Peds exam 3

a nurse is caring for a child who has absence seizures. Which of the following findings should the nurse expect? SATA Loss of consciousness Appearance of daydreaming dropping held objects falling to the floor having a piercing cry

Loss of consciousness (for 5-10 secs is a manifestation of absence seizures) Appearance of daydreaming dropping held objects

A nurse is reviewing cerebrospinal fluid analysis for a client who has suspected meningitis. Which of the following findings should the nurse identify as indicating viral meningitis? - Neg. gram stain - normal glucose stain - cloudy color - decreased WBC count - normal protein content

Neg. gram stain and normal protein content

A nurse is teaching the parents of a child who has cerebral palsy. Which of the following statements should the nurse make?

Your child will need a botulinum toxin A injection to help with muscle spasticity

A nurse is caring for a child who is receiving treatment for diabetic ketoacidosis and has current blood glucose level of 250mg/dL. Which of the following actions should the nurse take? a. Administer D5NS by continuous IV infusion b. give potassium as a rapid IV bolus c. administer 3 unites of ultralente insulin SQ d. obtain an HbA1c level stat

a. Administer D5NS by continuous IV infusion when the childs blood glucose level falls between 250 to 300mg/dl, the nurse should begin IV infusion of 5% or 10% dextrose in 0.9% sodium chloride. The goal is to maintain glucose levels between 120 and 240 mg/dl

A nurse is caring for a child who has been in Buck's traction for 2 days. Which of the following actions should the nurse take to prevent complications? a. manually move the weights to the floor when the child is experiencing pain b. check for pulses in the affected leg every 4 hrs c. cleanse the pins every 12 hrs d. inform parents to discourage visitors for the child

b. check for pulses in the affected leg every 4 hrs traction might lead to neurovascular compromise

A nurse is caring for a 4-year-old child who has superficial partial-thickness burns over 50% of his body. When planning for the nutritional needs of the child, which of the following actions should the nurse plan to take? a. administer pancrelipase to the child prior to each meal b. supplement the childs feedings with enteral feedings c. provide the child with a low protein meal d. perform dressing changes 10 min prior to the childs meal

b. supplement the childs feedings with enteral feedings a child who has burns in excess of 25% of TBSA requires enteral supplementation to consume enough cals to heal

A nurse is reviewing the medical record of a client who has Reye syndrome. Which of the following findings should the nurse identify as a risk factor for Reye syndrome? a. recent history of infectious cystitis caused by candida b. recent h/o bacterial otitis media c. recent episode of gastroenteritis d. recent episode of haemophilus influenza meningitis

c. recent episode of gastroenteritis gastroenteritis is a viral illness which is a risk factor for developing Reye syndrome. Reye syndrome typically follows a viral illness (influenze, varicella, or gastroenteritis)

A school nurse is assessing an adolescent child who returned to school following a case of mononucleosis. The child has a note from his provider excusing him from gym class. Which of the following findings should the nurse identify as the reason for this excusal? a. Potential for sustaining abdominal trauma b. deficient dietary intake c. exposing peers to Illness d. straining sore joints

a. Potential for sustaining abdominal trauma an adolescent who has mono will have lymphadenopathy and often splenomegaly which can persist for many months

A nurse is caring for a 2-day old infant who has myelomeningocele. which of the following actions should the nurse take? a. monitor the infants head circumference b. position the child in a supine position c. place the infant under a radiant warmer d. tape a piece of plastic over the protruding membranes

a. monitor the infant head circumference infants who have myelomeningocele have an increased risk for hydrocephalus.

A nurse is caring for a client who has suspected meningitis and a decreased LOC. which of the following actions should the nurse take? a. place client in NPO b. prepare client for liver biopsy c. position the client in dorsal recumbent d. put the client in protective equipment

a. place client in NPO place client in NPO status due to clients decreased LOC to prevent aspiration

A nurse is reviewing the medical record of a 2-month-old infant who has rotavirus. The nurse notes a hemoglobin level of 12g/dL and a hematocrit of 51%. Which of the following statements by the nurse indicates an understanding of the laboratory values? a. the infant might be dehydrated b. the infant might be anemic c. the infant might have receieved too much fluid d. the infant might have leukemia

a. the infant might be dehydrated an increased Hct level indicated dehydration. Hct levels rise when blood vol. is decreased during dehydration

A nurse is caring for a child who adheres to a vegetarian diet and has sustained superficial partial-thickness burns. The nurse should recommend which of the following food choices as having the highest protein content? a. medium baked potatoe b. wheat bagek with 1 tbsp of apricot jam c. large orange d. 1/2 cup of peanut butter with apple slices

d. 1/2 cup of peanut butter with apple slices peanut butter and apple slices have a total of 28.91g of protein. PB is high in protein

A nurse is teaching the parents of an infant who has congenital hypothyroidism. Which of the following statements should the nurse make? a. your child will need to take estrogen daily when she reaches puberty b. your child will need monthly blood coagulation studies c. your child will need surgery to remove diseased thyroid d. Your child will need to take thyroid hormone replacement for her entire life

d. Your child will need to take thyroid hormone replacement for her entire life

A nurse is assessing an adolescent who has sustained a broken tibia. Following the application of a fiberglass cast, the adolescent reports pain and a tingling feeling in the limb. Which of the following actions should the nurse take first? a. give ibuprofen b. elevate legs on pillows c. place an ice pack on the cast d. assess for manifestations of circulatory impairment

d. assess for manifestations of circulatory impairment The nurse should apply the ABC priority setting framework

A nurse is caring for a child who has a vesicular rash. The parents of the child asks the nurse what illness can cause this rash for 6 days. The nurse should expect that the child has which of the following conditions? a. measles b. 5th disease c. tetanus d. varicella

d. varicella Children who have varicella might commence with a maculopapular rash that progresses to vesicles on erythematous bases that eventually rupture and crust over.

A nurse is assessing a 4 month old infant who has meningitis. Which of the following manifestations should the nurse expect? a. depressed anterior fontanel b. constipation c. presence of rooting reflex d. high pitched cry

high pitched cry associated with meningitis between ages 3 months to 2 years