred vision at a far range and clear vision at a close range. In hyperopia, vision is unclear at a close range and is clearer at a far range. Strabismus, or crossed-eye appearance, results in misalignment of the eyes. Astigmatism may be present at birth or acquired. Light rays are unevenly distributed in the eyes, causing blurred vision at all distances. This condition is associated with birth hyperopia and myopia.

A hospitalized child is receiving calcium via a peripheral IV site. Which action by the nurse is most important? A. Assess the IV for blood return hourly. B. Document the infusion and child's response. C. Facilitate the next blood draw for calcium. D. Teach parents and child about the drug.

A Intravenous calcium infusions can cause extravasation if they infiltrate, so the nurse ensures the IV line is patent by checking the site and blood return frequently. The other actions are important as well, but for patient safety, monitoring the IV is the priority.

A child is in the clinic for follow-up after starting recombinant growth hormone for growth hormone deficiency. After obtaining the child's height, which assessment is the priority? A. Blood pressure B. Bowel function C. Respiratory effort D. Urinary osmolality

A One of the side effects of human growth hormone administration is hypertension. The nurse should assess the child's blood pressure. Bowel function, respiratory effort, and urine osmolality are not affected.

An infant born with spina bifida with a repaired myelomeningocele is brought the emergency department, where the parents report that the infant is very fussy and is feeding poorly. Which nursing action takes priority? A. Assess the baby's fontanels for bulging. B. Attach a cardiac and respiratory monitor. C. Obtain and document the baby's vital signs. D. Try feeding the baby with sucrose water.

A Poor feeding and irritability are signs of increased intracranial pressure (ICP) in infants. A child with spina bifida is at risk for hydrocephalus, which can lead to increased ICP. A corroborating sign would be bulging fontanels. The nurse should quickly palpate the infant's fontanels. Monitoring the child and obtaining vital signs are important actions too, but palpating the fontanels can be done quickly as the nurse handles the child and performs other procedures. The nurse should not attempt to feed this baby now.

A child has hyperthyroidism and is prescribed propranlol (Inderal). The mother states "Why is she taking this? I take Inderal for my blood pressure." Which response by the nurse is the most appropriate? A. Decreases the effects of the hyperthyroidism B. Keeps the child's blood pressure normal C. Prevents the development of thyroid storm D. Because thyroid problems often cause hypertension

A Propranolol is used to decrease the effects of the child's hyperthyroidism. It is not used for blood pressure control or to prevent thyroid storm.

Which information does the nurse provide the teen with type 2 diabetes mellitus regarding exercise? A. Aim for physical activity each day. B. Continue to exercise when sick. C. Exercise with caution, if at all. D. You need strenuous activity.

A The American Diabetes Association has a goal of 30-60 minutes of physical activity a day. When ill, the diabetic should rest. Strenuous activity is not required.

Which organ or gland is directed by the hypothalamus to release adrenocorticotropic hormone (ACTH)? A. Anterior pituitary gland B. Liver C. Pancreas D. Thyroid gland

A The anterior pituitary gland releases ACTH in response to the hypothalamus.

A student nurse is confused about the Monroe-Kelly doctrine. How does the registered nurse explain it to the student? A. Compensation for an increase in one of the skull's components B. Hypothesis about the length of a coma determining the outcome C. Immunomodulatory theory of an inborn resistance to rabies D. Theory that seizures change the neurons and provoke more seizures

A The brain consists of three components: brain matter, cerebral spinal fluid (CSF), and blood. Because the skull is a hard vault (after fontanels have closed), an increase in one of the components is not tolerated. The Monroe-Kelly doctrine states that in order to compensate for an increase in one of the components, there must be an equitable decrease in the other two components in order to prevent brain injury.

The pediatric nurse caring for hearing-impaired children teaches parents the recommended guidelines for communicating with their children. Which instruction is inconsistent with current guidelines? A. Ignoring any related stigmas B. Obtaining the child's attention before speaking C. Positioning yourself at the child's eye level D. Talking slowly and loudly to the child

A The following guidelines are used when communicating with the hearing-impaired child: obtain the child's attention prior to speaking, face the child when talking, position yourself at the child's eye level, talk slowly and loudly, modify the environment to reduce noise, and offer emotional support because the child may face stigmas related to his or her hearing loss.

An adolescent has frequent headaches accompanied by nausea and vomiting. What item is most appropriate for the nurse to include in the teaching plan for this adolescent patient? A. How to give him- or herself an injection of medication B. The maximum daily dose of acetaminophen (Tylenol) C. Ways to manage temporary ptosis or rhinorrhea D. What to do in case of a seizure during the headache

A These symptoms are characteristic of a migraine. Migraines can be treated with a variety of medications, including injectable sumatriptan (Imitrex). The nurse would determine if this medication was included in the treatment plan and offer related education. The child might also take Tylenol, in which case he or she needs to know the maximal daily dose, but that is not as specific for migraines as sumatriptan is. Ptosis and rhinorrhea are characteristic of cluster headache. Headaches are not generally accompanied by seizures.

A nurse is caring for a child who had a sudden onset of muscle weakness beginning in the legs and progressing in an ascending fashion, but who otherwise appears healthy. Which laboratory result would confirm the nurse's suspicion about the origin of this problem? A. Elevated CSF protein B. Increased liver enzymes C. Leukocytosis D. Low hemoglobin

A This child has manifestations of Guillain-Barré syndrome. Elevated CSF protein in the absence of infection supports this diagnosis.

A 5-year-old child is 3 hours postoperative after a total thyroidectomy. The nurse notes hand spasms as the blood pressure cuff is inflated, and the child reports numbness around her lips. After notifying the health-care provider, which action by the nurse takes priority? A. Bring the crash cart to the room. B. Call the laboratory to have blood work drawn. C. Prepare to administer oral vitamin D. D. Raise the head of the child's bed.

A This child is deomnstrating manifestations of critical hypocalcemia, a known complication of thyroid surgery. The nurse ensures emergency equipment is available, as the child may progress to laryngospasm and be unable to breathe. Alternatively, the nurse stays with the patient while a coworker brings the crash cart. Blood work will be done but is not the priority. In a child with a potential airway problem developing, oral meds and nutrition are not given. Raising the head of the bed may help with comfort, but it is not the priority.

A child being treated for hyperthyroidism has been admitted following a seizure. Once the child has been stabilized, which action by the nurse is the most appropriate? A. Assess the child for noncompliance. B. Determine child's nutritional intake. C. Refer the family to a social worker. D. Teach the parents how to treat seizures.

A Untreated hyperthyroidism leads to low calcium, high phosphate, and low magnesium levels. Seizures can occur due to these imbalances. The nurse should assess the child and family for noncompliance. The other actions may be appropriate, but this is the priority to prevent further problems from occurring.

A student nurse is tutoring another student on anatomy and physiology. What does the tutor explain is the function of myelin sheaths on certain nerves? A. Allow rapid transmission of nerve impulses B. Assist in long-term storage of memories C. Prevent "cross-communication" between nerves D. Protect the nerves from temperature changes

A White matter in the brain consists of nerves coated with myelin sheaths, which allow nerve impulses to travel rapidly.

A nursing student asks why the child with hypothyroidism would have high levels of thyroid-stimulating hormone (TSH). Which response by the faculty is the most appropriate? A. "Stimulating-hormone functions are not disrupted by thyroid disorders." B. "The pituitary gland keeps secreting TSH to try to make the thyroid function." C. "TSH exists in an inverse relationship with the other thyroid hormones." D. "Thyroid hormone function is very poorly understood and the reason is not clear."

B Because the levels of thyroid hormone are low, the anterior pituitary gland keeps secreting more and more TSH to try to force the thyroid into producing its hormones. This also clues the provider that the problem is in the thyroid gland itself, not in the brain regulating system. The other answers are not accurate.

A nurse is teaching the parents of a child with growth hormone deficiency about medication administration. Which action charted by the nurse indicates that the goals for teaching have been met? A. Administers growth hormone using correct intramuscular technique B. Administers growth hormone using correct subcutaneous technique C. Demonstrates ability to properly mix growth hormone with liquids D. Rinses inhaler with warm water after each dose is administered

B Growth hormone is administered via subcutaneous injections. It is not given orally, intramuscularly, or by inhalation.

A pediatric dentist refers a child to an endocrinologist because of a concern about the child having so few teeth. Which laboratory testing does the nurse anticipate ordering for the child? A. 24-hour urinalysis for cortisol B. Growth hormone stimulation test C. Serum testosterone D. Water deprivation test

B Growth hormone stimulation testing is often done with insulin or arginine. If the substance used does not stimulate an appropriate amount of growth hormone release, the diagnosis can be made. Measurements of cortisol are done to test adrenal gland function. Testosterone tests are done for sex hormone testing. The water deprivation test is done for diabetes insipidus.

A nurse on an inpatient endocrine unit has received report on a group of four patients. Which patient should the nurse see first? A. Blood glucose of 78 mg/dL, 12-year-old child B. Had Humalog injection and is not eating C. Needs teaching on giving insulin injections D. NPH insulin given, waiting an hour to eat

B Humalog is a rapid-acting insulin, and a meal must be eaten within about 15 minutes of the injection, so the nurse needs to assess this patient first. The 12-year-old's blood sugar is normal, and if it gets lower the child is old enough to recognize hypoglycemia and call the nurse. NPH has an onset of action of 2-4 hours, so waiting an hour to eat will not cause a problem. The child who needs teaching will need an extended amount of time, so the nurse ensures all the other patients are stable prior to beginning the teaching session.

A child is brought to the emergency department with severe flank pain, hematuria, and vomiting. When assessing the child's laboratory findings, which value does the nurse correlate with this condition? A. Calcium, 6.8 mg/dL B. Calcium, 10.2 mg/dL C. Potassium, 3.6 mEq/L D. Potassium, 5.2 mEq/L

B Hypercalcemia can lead to kidney stones, which this child is manifesting. The other laboratory values are not related.

The clinic nurse reads in a child's chart that the parent reports hyperhidrosis. Which item should the nurse take into the examination room? A. Disposable stethoscope B. Extra hand towels C. Incontinence pads D. Large blood pressure cuff

B Hyperhidrosis is excessive sweating. The nurse might want to offer the child some extra washcloths or hand towels. The other items are not related.

A nurse is caring for an 8-year-old with Guillain-Barré Syndrome (GBS). On hourly rounds, the nurse assesses that the child's lung sounds are diminished, respiratory rate is 8 breaths/min and shallow, and pulse oximeter is 88%. What action by the nurse takes priority? A. Administer high-flow oxygen by mask. B. Call the rapid response team; prepare for intubation. C. Encourage the patient to take slow, deep breaths. D. Have the patient use the incentive spirometer.

B In GBS, respiratory muscles can be affected, leading to respiratory failure. The nurse needs to prepare for intubation. The child's muscles are too weak for oxygen or the spirometer to help her, and she may be too weak to use the spirometer or to take deep breaths.

A nurse admits a 5-year-old child with bacterial meningitis to the pediatric intensive care unit. Which information obtained by the nurse during the intake history is most helpful for the nurse to document? A. Fell off swing hitting head 2 months ago B. History of recent sinus infection C. Mother with history of herpes simplex D. Sibling with upper respiratory infection

B In a child this age, common causes of bacterial meningitis include septicemia, surgical procedures involving the CNS, penetrating wounds, otitis media, sinusitis, cellulitis of the scalp or face, dental cavities, pharyngitis, and orthopedic diseases. Blunt trauma from falling off a swing and a sibling with a URI are noncontributory. Herpes simplex is an important cause of neonatal viral meningitis.

A 6-week-old baby is brought to the clinic for a follow-up visit after having surgical repair of a myelomeningocele. His head circumference was 33 cm (12 inches) at birth. Now the nurse assesses his head circumference at 36 cm (14.1 inches). What action by the nurse is most appropriate? A. Assess the child for signs of hydrocephalus. B. Document the measurement in the child's chart. C. Educate the parents on possible shunt placement. D. Inquire about signs of increased intracranial pressure.

B Increasing head circumference is a sign of possible hydrocephalus. The average head circumference of an infant at birth is 33-38 cm (12-14 inches) and increases by 2 cm/month (0.75 inches/month). This child's head circumference is normal and the nurse should document the information; no other actions are needed.

A student nurse is preparing to give a 48.5-lb(22-kg) child IV mannitol (Osmitrol). What action by the student causes the nursing instructor to intervene? A. Assesses child's pain including report of headache B. Confirms the dose of 66 g in a 20% solution C. Double-checks child's urine output for the shift D. Explains to the child that nausea may occur

B Mannitol is an osmotic diuretic often used to decrease intraocular pressure. The correct dose is 1-2 g/kg, so the safe dose range is 22-44 g. The nurse would intervene if the student prepared to administer 66 g. The other actions are appropriate.

A teenager has Crohn's disease and presents to the emergency department with a 3-day history of decreased appetite, lethargy, and fatigue. Today the parent reports the child is confused and "looks blue." The nurse finds the child hypotensive. Which assessment question is most helpful? A. "Could your child be using illicit recreational drugs?" B. "Has your child been taking steroids for Crohn's disease?" C. "Have you taken her temperature today or yesterday?" D. "Is anyone else in your family sick now or recently?"

B Steroids are often used to treat Crohn's disease and other autoimmune disorders. Because the child is manifesting signs of Addisonian crisis, the nurse should inquire about the use of steroids. Also, because the patient is a teenager, noncompliance is always a possibility. Abrupt discontinuation of steroids can precipitate an Addisonian crisis. The other assessment questions may yield valuable information but are not directly related to this child's history and presentation.

An adolescent has Cushing's syndrome due to long-term use of steroid therapy for another illness. When writing this child's care plan, which nursing diagnosis takes priority? A. Activity intolerance B. Altered body image C. Fluid volume deficit D. Impaired skin integrity

B The child with Cushing's syndrome has a typical appearance consisting of a pendulous abdomen, round "moon" face, facial flushing, a buffalo hump, thin fragile skin, and striae. This would lead the teen to have an altered body image, as he or she would want to look like his or her peers. The other nursing diagnoses may or may not apply to individual children.

A nurse admits a child experiencing drowsiness and vomiting who has had a seizure at home. The parents state the child was healthy until 2 weeks ago when she had a viral illness. Which diagnostic testing does the nurse facilitate as a priority? A. Complete blood count B. Liver biopsy C. Lumbar puncture D. Serum glucose

B This child has manifestations of Reye syndrome. The definitive diagnosis of this disease is made via a liver biopsy.

A mother brings her baby to the emergency department stating that the baby no longer makes tears when crying but is having multiple soaked diapers per day. Which assessment by the nurse takes priority? A. Last bowel movement B. Palpation of fontanels C. Prenatal history D. Time of last meal

B This child has manifestations of dehydration, and with the frequent soaked diapers, may have diabetes insipidus. Assessments of circulation take priority. The nurse assesses the other factors, but they can wait until more important assessments have been completed.

A child has been admitted with suspected pheochromocytoma. What action by the nurse takes priority? A. Auscultate lung sounds every 4 hours during fluid therapy. B. Facilitate stat laboratory draws when the child has episodic symptoms. C. Perform a complete abdominal assessment including palpation. D. Withhold water for 8 hours and collect hourly urine samples.

B When the child has episodic symptoms of pheochromocytoma, it is important to have stat labs drawn to measure catecholamine levels, which will be transiently high. The other actions are not warranted.

The nurse caring for children with endocrine problems recognizes which classic signs of Addison's disease? (Select all that apply.) A. Bounding, rapid pulse B. Hyperpigmentation C. Ketonemia D. Low sodium levels E. Warm intolerance

B, C, D There are many signs and symptoms of Addison's disease, including hyperpigmentation, ketonemia, and hyponatremia. The patient's pulse is probably rapid but thready due to dehydration. The patient will complain of cold intolerance.

The nurse is teaching parents of an infant diagnosed with hypothyroidism. Which items are appropriate to include in the teaching plan? (Select all that apply.) A. Dissolving the levothyroxine (Synthroid) completely in formula B. Frequent monitoring of the child's height and weight C. Keeping a log or diary of developmental milestones the child meets D. Monitoring the child for behavioral changes as he or she grows E. The need for frequent laboratory testing during the child's life

B, C, D, E The parents of an infant diagnosed with hypothyroidism need to maintain logs of the child's height, weight, and developmental milestones to help ensure his or her growth and development stays within normal ranges. The child will need frequent blood tests, and the parents can also monitor for behavioral changes that might indicate a need to increase the medication as the child grows. For an infant, the medication is crushed and dissolved in a small amount of liquid and administered via a syringe. It is not added to a bottle of formula.

The nurse is explaining to a nursing student that which of the following affect the feedback mechanisms active in the endocrine system? (Select all that apply.) A. Activity B. Nutrition C. Sleep D. Stress E. Temperature

B, D, E Feedback regulation can be affected by stress, temperature, and nutritional status.

The student nurse caring for a child with type 1 diabetes mellitus learns which classic signs? (Select all that apply.) A. Polydactyly B. Polydipsia C. Polyneuritis D. Polyphagia E. Polyuria

B, D, E The classic signs of diabetes type 1 are polyuria (frequent urination), polyphagia (extreme hunger), and polydipsia (extreme thirst). Polydactyly is having more than five fingers or toes. Polyneuropathy is having an abnormal condition affecting multiple nerves.

A nurse is caring for a 10-year-old child with a brain injury. On assessing the child, the nurse finds the following data: opens eyes only to pain, mutters inappropriate words, has abnormal extension to stimulation. Which action by the nurse takes priority? A. Alert the operating room for emergent surgery. B. Document the findings; reassess in 15 minutes. C. Notify the provider; prepare for intubation. D. Raise the head of the child's bed to 45°.

C A child with a Glasgow Coma Score of less than 8 needs to be intubated and mechanically ventilated. This child's score is 7 (eye opening = 2, verbal response = 3, motor response = 2). The child may need an invasive procedure due to the increased intracranial pressure, but this would not take priority over managing the airway and providing adequate oxygenation. The findings need to be documented, but further action is needed. Raising the head of the bed may or may not be beneficial, but does not take priority over intubation.

A nurse is preparing to administer an octreocide depot injection. Which information about this procedure does the nurse provide the parent? A. "Octreocide stimulates growth hormone." B. "The medication goes deep into a muscle." C. "This shot lasts longer than a regular shot." D. "Your child will need these shots weekly."

C A depot injection is one in which the medication effect lasts a longer time, such as 2 or 3 months. Octreocide suppresses growth hormone. Depot injections can be either subcutaneous or intramuscular. Because the medication lasts for months, the child does not need weekly injections.

An adolescent with type 1 diabetes mellitus is hospitalized for the third time in 1 year with an infection. Which laboratory value would provide the nurse the most important information? A. Albumen: 4 g/dL B. Fasting blood sugar: 99 mg/dL C. Hemoglobin A1C: 9.8% D. White blood count: 15,000/mm3

C A diabetic adolescent with many infections should be assessed for noncompliance. The hemoglobin A1C is the average blood glucose over the last 3 months and will be helpful to determine how the teen's blood glucose has been controlled over time, thus giving information about compliance. The albumen is normal. The fasting blood sugar is normal and, while in the hospital, is not surprising. The WBC is high, indicating infection.

A child has had an episode of lip smacking while staring into space, but did not seem to lose consciousness. She was confused afterward but said her hands felt tingly before the other symptoms started. How should the nurse document this event? A. Alteration in consciousness B. Convulsion C. Focal seizure D. Generalized seizure

C A focal seizure involves only one part of the brain and manifests with involuntary movements, sensory symptoms, possible staring into space, no loss of consciousness, and confusion afterward. "Alteration in consciousness" is too vague in this case to be a useful description. "Convulsion" is an outdated term. A generalized seizure involves both hemispheres of the brain and manifestations usually include loss of consciousness and tonic-clonic movements.

A child has been admitted with bacterial meningitis. Which action by the nurse takes priority? A. Administering broad-spectrum antibiotics B. Assessing and treating pain aggressively C. Facilitating blood cultures and lumbar puncture D. Maintaining a quiet, nonstimulating environment

C All actions are appropriate for the child with acute bacterial meningitis. However, the priority is obtaining cultures so that appropriate therapy can be identified. After cultures are obtained, the nurse will administer broad-spectrum antibiotics until the culture and sensitivity results are known.

A child has an invasive intracranial pressure monitoring device in place. Which assessment finding indicates that goals for a priority nursing diagnosis have been met? A. Daily weight equals admission weight. B. Joints move freely during range of motion. C. No signs of infection are present at the insertion site. D. Skin is intact without redness or breakdown.

C All indications show that goals for various nursing diagnoses have been met; however, the priority here would be preventing infection at the intracranial pressure monitoring site, which would have a direct route to the brain.

Which does the nurse include on the teaching plan for the parents of a child with Addison's disease? A. How to administer steroids subcutaneously B. How to eliminate all stress from the child's life C. How to give hydrocortisone (A-Hydrocort) IM D. How to keep the child hydrated when ill

C An important safety measure the nurse teaches the parents of this child is how to administer hydrocortisone intramuscularly in case the child is vomiting. It is not given subcutaneously. The parents will not be able to eliminate all stress from the child's life. Keeping the child hydrated when ill is important, but is not specific for this disease process.

The student nurse studying the neurological system learns that areas of gray matter are found deep in the brain. To determine damage to the basal ganglia, what will the nurse assess? A. Blood pressure B. Homeostasis C. Movement D. Sensory impulses

C Areas of gray matter are found deep in the brain. These areas include the basal ganglia (affect movement), the hypothalamus (maintains homeostasis and regulates blood pressure, heart rate, and temperature), and the thalamus (processes sensory impulses and sends them to the cerebral cortex).

A nurse in a well-child clinic notes that a 5-month-old is not able to hold her head up. Which action by the nurse is the most appropriate? A. Ask about other developmental milestones . B. Document the finding in the child's chart. C. Measure the child's head circumference. D. Obtain the child's length and weight.

C Difficulty holding the head up by an appropriate age is a manifestation of hydrocephalus. Another sign of this disorder is an enlarging head, so the nurse measures the child's head and compares it to age-related norms. The other actions are appropriate, but not as specifically associated with hydrocephalus as measuring head circumference.

A child is born with pseudohermaphroditism. After determining that the baby is a girl through genetic testing, the parents ask about her potential fertility. Which response by the nurse is the most appropriate? A. "It is impossible to determine that until she reaches puberty." B. "She is fertile but her uterus is abnormal so she can't carry a baby." C. "Because her internal female organs are normal, she probably is fertile." D. "Unfortunately, all babies born with this condition are infertile."

C Females born with pseudohermaphroditism have normal internal reproductive organs, so the chances are good that she will be fertile. Waiting until puberty will not reveal anything new.

A child is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). The parent asks why the child's sodium level is so low. Which response by the nurse is the most appropriate? A. "It's a side effect of oral desmopressin (DDAVP)." B. "Sodium is being excreted in the large volume of urine." C. "The water your child retains is diluting the sodium." D. "Your child is not absorbing sodium in the intestines."

C Hyponatremia is most often caused by dilution. In this case, the excess fluid the child is retaining is the cause. DDVAP is used to treat diabetes insipidus, not SIADH. In SIADH, urine volume is low. Absorption of sodium is not the issue.

A child is diagnosed with congenital adrenal hyperplasia. The child's parents ask the nurse what this means. Which response by the nurse is the most appropriate? A. "Your child is not producing ACTH." B. "Your child is not producing androgens." C. "Your child is not producing cortisol." D. "Your child is not producing corticosteroid-releasing hormone."

C In this syndrome, the adrenal glands do not produce cortisol. The other hormones listed are produced in higher-than-normal amounts.

A child has been diagnosed with diabetes insipidus (DI). The nurse is teaching the parents and child about self-care measures. Which item does the nurse explain is the priority for the child to have at all times? A. Epinephrine injector B. Medic-Alert bracelet C. Medications D. Water bottle

D A Medic-Alert bracelet, medications, and a water bottle are all important for the child with DI to have with him or her. However, preventing dehydration takes priority, so the most important item is the water bottle or other ready access to water.

A nurse is caring for a child who only awakens to painful stimuli and produces no verbal responses. Which term is the most appropriate when documenting this child's status? A. Lethargy B. Obtundation C. Persistent vegetative state D. Stupor

D A child who is stuporous only responds to painful stimuli and has verbal responses that are either absent or slow. A lethargic patient opens his or her eyes to loud voices and appears confused and falls asleep without continued stimulation. Obtundation is demonstrated when a person is aroused by tactile stimulation, such as gentle shaking, but does not show great interest in surroundings. A persistent vegetative state is a coma-like condition that has lasted for over 4 weeks.

A pediatric nurse performs a physical examination on a neonate and notes a spinal lesion with the meninges protruding through the defect that contains spinal cord elements. The nurse documents which condition as being present? A. Hydrocephalus B. Meningitis C. Meningocele D. Myelomeningocele E. Spina bifida occulta

D A myelomeningocele is the most severe form of spina bifida and is evident on delivery. The meninges protrude through the defect, and they contain spinal cord elements. It appears as a very pronounced skin defect, usually covered by a transparent membrane, and neural tissue may be attached to the inner surface.

A teenager is admitted with Addison's disease. Which laboratory findings does the nurse correlate with this condition? (Select all that apply.) A. Blood glucose: 54 mg/dL B. Potassium: 6.5 mEq/L C. Sodium: 3.9 mEq/L D. Urine culture: negative E. White blood cell count: 5500/mm3

A, B In Addison's disease, the lack of adrenal hormones can cause decreased blood glucose, due to increased sensitivity to insulin, and elevated potassium levels. The other findings are not related.

A nurse is teaching a new diabetic child and family about sick-day management. What information does the nurse plan to include? (Select all that apply.) A. Check blood sugars every 4 hours. B. Hold insulin if the child is vomiting. C. Provide plenty of rest and sleep. D. Offer calorie-containing liquids. E. Try to follow the usual meal plan.

A, C, D, E Sick-day rules are important to prevent diabetic ketoacidosis (DKA). The child should take the normal dose of medication (the liver continues to produce glucose even when not eating) while trying to follow the meal plan. If solids are not tolerated, then offer liquids that contain calories. Check blood sugars every 4 hours while the child is ill, and check ketones with each instance of voiding. Be sure to notify the physician for any concerns.

The nursing student knows that which glands control antidiuretic hormone (ADH)? (Select all that apply.) A. Adrenal cortex B. Anterior pituitary C. Hypothalamus D. Pineal body E. Posterior pituitary

C, D ADH is secreted by the hypothalamus and stored (and subsequently released) by the posterior pituitary glands.

The nursing faculty member explains the functions of the anterior pituitary as regulating which processes? (Select all that apply.) A. Cognition B. Digestion C. Growth D. Metabolic activity E. Sexual development

C, D, E The anterior pituitary produces hormones that influence and regulate growth, metabolic activity, and sexual development.

A nurse is caring for a child who has intracranial pressure (ICP) monitoring. The nurse assesses the child and notes that the ICP is 9 mm Hg. Which action by the nurse is most appropriate? A. Activate the rapid response team. B. Document the finding in the chart. C. Hyperventilate the patient. D. Prepare to administer mannitol (Osmotrol).

B A normal ICP is 0-10 mm Hg. This finding is normal and the nurse needs only to document it and continue monitoring. No other actions are needed.

A hospitalized child has been diagnosed with hyperthyroidism and has a calcium level of 6.8 mg/dL. Which action by the nurse takes priority? A. Administer calcium. B. Apply telemetry. C. Pad the side rails. D. Start an IV.

B All actions are appropriate for this child. However, hypocalcemia can cause fatal cardiac dysrhythmias, and the child needs to be placed on telemetry monitoring so the nurse can assess and intervene immediately if this occurs.

The student studying endocrine disorders learns that which gland controls overall physiologic homeostasis? A. Anterior pituitary B. Hypothalamus C. Parathyroid D. Posterior pituitary

B Although all endocrine glands have a role in homeostasis, the job of the hypothalamus is to communicate the messages of the central autonomic nervous system to the organs/glands of the endocrine system, thus maintaining homeostasis throughout the body.

The nurse is helping a new diabetic child pick breakfast from the menu. Which selection would require the nurse to reinforce dietary teaching for this child? A. Egg, bacon, whole-wheat toast B. Cinnamon roll and juice C. Oatmeal, almonds, artificial sweetener D. Pancakes with sugar-free maple syrup

B Although no food is off limits, the child with diabetes does need to learn the typical diet plan: 40-50% carbohydrates (complex is better than simple), 20-30% fats, and 15-20% protein. The first meal is appropriate. The oatmeal is a carbohydrate, but the nuts give some protein and some fat. The pancakes with sugar-free syrup are alright if the child adds a protein. The cinnamon roll and juice are all simple carbohydrates, and this selection shows the child needs further instruction.

A parent reports that his 7-year-old child is very short compared to his peers, and his teeth came in slowly when he was younger. After searching the Internet the parent is worried about growth hormone deficiency (GHD). Which response by the nurse is the most appropriate? A. "GHD is the only cause of the symptoms you describe." B. "Has your child ever had his thyroid evaluated?" C. "I will refer your child to an endocrinologist right away." D. "What did the dentist say about his teeth being delayed?"

B Although those manifestations do sound like GHD, they could also be indicative of hypothyroidism. The nurse asks if the child's thyroid function has ever been checked. The nurse cannot refer to an endocrinologist without a provider order. Asking about the dentist's opinion may be important, but it is not as specific for the problem as asking about thyroid function testing.

A student nurse is caring for a child with gigantism. Which hormones does the faculty member explain are important in this condition? (Select all that apply.) A. Androgens B. Corticosteroids C. Growth hormone D. Insulin-like growth factor E. Somatostatin

C, D, E The nurse must understand the interplay of three hormones important in gigantism: growth hormone, insulin-like growth factor, and somatostatin.

The high school nurse is teaching a healthy living class to high school seniors. One student asks why she should take folic acid now when she is not planning to become pregnant. Which response by the nurse is the most appropriate? A. "It is a good habit to get into while you are young and can develop good habits." B. "Most people in this country have a serious deficiency of vitamins and folic acid." C. "Neural tube defects occur so early that you might not know you are even pregnant." D. "There are no foods that contain folic acid so you have to take a supplement."

C Neural tube defects (NTDs) generally occur between the 18th and 28th days of pregnancy, often before the woman knows she is pregnant. All women of childbearing age should get 400 µg/day of folic acid to help prevent NTDs. It is a good habit to get into prior to contemplating pregnancy, but this answer does not give specific information. Most people do not have a serious deficiency of folic acid; however, pregnant women (and those who could be pregnant) need to have a minimal amount of folic acid. Several foods are good sources of folic acid, including green leafy vegetables, liver, legumes, orange juice, and fortified breakfast cereals; it is also contained in multivitamins.

A child who is intubated and mechanically ventilated has an intracranial pressure monitoring device in place. The child is agitated. Which medication order would the nurse question based on the assessment data? A. Fentanyl (Sublimaze) B. Lorazepam (Ativan) C. Methylprednisolone (Solu-Medrol) D. Morphine (Astramorph)

C Pain and agitation are treated aggressively because they both can increase intracranial pressure. Appropriate drug choices include fentanyl, lorazepam, and morphine. Corticosteroids do not treat either pain or agitation and their use in cerebral edema is controversial.

A child is started on recombinant growth hormone. Which teaching point does the nurse provide the parents and child? A. Drink adequate fluids during the day. B. Encourage increased activity. C. Ensure proper oral hygiene. D. Weigh daily on the same scale.

C Proper oral hygiene and regular visits to the dentist are important because growth hormone treatments make the child's teeth softer and more prone to cavities. The other options do not address a specific issue related to this treatment.

A nurse is caring for a child with suspected epilepsy. Which diagnostic test does the nurse facilitate as the priority for this child? A. Cerebral angiogram B. Electrocardiogram (ECG) C. Electroencephalogram (EEG) D. Lumbar puncture (LP)

C The EEG is the gold standard diagnostic test for a seizure disorder

The parent of a child with hypopituitarism asks why this condition occurs. Which response by the nurse is the most appropriate? A. "Infection in the brain is the most common cause." B. "It's usually a brain tumor near the pituitary gland." C. "There are many possible causes, and often we don't know." D. "Usually this is due to damage to the brain from trauma."

C The cause of hypopituitarism is often unknown, but there are many possibilities. CNS tumor is the most common, accounting for 47%. Trauma accounts for about 3% of the cases of this condition. Infection is an uncommon cause (1%).

Which long-term goal is most appropriate for the adolescent diabetic patient? A. Appropriate food items chosen for meals B. Glucose within target range 90% of the time C. No evidence of long-term complications D. Takes medications correctly and on time

C The most appropriate long-term goal is that the teen is free from complications, some of which can be devastating. Choosing appropriate foods, blood glucose readings, and taking medications are good goals too, but are too specific for an overall long-term goal.

A school-aged child wishes to learn embroidery from her grandmother, but the grandmother reports that the child can only concentrate on the projects for a short time and seems frustrated. What action by the nurse is the most appropriate? A. Advise that the child needs more physical activity. B. Explain that the child is too young for this project. C. Suggest that the child have a routine vision exam. D. Teach behavior modification to the grandmother.

C The most common refractive disorder in children is hyperopia (farsightedness). Symptoms include reports of objects being unclear at close range and clearer at a distance. Younger children may have trouble focusing on a project that requires close vision work. The nurse should suggest that the child have a routine eye examination. The other options may or may not be beneficial, but do not address the potential visual problem.

A child has been examined by a pediatric ophthalmologist, and findings indicate a dulled red reflex and cloudy lens. Which treatment plan does the nurse educate the parents on based on these findings? A. Occlusion therapy to the affected eye for 6 months B. Periodic administration of IV mannitol (Osmotrol) C. Surgery to remove the cataract and placement of a lens D. Use of eyedrops for the rest of the child's life

C These manifestations are characteristic of cataracts, which can be congenital or acquired. Typical treatment includes surgical removal of the cataract and lens implant. The other options are not part of the treatment for cataracts.

A hospitalized diabetic child is sweating, nauseated, and has a headache. What action by the nurse takes priority? A. Administer sliding-scale insulin. B. Call laboratory for a stat blood sugar. C. Give the child some orange juice. D. Perform a urine ketone test.

C This child is exhibiting signs of hypoglycemia. The nurse should first treat the child instead of waiting for the laboratory to come draw blood. If the nurse has bedside glucose monitoring available, check the glucose first, then treat, but do not wait the several minutes it will take for phlebotomy. Because the child has low blood sugar, do not give insulin. Do not delay by trying to get a urine sample; also, ketones are present in hyperglycemia.

A parent with his 7-year-old son at the pediatric clinic expresses concern that the child is too short. The nurse measures the child and finds him to be 100 cm (39.3 inches) tall. Which statement by the nurse is most appropriate? A. "Children are often 'too short' until they reach puberty." B. "He's shorter than average, but it's not significant." C. "Let's discuss some options for promoting growth." D. "Your child is of average height for a 7-year-old."

C This child's height is well below the 5th percentile for age, so he could have hypopituitarism leading to growth hormone deficiency. The nurse should acknowledge the fact and begin discussions about the condition gently and objectively. The other answers are not appropriate.

The student nurse knows that which gland produces the hormone triiodothyronine? A. Adrenal B. Hypothalamus C. Parathyroid D. Thyroid

C Triiodothyronine (T3) is produced by the parathyroid gland.