Pediatrics

A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse notes that the child is restless, the pulse rate is elevated, and the BP has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? 1. Place the child in a supine position 2. Place the child in Trendelenburg's position 3. Increase the flow rate of the IV fluids 4. Notify the primary health care provider (PHCP)

4. Notify the primary health care provider In the event of shock, the PHCP is notified immediately before the nurse changes the child's position or increases IV fluids. After craniotomy, a child is never placed in the supine or Trendelenburg's position because it increases ICP and the risk of bleeding.

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. Administer an analgesic 2. Release the skin traction 3. Apply ice to the extremity 4. Notify the primary health care provider (PCHP)

4. Notify the primary health care provider (PCHP) An absent pulse to an extremity of the affected limb after a bone fracture could mean the child is developing or experiencing compartment syndrome

A child is diagnosed with Reye's syndrome. The nurse creates a nursing care plan for the child and should 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. Providing a quiet atmosphere with dimmed lighting 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. Decreasing stimuli in the environment by providing a quiet environment with dimmed lighting would decrease the stress on the cerebral tissue and neuron responses

A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? 1. Elevated vanillymandelic acid urinary levels 2. The presence of blast cells in the bone marrow 3. The presence of Epstein-Barr virus in the blood 4. The presence of Reed-Sternberg cells in the lymph nodes

4. The presence of Reed-Sternberg cells in the lymph nodes The presence of giant, multinucleated cells (Reed-Sternberg) is the classic characteristic of this disease.

The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. Which assessment findings are specifically characteristic of this disease? Select all that apply: 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful, enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area

1. Abdominal pain 5. Painless, firm, and movable adenopathy in the cervical area

The nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,5000 mm3. On the basis of the lab result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions 2. Monitor closely for sign of infection 3. Monitor the temperature every 4 hours 4. Initiate protective isolation precautions

1. Initiate bleeding precautions If a child has a low platelet count, <50,000 mm3, bleeding precautions need to be initiated because the increased risk of bleeding and hemorrhage

The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms Tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the BP for the presence of HTN

1. Palpating the abdomen for a mass Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and HTN are clinical manifestations associated with Wilms tumor

The nurse is monitoring a 3-year-old child for S/S of increased ICP after a craniotomy. The nurse plans to monitor for which early S/S of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal HA

1. Vomiting

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? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

2. "The child does not experience pain at the primary tumor site." Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site

A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? 1. Lumber puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 mm3 (350 x 10 mm3) 4. WBC count 4500 mm3 (4.5 x 10 mm3)

2. Bone marrow biopsy showing blast cells Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow.

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply: 1. Maintain the child in a semiprivate room 2. Reduce exposure to environmental organisms 3. Use strict aseptic technique for all procedures 4. Ensure that anyone entering the child's room wears a mask 5. Apply firm pressure to a needle-stick area for at least 10 minutes

2. Reduce exposure to environmental organisms 3. Use strict aseptic technique for all procedures 4. Ensure that anyone entering the child's room wears a mask

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 BP every 15 min

2. Reposition the infant frequently 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

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 ROM exercises at this time. The nurse should make which response? 1. "Avoid all exercise during painful periods." 2. "ROM exercises must be performed everyday." 3. "Have the child perform simple isometric exercises during this time." 4. "Administer additional pain medication before performing ROM exercises."

3. "Have the child perform simple isometric exercises during this time." These exercises do not involve joint movement

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 moderated to severe intellectual disabilities

3. A chronic disability characterized by impaired muscle movement and posture Cerebral palsy is a chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system

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

3. Nasotracheal suction as needed Because of the nature of the injury, there is a possibility that the catheter will enter the brain through the fracture, creating a high risk of secondary infection

The nurse is reviewing the record of a child with increased ICP 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. Rigid extension and pronation of the arms and legs Decerebrate (extension) posturing is characterized by the rigid extension and pronation of the arms and legs

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should 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. Maintain respiratory precautions for at least 24 hours after the initiation of antibiotics

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 1. Administer an antiemetic. 2. Increase the intravenous fluids. 3. Place the child in a Sims's position. 4. Notify the health care provider (HCP).

4. Notify the health care provider (HCP) A complication after surgical treatment of scoliosis is superior mesenteric artery syndrome. The disorder results in a syndrome of emesis and abdominal distention similar to that which occurs with intestinal obstruction or paralytic ileus

The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside? 1. Emergency cart 2. Tracheostomy set 3. Padded tongue blade 4. Suctioning equipment and oxygen

4. Suctioning equipment and oxygen Because increased oral secretions and apnea can occur during and after the seizure, oxygen and suctioning equpment are placed at the bedside

The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which action should the nurse perform immediately? 1. Notify the surgeon 2. Reinforce the dressing 3. Document the findings and continue to monitor 4. Circle the area of drainage and continue to monitor

1. Notify the surgeon Colorless drainage on the dressing in a child after craniotomy indicates the presence of CSF and should be reported to the surgeon immediately

The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply: 1. Time the seizure 2. Restrain the child 3. Stay with the child 4. Place the child in a prone position 5. Move furniture away from the child 6. Insert a padded tongue blade in the child's mouth

1. Time the seizure 3. Stay with the child 5. Move furniture away from the child

A 4-year-old child sustains a fall at home. After an x-ray examination, the child is determine to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a need for further instruction? 1. "The cast may feel warm as the cast dries." 2. "I can use lotion or powder around the cast edges to relieve itching." 3. "A small amount of white shoe polish can touch up a soiled white cast." 4. "If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast."

2. "I can use lotion or powder around the cast edges to relieve itching." Lotions or powders can become sticky or caked and cause skin irritation

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? 1. "I will encourage my child to perform prescribed exercises." 2. "I will have my child wear soft fabric clothing under the brace." 3. "I should apply lotion under the brace to prevent skin breakdown." 4. "I should avoid the use of powder because it will cake under the brace."

3. "I should apply lotion under the brace to prevent skin breakdown." The use of lotions or powders under a brace should be avoided because they can become sticky and cake under the brace, causing irritation

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Lab results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and askes the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. "I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."

3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." For a hospitalized neutropenic child, flowers or plants should not be kept in the room, because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible

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

3. Ortolani's maneuver

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 The inability to extend the leg when the thigh is flexed anteriorly at the hip is a positive Kernig's sign, noted in meningitis

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and CSF 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. Cloudy CSF, elevated protein, and decreased glucose levels 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

A mother arrives at the ED with her 5-year-old child and states 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 ICP. Which is a late sign of increased ICP? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia

4. Bradycardia

A child is placed in skeletal traction for treatment of a fractured femur. The nurse develops a plan of care and includes which intervention? 1. Ensure that all ropes are outside the pulleys. 2. Ensure that the weights are resting lightly on the floor. 3. Restrict diversional and play activities until the child is out of traction. 4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied

4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied