PEDS EXAM 2
A health care provider (HCP) has prescribed a sterile urine specimen for a 3-year-old boy with a history of recurrent urinary tract infections. The family is upset because the last time the child was catheterized, the procedure was very painful and traumatic. What is the nurse's best response?
"I will get a prescription for a lubricant with numbing medicine to make the procedure more comfortable."
A nurse has identified a problem of anxiety for a 4-year-old preparing for a tonsillectomy. What should the nurse tell the child?
"The doctor will put you to sleep so you don't feel anything"
After a tonsillectomy and adenoidectomy, which finding should alert the nurse to suspect early hemorrhage in a 5-year-old child?
A> Drooling bright red secretions because often times after a tonsillectomy drooling occurs because of discomfort, frequent swallowing could also be a sign
Which assessment finding should lead the nurse to suspect that a toddler is experiencing respiratory distress? SATA
Coughing Respiratory rate of 35 breaths/min Restlessness Diaphoresis
Which statement by the parent of a toddler most suggests that the child is at risk for iron- deficiency anemia?
He drinks over four glasses of milk per day.
A child with nephrosis is taking prednisone. The nurse should teach the caregivers to report which adverse effects? Select all that apply.
Hematemesis respiratory infection vision problems
After the nurse teaches the parent of a child newly diagnosed with leukemia about the disease, which description if given by the parents best indicated the understanding of the nature of leukemia?
Leukemia is a type of cancer characterized by an increase in immature white blood cells
When explaining to parents how to reduce the risk of sudden infant death syndrome (SIDS), the nurse should teach about which measures? SATA
Maintain a smoke-free environment Breastfeed the baby Place the baby on his or her back to sleep
A child with hemophilia presents with a burning sensation in the knee and reluctance to move the body part. The nurse collaborates with the care team to provide factor replacement and implements which intervention?
RICE: institutes rest, ice, compression and elevation
After doing well for a period of time, a child with leukemia develops an overwhelming infection. The child's death is imminent. Which statement offers the nurse the best guide in making plans to assist the parents in dealing with their child's imminent death?
Relatives are especially grieved when a child does well at first but then declines rapidly
A child with cystic fibrosis does not like taking a pancreatic enzyme supplement with meals and snacks. The parent does not like to force the child to take the supplement. What is the most important reason for the child to take the pancreatic enzyme supplement with meals and snacks?
The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins.
A 15-year-old has been diagnosed with acute glomerulonephritis and has been in the hospital for 1 day. Which of the following findings requires immediate action?
Urine specific gravity of 1.030
A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The health care provider (HCP) has prescribed IV fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4 mEq/L (3.4 mmol/L). What should the nurse do first?
Verify that the infant has urinated
Which finding would most likely alert the nurse to the possibility that a preschooler is experiencing moderate dehydration?
absence of tear formation
Which statement by the parent of a toddler diagnosed with nephrotic syndrome indicates that the parent has understood the nurse's teaching about this disease?
A> "My child really likes chips and bologna. I guess we'll have to find something else". This child should be on a low-sodium diet.
The triage nurse in the emergency department must prioritize the children waiting to be seen. Which child is in the greatest need of emergency medical treatment?
A> 6 year old with a fever of 104 degrees F (40 degrees C), muffled voice, no spontaneous cough, and drooling Explanation: This child is exhibiting signs and symptoms of epiglottitis, which is a medical emergency because of its risk of complete airway obstruction.
The nurse admits a 1-year-old child to the hospital with the diagnosis of sickle cell crisis. The nurse explains to the parents that which condition leads to local tissue damage during a sickle cell crisis?
A> Obstruction to circulation Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.
A toddler diagnosed with nephrotic syndrome has fluid volume excess related to fluid accumulation in the tissues. Which measure should the nurse anticipate including in the child's plan of care?
A> Weighing the child before breakfast.
The nurse teaches the family of child with leukemia about preventing infections. How should the nurse explain to the parents why their child is risk for infection?
Immature white blood cells are incapable of handling an infectious process
A teaching care plan to prevent the transmission of the respiratory syncytial virus (RSV) should include what information? SATA
The virus can be spread by direct contact. The virus can be spread by indirect contact. Frequent handwashing helps reduce the spread of RSV. ???
A school-age client with hemophilia A has fallen and badly bruised his knee. Which action should the nurse do first to manage the client's hemarthrosis?
Apply pressure and immobilize the joint.
An 11-year-old is admitted for treatment of an asthma attack. Which finding indicates immediate intervention is needed?
intercostal retractions
When teaching the mother of a toddler diagnosed with lead poisoning, what should the nurse include as the most serious complication if the condition goes untreated?
neurologic deficits
The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best
The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old.
The nurse determines that interventions for decreasing fluid retention have been effective when the nurse makes which assessment in a child with nephrotic syndrome?
decreased abdominal girth
A parent of a child with acute poststreptococcal glomerulonephritis (APSGN) asks how a strep infection caused the child to have a kidney problem. What is the nurse's best response?
A>"By-products of immune complexes that fought the infection are depositing in the kidneys." *APSGN is an immune complex disease. Large antigen-antibody complexes have formed that deposit in the glomerular capillary loops leading to obstruction. APSGN is considered an autoimmune disorder, not an infection. Antibodies do not attack the kidneys in this disorder.
After teaching the parents of a neonate diagnosed with a tracheoesophageal fistula (TEF) about this anomaly, the nurse determines that the teaching was successful when the parent describes the condition in which way?
"There is a blind upper pouch and an opening from the esophagus into the airway." Although a TEF can include several different structural anomalies, the most common type involves a blind upper pouch and a fistula from the esophagus into the trachea
Which finding would be most important in a 8-month-old infant admitted with severe diarrhea?
Depressed anterior fontanelle
After teaching the parents of an infant diagnosed with Hirschsprung's disease, the nurse determines that the parents understand the diagnosis when the parent makes which statement?
A> "The nerves at the end of the large colon are missing"
A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention?
A> Fever and Petechiae Fever and petechiae associated with acute lymphocytic leukemia indicate suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks.
The nurse is caring for an infant newly diagnosed with hirschsprung disease. What does the nurse understand about the infant's condition?
A> There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distension
When an infant with pyloric stenosis is admitted to the hospital, which aspect of the plan of care should the nurse implement FIRST
weigh the infant
A father brings his 4-week-old son to the clinic for a checkup, stating that he believes his son's testicle is missing. Which explanation would be most appropriate?
"Although the testes normally descend by 1 year of age, I can understand your concern."
A child has viral pharyngitis. What should the nurse advise the parents to do? SATA
-use a cool mist vaporizer -administer acetaminophen -offer a soft to liquid diet -secretion precautions? -amoxicillin?
When developing the plan of care for a toddler who has taken an acetaminophen overdose, which intervention should the nurse expect to include as part of the initial treatment?
GASTRIC LAVAGE?
A 10-month-old infant is hospitalized for respiratory syncytial virus (RSV). Using knowledge of growth and development according to Erik Erikson and Jean Piaget, the nurse should do which of the following to meet the infant's developmental needs?
Provide a consistent routine, and touch, rock, and cuddle the infant throughout the hospitalization.
Which question would be most helpful in obtaining a nursing history from the mother of an infant with suspected intussusception?
What do your child's stools look like?
Which factor, if described by the parents of a child with cystic fibrosis (CF), indicates understanding the underlying problem of the disease?
an abnormality in the body's mucus secreting glands
A school-age client admitted to the hospital because of decreased urine output and periorbital edema is diagnosed with acute post-streptococcal glomerulonephritis. Which assessment gives the nurse the best indication of the child's fluid balance?
obtain daily weight measurement. *weight is the best indicator of fluid balance*
The parent of a 16-month-old child calls the clinic because the child has a low-grade fever, cold symptoms, and a hoarse cough. What should the nurse suggest that the parent do?
offer extra fluids
An infant is being treated at home for bronchiolitis. What should the nurse teach the parent about home care? (SATA)
offer small frequent fluids watch for difficulty breathing
When developing the discharge plan for a school-age diagnosed with acute poststreptococcal glomerulonephritis, which instruction should the nurse plan to discuss?
prevent respiratory infections
When developing the plan of care for a child with cystic fibrosis (CF) who is scheduled to receive postural drainage, the nurse should anticipate performing postural drainage at which times
A> before meals (avoid the possibility of vomiting or regurgitating food)
A nurse is teaching the parent of a preschool-age-child with celiac disease about a gluten-free diet. The nurse determines that teaching has been successful when the parent tells the nurse she will prepare which breakfast for the child?
eggs and orange juice
Which question should the nurse ask first when obtaining a history from the parent of a school-age child with a fever, malaise, and swelling around the eyes?
A> "Does the child urinate as much as usual?" *Most likely, the nurse suspects that the child is exhibiting signs and symptoms of glomerulonephritis, such as periorbital edema and fever. Other signs and symptoms include loss of appetite, dark-colored urine, pallor, headaches, and abdominal pain . To confirm this suspicion, the nurse would ask about the child's urinary elimination patterns. Typically the child with glomerulonephritis experiences a decrease in urine output. Asking about any recent sore throat would provide additional information to confirm the suspicion of glomerulonephritis, because the most common type is acute poststreptococcal glomerulonephritis, which follows a strep throat by 10 to 14 days. Frequently , the children have only mild cold symptoms and do not realize they have a streptococcal infection. Asking whether the child plays with friends as usual is important and gives the nurse information about how the child feels in general. However, this is a general question that would be appropriate to ask later on in the history. Although asking the mother about the color of the child's urine is important, the nurse needs to determine whether there is any change in the child's urinary output first.
The toddler with nephrotic syndrome responds to treatment and is ready to go home. When helping the family plan for home care, the nurse should include which instruction in the teaching?
A> Keep the child away from others with an infection. Because they will be on corticosteroids for about 6 weeks after the procedure.
The parents report that their 1-day-old is drooling and having choking episodes with excessive amounts of mucus and color changes, especially during feedings. The nurse should contact the health care provider (HCP) to further assess the baby and request which prescription?
A> an x-ray for gastric tube placement Explanation: The drooling and excessive mucus production is highly suggestive of a tracheoesophageal fistula (TEF). The initial diagnosis is made when a gastric tube cannot be passed to the stomach.
The parents of a neonate with hypospadias and chordee wish to have him circumcised. Which explanation should the nurse incorporate into the discussion with the parents concerning the recommendation to delay circumcision?
A> The foreskin is used to repair the deformity surgically. The condition in which the urethral opening is on the ventral side of the penis or below the glans penis is referred to as hypospadias. Chordee refers to a ventral curvature of the penis that results from a fibrous band of tissue that has replaced normal tissue. Circumcision is delayed because the foreskin, which is removed with a circumcision, often is used to reconstruct the urethra. The chordee is corrected when the hypospadias is repaired. Circumcision is performed at the same time.
The charge nurse reviews the laboratory results of a child admitted with nephrotic syndrome with a nurse new to the pediatric unit. The nurse is aware that teaching is required when the new nurse states that which finding is expected with nephrotic syndrome?
A> hyperalbuminemia The child with nephrotic syndrome would present with hypoalbuminemia due to a decrease of albumin in the bloodstream and to the increase in the glomerular permeability. Nephrotic syndrome is characterized by edema, massive proteinuria, hypoalbuminemia, hypoproteinemia, hyperlipidemia, and altered immunity.
The nurse is planning intervention for a school-age child hospitalized with acute post-streptococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include?
A> playing a card game with someone the same age Explanation:Generally, school-age children enjoy activities with their peers first, then family members, and lastly younger children. School-age children like to be busy but also to accomplish something. This helps to meet their task of industry versus inferiority, feeling good about what they are able to accomplish.
Which finding would alert the nurse to suspect that a child with severe gastroenteritis who has been receiving intravenous therapy for the past several hours may be developing circulatory overload?
A>auscultation of moist crackles Explanation:An early sign of circulatory overload is moist rales or crackles heard when auscultating over the chest wall. Elevated blood pressure, engorged neck veins, a wide variation between fluid intake and output (with a higher intake than output), shortness of breath, increased respiratory rate, dyspnea, and cyanosis occur later.
A recent history of which problem should alert the nurse to gather additional information about the possibility of a urinary tract infection in a toddler who is exhibiting fever and fussiness?
Abdominal pain
