Peds exam 3 Questions

A child has an NG tube to continuous low intermittent suction. The physician's prescription is to replace the previous 4-hour NG output with a normal saline piggyback over a 2-hour period. The NG output for the previous 4 hours totaled 50 ml. What milliliter/hour rate should the nurse administer to replace normal saline piggyback? (Record your answer in a whole number.)

25

A seven year old is admitted to the pediatric intensive care unit for a shunt infection. Surgery is performed to externalize the shunt. The nurse would expect the drainage bag to be aligned with which of the following: a. The ear b. The eyebrow c. The jaw d. The axilla

A

A toddler is brought to the emergency room with sudden onset of abdominal pain, vomiting, and stools that look like current jelly. To confirm intussusception, the nurse expects the doctor to order which of the following? a. A barium enema b. Suprapubic catheter insertion c. Nasogastric tube insertion d. Nasogastric tube insertion

A

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a. "I should administer all the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

A

Forty eight hours after birth, a neonate has not passed meconium. The nurse suspects which condition? a. Cystic fibrosis b. Celiac disease c. Intussusception d. An abdominal wall defect

A

The Heimlich maneuver is recommended for airway obstruction in children older than _____ year(s) a. 1 b. 4 c. 8 d. 12

A

The nurse is evaluating the laboratory results on cerebral spinal fluid (CSF) from a 3-year-old child with bacterial meningitis. Which findings confirm bacterial meningitis? (Select all that apply.) a. Elevated white blood cell (WBC) count b. Decreased glucose c. Normal protein d. Elevated red blood cell (RBC) count

A, B

Calcium carbonate is given with meals to a child with chronic renal disease. What is the purpose of administering calcium carbonate? a. Prevent vomiting b. Bind phosphorus c. Stimulate appetited. Increase absorption of fat-soluble vitamins

B

The nurse is providing education to Kirsten's parents. Kirsten is a 6 week old infant diagnosed with gastroesophageal reflux (GER). Which of the following should the nurse include in her teaching plan? a. Although most children should be put on their backs to sleep, Kirsten should be placed on her side to avoid aspiration b. Kirsten should be fed in smaller amounts each feeding c. The time between Kirsten's feedings should be stretched out as much as possible to assure the stomach is fully empty. d. Kirsten's parents should decrease the caloric density of her feedings

B

The nurse is teaching nursing students about childhood fractures. Which describes a compound skull fracture? a. Involves the basilar portion of the occipital bone b. Bone is exposed through the skin c. Traumatic separations of the cranial sutures d. Bone is pushed inward, causing pressure on the brain

B

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases .b. Repeated exposure to organisms causes increased immunity c. Viral organisms are less prevalent in the population d. Secondary infections rarely occur after viral illnesses.

B

Which statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

B

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a. not necessary because of child's age. b. not necessary because colostomy is temporary. c. necessary because it will be an adjustment. d. necessary because the child must deal with a negative body image.

C

The nurse is caring for a 3 year old who has been diagnosed with nephrotic syndrome. When reviewing the lab results, the nurse would expect to find which of the following? a. Frank hematuria b. Hyperalbunemia c. Proteinuria d. Urine with low specific gravity

C

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a. Abdominal rigidity and pain on palpation b. Rounded abdomen and hypoactive bowel sounds c. Visible peristalsis and weight loss d. Distention of lower abdomen and constipation

C

Which is the initial clinical manifestation of generalized seizures? a. Being confused b. Feeling frightened c. Losing consciousness d. Seeing flashing lights

C

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation? a. Fussiness b. Coughing c. A fever over 99° F d. Signs of an earache

D

The urine specimen of a child with acute glomerulonephritis would probably be: a. normal in color but a very scant amount b. normal in color but cloudy due to loss of albumin c. normal in color and amount d. rusty brown color due to loss of blood

D

What are the results of excessive vomiting in an infant with pyloric stenosis? a. Hyperchloremia b. Hypernatremia c. Metabolic acidosis d. Metabolic alkalosis

D

What should be included in caring for the newborn with a cleft lip and palate before surgical repair? a. Gastrostomy feedings b. Keeping infant in near-horizontal position during feedings c. Allowing little or no sucking d. Providing satisfaction of sucking needs

D

When caring for a 12 month old with diarrhea and metabolic acidosis, the nurse expects to see which of the following? a. A reduced white blood cell count b. A decreased platelet count c. Shallow respirations d. Tachypnea

D

Which clinical manifestation would be seen in a child with chronic renal failure? a. Hypotension b. Massive hematuria c. Hypokalemia d. Unpleasant "uremic" breath odor

D

A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.) a. Positioning child on the right side b. Assessing the chest tube and drainage device for correct settings c. Administering prescribed doses of analgesia d. Clamping the chest tube when child ambulates e. Monitoring for need of supplemental oxygen

B, C, E

A 6-year-old child is having a generalized seizure in the classroom at school. Place in order the interventions the school nurse should implement starting with the highest-priority intervention sequencing to the lowest-priority intervention. Provide the answer using lowercase letters separated by commas (e.g., a, b, c, d, e). a. Take vital signs. b. Ease child to the floor. c. Allow child to rest .d. Turn child to the side .e. Integrate child back into the school environment.

B, D, A, C, E

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased intracranial pressure (ICP) in an infant? (Select all that apply.) a. Tachycardia b. Alteration in pupil size and reactivity c. Increased motor response d. Extension or flexion posturing e. Cheyne-Stokes respirations

B, D, E

The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing? (Select all that apply.) a. NPO for 24 hours b. Administration of analgesics for pain c. Ice bag to the incisional area d. IV fluids continued until tolerating PO e. Clear liquids as the first feeding

B, D, E

A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made? a. "I will record the average of the readings." b. "I should be sitting comfortably when I perform the readings." c. "I will record the readings at the same time every day." d. "I will repeat the routine two times."

C

An 11 year old has just been diagnosed with asthma. When reviewing the patient's history, the nurse would expect to hear which of the following? a. The patient has been complaining that "Just can't get a deep enough breath" b. The patient has been having trouble concentrating at school and seems to cough more in the afternoon c. The patient looks exhausted and states not sleeping well at night d. The patient has noticed difficulty breathing and a whistling noise when breathing in

C

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect? a. Weight gain b. Bradycardia c. Poor skin turgor d. Brisk capillary refill

C

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. What should the nurse suspect caused the constipation? a. Diet b. Allergies c. Antihistamines d. Emotional factors

C

During the first few days after surgery for cleft lip, which intervention should the nurse do? a. Leave infant in crib at all times to prevent suture strain. b. Keep infant heavily sedated to prevent suture strain c. Remove restraints periodically to cuddle infant. d. Alternate position from prone to side-lying to supine.

C

Effective lone-rescuer CPR on a 5-year-old child should include a. two breaths to every 30 chest compressions. b. two breaths to every 15 chest compressions. c. reassessment of the child after 50 cycles of compression and ventilation. d. reassessment of the child every 10 minutes that CPR continues.

A

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a. Diet should be high in carbohydrates and protein b. Diet should be high in easily digested carbohydrates and fats c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

A

One goal of asthma management is prevention of respiratory tract infections because infections a. Can trigger an episode or aggravate asthma b. Cause exercise-unduced asthma. C. Increase sensitivity to allergens d. Lessent he effectiveness of medications

A

The mother of newborn Hannah, an infant with cleft palate tells the nurse that she is so disappointed because she probably won't be able to nurse Hannah. Which of the following is the nurse's best response? a. "Some mother's are still able to nurse their baby, have you tried yet?" b. "I understand you are frustrated, let's talk about other ways to feel close to Hannah." c. The risk of aspiration is too great, I know you want what is best for Hannah." d. "It will be hard enough to feed Hannah with a bottle. I certainly wouldn't attempt to breastfeed."

A

The nurse is assessing a child with respiratory distress. Which assessment would highly indicate impending respiratory failure? a. Decreased level of consciousness b. Respiratory rate of 50 c. Intercostal retractions d. Decreased breath sounds

A

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which nursing action is the most appropriate? a. Notify practitioner b. Measure abdominal girth c. Auscultate for bowel sounds d. Take vital signs, including blood pressure

A

The nurse is providing education about proper feeding of a two month old after a cleft lip repair. Which is the correct information to provide to parents about feeding their infant? a. Breast-feed or bottle-feed b. Use a cup c. Use a paper straw d. Use a medicine dropper

A

The nurse is taking care of a child who is alert but showing signs of increased intracranial pressure. Which test is contraindicated in this case? a. Oculovestibular response b. Doll's head maneuver c. Funduscopic examination for papilledema d. Assessment of pyramidal tract lesions

A

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

A, C, D

The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations should be expected? (Select all that apply.) a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash

A, C, F

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.) a. Cluster care to conserve energy b. Round-the-clock administration of antitussive agents c. Strict intake and output to avoid congestive heart failure d. Administration of antibiotics

A, D

A nurse is planning preoperative care for a newborn with tracheoesophageal fistula (TEF). Which interventions should the nurse plan to implement? (Select all that apply.) a. Positioning with head elevated on a 30-degree plane b. Feedings through a gastrostomy tube c. Nasogastric tube to continuous low wall suction d. Suctioning with a Replogl e tube passed orally to the end of the pouch e. Gastrostomy tube to gravity drainage

A, D, E

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.) a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

A, D, E

The nurse enters a room and finds a 6-year-old child who is unconscious. After calling for help and before being able to use an automatic external defibrillator, which steps should the nurse take? Place in correct order. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e, f). a. Place on a hard surface. b. Administer 30 chest compressions with two breaths. c. Feel carotid pulse while maintaining head tilt with the other hand. d. Use the head tilt-chin lift maneuver and check for breathing. e. Place heel of one hand on lower half of sternum with other hand on top. f. Give two rescue breaths.

A, D, F, C, E, B

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care? (Select all that apply.) a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.

A, E, F

Which is included in the diet of a child with minimal change nephrotic syndrome? a. High protein b. Salt restriction c. Low fat d. High carbohydrate

B

Which of the following assessments would you expect to find when caring for the child with pyloric stenosis? a. Projectile vomiting of bile-tinged emesis b. Visible peristaltic waveS c. Metabolic acidosis d. Non-projectile vomiting

B

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years b. It is the preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

B

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

B

Which vaccine is now recommended for the immunization of all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines

B

You are caring for a 3 year old admitted with diarrhea and dehydration. She is NPO for bowel rest. She has an order for IV maintenance fluids. Her weight is 13 kg. You calculate her IV fluid rate to be approximately: a. 52 ml/hr b. 46 ml/hr c. 36 ml/hr d. 26 ml/hr

B

A 6-year-old child is scheduled for an IV urography (IVP) in the morning. Which preparatory interventions should the nurse plan to implement? (Select all that apply.)a. Clear liquids in the morning before the procedure b. Cathartic in the evening before the procedure c. Soapsuds enema the morning of the procedure d. Insertion of a Foley catheter before the procedure e. Teaching with regard to insertion of an intravenous catheter before the procedure

B, C, E

In reviewing potential susceptibility to respiratory infections for children, which statement is based on supportive physiological evidence? a. Newborns are likely to develop respiratory infections in the neonatal period due to changes from the intrauterine environment b. With advancing age, immunity decreases leading to greater chances of developing respiratory infections c. There is an increase in infection rate between 3 to 6 months of age due to loss of protective effects of maternal antibodies d. Viral respiratory infections increase dramatically by 5 years of age

C

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

C

Mrs. Walker asks the nurse if it matters when they give their infant Tyler his ranitidine. Which of the following is the nurse's best response? a. "Since ranitidine is an antacid it doesn't matter when you give it." b. "It would be easiest to give it with Tyler's feeding." c. "It would be best to give the medication 30 minutes before Tyler eats." d. "It would be best to give the medication 30 minutes after Tyler eats."

C

Parents of two school-age children with asthma ask the nurse, "What sports can our children participate in?" The nurse should recommend which sport? a. Soccer b. Running c. Swimming d. Basketball

C

The nurse has documented that a child's level of consciousness is obtunded. Which describes this level of consciousness? a. Slow response to vigorous and repeated stimulation b. Impaired decision making c. Arousable with stimulation d. Confusion regarding time and place

C

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? a. pH b. Osmolality c. Creatinine d. Protein level

C

The nurse is planning care for an 8-year-old child with a concussion. Which is descriptive of a concussion? a. Petechial hemorrhages cause amnesia. b. Visible bruising and tearing of cerebral tissue occur .c. It is a transient and reversible neuronal dysfunction. d. A slight lesion develops remotely from the site of trauma.

C

The nurse is providing dietary teaching for the parents of a child with celiac disease. This child should avoid: a. Vegetables b. Fruits c. Prepared puddings d. Rice

C

The nurse is reviewing information on pyloric stenosis. Which of the following reflects accurate information? a. It only occurs in males b. Vomiting will gradually become more projectile and contain more bile as the pylorus muscle thickens c. Surgical correction involves spreading open the muscle around the pyloric valve. d. A sausage shaped mass can be palpated in the lower abdomen

C

The nurse is teaching a class to a group of parents when one parent asks for information about febrile seizures. Which of the following should the nurse include in the teaching? a. There is no family pattern associated with febrile seizures b. Once a child has had a febrile seizure, they will rarely have another one c. Febrile seizures tend to occur as the temperature is rapidly risingd. Febrile siezure s are more common in children over age 5

C

The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching? a. "These injections will help with the hypertension." b. "We're glad the injections only need to be given once a month." c. "The red blood cell count should begin to improve with these injections." d. "Urine output should begin to improve with these injections."

C

Thenurse is teaching on the administration of pancreatic enzymes for the CF patient. The nurse knows the mom understands the teaching when she states which of the following? a. "I will give the enzymes with meals but not with snacks" b. "I will give extra enzymes when the meal is low in fat" c. "I will give extra enzymes if my child has more than three stools in a day" d. "As long as my child is not losing weight, I know I am giving enough medication"

C

What nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child? a. Suction the child frequently to prevent secretion build up b. Provide environmental stimulation c. Avoid activities that cause pain or crying d. Turn side to side every two hours

C

When developing a postoperative plan of care for an infant scheduled for cleft lip repair, the nurse should assign highest priority to which intervention? a. Comforting the child as quickly as possible b. Maintaining the child in a prone position c. Restraining the child's arms at all times using elbow restraints d. Avoid disturbing any crusts that form on the suture line

C

Which is a major complication in a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

C

Which is a parasite that causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

C

Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a. Risk for Injury related to malignant process and treatment b. Fluid Volume Deficit related to excessive losses c. Fluid Volume Excess related to decreased plasma filtration d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces

C

Which observation made of the exposed abdomen is most indicative of pyloric stenosis? a. Abdominal rigidity b. Substernal retraction c. Palpable olive-like mass d. Marked distention of lower abdomen

C

Which pathogen is the viral pathogen that frequently causes acute diarrhea in young children? a. Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

C

Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months. b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

C

You are caring for a school age child with cystic fibrosis. Which of the following sports would be most appropriate for this child? a. Basketball b. Golf c. Swimming d. Baseball

C

Julie is a newborn infant diagnosed with tracheoespohageal fistula (TEF). When reveiwing Julie's history, the nurse would expect to find which of the following? a. Julie tolerated feedings for a few days, then experienced projectile vomiting b. Julie's mother stated that she barely looked pregnant and never needed to wear maternity clothes c. Julie continuously appeared hungry despite begin fed every 2 hours d. Julie appeared to have a lot of secretions and became cyanotic when fed

D

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). What nursing considerations should be included? a. Do not administer pancreatic enzymes if the child is receiving antibiotics. b. Decrease dose of pancreatic enzymes if the child is having frequent, bulky stools. c. Administer pancreatic enzymes between meals if at all possible. d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

D

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on which statement? a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccination to prevent Haemophilus influenzae type B meningitis has decreased the frequency of this disease in children.

D

The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn? a. Absence of a urethral opening is noted. b. Penis appears shorter than usual for age. c. The urethral opening is along the dorsal surface of the penis .d. The urethral opening is along the ventral surface of the penis.

D

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. Which is the most essential part of the nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

D

The nurse is caring for a 3 year old injured in a motor vehicle accident. The child is admitted to the pediatric unit with a diagnosis of closed head injury. Which of the following should be included in Jason's plan of care? a. Assess ear and nose drainage for low glucose counts b. Monitor vital signs every shift c. Assess level of consciousness every four hours while awake d. Promote bed rest and limit unnecessary movements

D

The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death? a. Papilledema b. Delirium c. Doll's head maneuver d. Periodic and irregular breathing

D

The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. To what are these behaviors most likely related? a. Neurologic manifestations that occur with dialysis b. Physiologic manifestations of renal disease c. Adolescents having few coping mechanisms d. Adolescents often resenting the control and enforced dependence imposed by dialysis

D

The nurse is doing discharge teachign for a newly diagnosed patient with asthma. When discussing potential side effects of medications, which statement by the mother would indicate need for further teaching? a. "My child may appear nervous and jittery after taking the quick relief medication" b. "My child may complain of headache after taking the quick relief medication" c. "My child may vomit after taking the quick relief medication." d. "My child may be more irritable and need more sleep after taking the quick relief medication."

D

The nurse is performing a Glasgow Coma Scale on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record? a. 8 b. 11 c. 13 d. 15

D

The nurse is providing education on cleft lip and palate to a group of nursing students. It is apparent that more education is needed when a student states that the infants are at risk for: a. Pneumonia b. Otitis media c. Altered bonding with parents d. Gastroesophageal reflux

D

What is beneficial in reducing the risk of Reye syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin to treat fever associated with influenza

D

What is invagination of one segment of bowel within another called? a. Atresia b. Stenosis c. Herniation d. Intussusception

D

Which clinical manifestation would be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Abdominal pain that is most intense at McBurney point

D

Which therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel

D

You are caring for a seven month old who is suspected of having intussusception. What clinical manifestations most likely be present? a. Abdominal pain, vomiting, olive shaped mass to the right of the umbilicus b. Anorexia, abdominal distention, constipation c. Malnourished looking child, fever, diarrhea d. Inconsolable crying, abdominal pain, sausage shaped mass in the right lower quadrant

D

Which are clinical manifestations of increased intracranial pressure (ICP) in infants? (Select all that apply.) a. Low-pitched cry b. Sunken fontanel c. Diplopia and blurred vision d. Irritability e. Distended scalp veins f. Increased blood pressure

D, E

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage the child to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

D, E, F

A nurse is admitting an infant with biliary atresia. Which is the earliest clinical manifestation of biliary atresia the nurse should expect to assess? a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

A

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing? a. Dyspnea b. Tachypnea c. Hypopnea d. Orthopnea

A

A 4-year old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it most effectively. The nurse should suggest that he use a a. Spacer b. Nebulizer c. Peak expiratory flow meter d. Trial of chest physiotherapy

A

A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis? a. Nonproductive cough, wheezing b. Fever, general malaise c. Productive cough, rales d. Stridor, substernal retractions

A

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which diagnosis? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

A

A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status? a. Continuous b. Every 30 minutes c. Every hour d. Every 2 hours

A

Beta-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. Which describes their action? a. Liquefy secretions b. Dilate the bronchioles c. Reduce inflammation of the lungs d. Reduce infection

B

It is important for a child with acute streptoccocal pharyngitis to be treated with antibiotics to prevent which complication a. Otitis media b. Diabetes insipidus c. Nephrotic syndrome d. Acute rheumatic fever

D

A child is being admitted to the hospital to be tested for cystic fibrosis (CF). Which tests should the nurse expect? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool test for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

A

A 12 year old with inflammatory bowel disease (IBD) has recently developed mouth ulcers and arthritis in the joints. Which of the following is likely? a. The patient has Crohn's disease b. The patient has Ulcerative colitis c. It is impossible to determine the type of IBD, but it is likely there is a secondary inflammatory illness unrelated to IBD d. The medications used to treat IBD tend to cause mouth ulcers and arthritic pain

A

The nurse is working in the emergency room when Mrs. Evans brings 4 year old Sally in to be evaluated. Sally has been vomiting and having diarrhea for 2 days. Mrs. Evans states Sally hasn't been able to keep anything down. The nurse notes Sally is pale adn has dark circles around her eyes. Sally is very lethargic and doesn't cry or move when the nurse obtains her vital signs. Which of the following should the nurse anticipate will be included in Sally's plan of care? a. Administering an IV bolus of normal saline b. Administering an IV bolus with fluids containing both saline and glucose to help correct dehydration and hypoglycemia c. Give Sally a Pedialyte popsicle to avoid traumatizing her with an invasive procedure d. Encourage Sally's mother to attempt giving her clear liquids by mouth prior to starting an IV.

A

When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as a. uremia. b. oliguria. c. proteinuria. d. pyelonephritis.

A

Which condition in a child should alert a nurse for increased fluid requirements? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure (ICP)

A

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried. d. A more comfortable environment is produced.

A

Which is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. Raisins b. Pancakes c. Muffins d. Ripe bananas

A

Which is an important nursing consideration in the care of a child with celiac disease? a. Refer to a nutritionist for detailed dietary instructions and education. b. Help child and family understand that diet restrictions are usually only temporary. c. Teach proper hand washing and standard precautions to prevent disease transmission. d. Suggest ways to cope more effectively with stress to minimize symptoms.

A

Which is instituted for the therapeutic management of minimal change nephrotic syndrome? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis

A

Which of the following types of seizures may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

A

Which should the nurse recommend to prevent urinary tract infections in young girls? a. Wear cotton underpants. b. Limit bathing as much as possible. c. Increase fluids; decrease salt intake. d. Cleanse perineum with water after voiding.

A

Which type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion"? a. Isotonic dehydration b. Hypotonic dehydration c. Hypertonic dehydration d. All types of dehydration in infants and small children

A

You know that infants and children are more prone to otitis media because: a. The eustachian tubes are short and in a horizontal position b. Children are always putting objects and fingers in their ears c. They have immature immune systems d. They eat by sucking, which increases susceptibility to ear infections

A

Eight week old Hannah is admitted for surgery to repair her cleft lip. What is the most important nursing intervention following surgery? a. Lay the baby on her stomach to prevent aspiration b. Decrease stress on the suture line c. Provide adequate oral nutrition d. Use a hard nipple and pacifier in order to teach the child how to suck properly

B

One of the clinical manifestations of chronic renal failure is uremic frost. Which best describes this term? a. Deposits of urea crystals in urine b. Deposits of urea crystals on skin c. Overexcretion of blood urea nitrogen d. Inability of body to tolerate cold temperatures

B

Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The nurse should further ask the parents if the toddler has which associated factor that is causing the acute diarrhea? a. Celiac disease b. Antibiotic therapy c. Immunodeficiency d. Protein malnutrition

B

The 1 day old neonate is suspected to have tracheoesophageal fistula. Which nursing intervention is most appropriate for this infant? a. Avoiding suctioning unless cyanosis occurs b. Elevating the head of the bed/crib and giving nothing by mouth c. Elevating the neonate's head for 1 hour after feedings d. Giving the neonate only glucose water for the first 24 hours

B

A 10-month old child with recurrent otitis media is brought to the clinic for evaluation. To help determine the cause of the child's condition, the nurse should ask the parents: a. "Does water ever get into the baby's ears during shampooing?" b. "Do you give the baby a bottle to take to bed?" c. "Have you noticed a lot of wax in the baby's ears?" d. "Can the baby combine two words when speaking?"

B

A child is suspected of having Hirschprung's disease. The nurse would expect the child's history of present illness to include which of the following? a. Anemia, abdominal distention, fecal soiling b. Abdominal distention, constipation, foul smelling stools c. Bloody diarrhea, fever, vomiting d. Irritability, severe abdominal cramping, fecal soiling

B

A four year old who has just had her appendix out, wakes up with her mother at the bedside. Which of the following comments would be most developmentally appropriate: a. "When you feel better your friends can come visit you" b. "There is a big band-aid where the doctors fixed your belly pain" c. "You will be able to return to preschool really soon" d. "Let's close the curtain while I look at your tummy'

B

A mother who intended to breastfeed has given birth to an infant with a cleft palate. What nursing interventions should be included? a. Giving medication to suppress lactation. b. Encouraging and helping mother to breastfeed. c. Teaching mother to feed breast milk by gavage. d. Recommending use of a breast pump to maintain lactation until infant can suck.

B

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. What is the initial therapeutic approach for the mother? a. Restating what the physician has told her about plastic surgery. b. Encouraging her to express her feelings. c. Emphasizing the normalcy of her baby and the baby's need for mothering. d. Recognizing that negative feelings toward the child continue throughout childhood.

B

A nurse is admitting an infant with asthma. What usually triggers asthma in infants? a. Medications b. A viral infection c. Exposure to cold air d. Allergy to dust or dust mites

B

Andy is 30 kg child who is admitted to the pediatric unit with dehydration He is currently NPO and is receiving IV fluids at maintenance. What is the hourly rate that the IV should be set at? a. 60 ml/hr b. 70 ml/hr c. 80 ml/hr d. 90 ml/hr

B

The emergency room nurse is caring for Ella, a 3 year old who is suspected of having epiglottitis. Ella, who is very irritable and anxious is seated in her mother's lap, leaning forward. She is drooling and points to her throat when the nurse asks what hurts. Which of the following should be included in Ella's care? a. Allow Ella to play with the flashlight and tongue blade prior to examining her throat b. Allow Ella's mom to accompany her to radiology c. Quickly perform an assessment while Ella's mom is out of the room registering Ella d. Obtain Ella's vital signs prior to performing a complete assessment

B

The greatest post-operative danger from a cleft palate repair is: a. Pain b. Rupture of the suture lines c. Infection d. Dehydration

B

The most appropriate time to perform bronchial postural drainage is a. Immediately before all aerosol therapy b. Before meals and at bedtime c. Immediately upon arising and at bedtime d. 30 minutes after meals and at bedtime

B

The nurse is caring for Jed, a newborn with suspected TEF. When his mother offered him his first feeding, Jed became cyanotic with coughing and choked. Which of the following would the nurse expect to be part of Jed's care? a. Allow Jed's mother to feed him pedialyte slowly in a monitored area, stopping all feedings six hours before surgery b. Begin IV fluids and IV antibiotics c. Admit Jed to the ICU and immediately place him on 100% oxygen d. Allow Jed's parents to visit him in the PICU, but not hold him unitl immediately before his surgery

B

The nurse is caring for a 10 year old with acute renal failure. Which of the following serum lab results would the nurse expect to find? a. Decreased BUN and creatinine and increased sodium b. Increased BUN and creatinine and decreased sodium c. Decreased BUN and creatinine and decreased sodium d. Increased BUN and creatinine and increased sodium

B

The nurse is caring for a child who is noted to have inspiratory stridor. The nurse knows that this indicates which of the following? a. Air within the lungs has been replaced with fluid b. There is edema in the upper airway c. There is inflammation in the bronchioles of the lungs d. There is a high possibility of impeding respiratory failure

B

The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which is essential in this child's care? a. Monitor pulse oximetry. b. Monitor arterial blood gases .c. Administer oxygen if respiratory distress develops. d. Administer oxygen if child's lips become bright, cherry red.

B

The nurse is conducting teaching for an adolescent being discharged to home after a renal transplant. The adolescent needs further teaching if which statement is made? a. "I will report any fever to my primary health care provider. "b. "I am glad I only have to take the immunosuppressant medication for two weeks." c. "I will observe my incision for any redness or swelling." d. "I won't miss doing kidney dialysis every week."

B

The nurse is providing discharge instructions to a 14 year old with ulcerative colitis. Which is the nurse's best advice concerning her diet? a. "You'll know what to eat by how your body responds. Keeping a journal is always a good idea." b. "It is recommended that you eat high protein, high calorie, and low fat foods." c. "It is recommended that you eat high protein, high fat foods." d. "That is a good question. I will have the dietician come talk to you."

B

The nurse receives a call from the admitting nurse in the emergency room. A six year old with bacterial meningitis is being admitted to the pediatric floor. In order to care for the child, which of the following precautions will be necessary? a. Gloves and gown b. Mask, gown, gloves c. Standard precautions d. Mask and gown

B

What is the best description of pyloric stenosis? a. Dilation of the pylorus b. Hypertrophy of the pyloric muscle c. Hypotonicity of the pyloric muscle d. Reduction of tone in the pyloric muscle

B

What is the most common assessment finding in a child with ulcerative colitis? a. Abdominal cramps b. Bloody diarrhea c. Anal fissures d. Abdominal distention

B

When is the best time to administer pancreatic enzymes for the child with cystic fibrosis? a. 30 minutes before meals b. Immediately before meals c. In the middle of the meal d. 30 minutes after the meal

B

When planning care for a child with epiglottis, the nurse should assign highest priority to which of the following interventions? a. Providing psychological support b. Ensuring respiratory patency c. Instituting infection control practices d. Administering prescribed drug therapy

B

When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised that a week ago the child had recovered from: a. measles. b. varicella. c. meningitis. d. hepatitis. e. "Your child has had only one convulsion; it probably won't happen again."

B

A 3 month old infant who is receiving tube feeds due to a temporary malformation of the GI system is admitted to the pediatric floor. Which of the following should the nurse encourage Amelia's mother to do during her feedings? a. Sing or play music that is calm during her feedings b. Stroke Amelia's head and talk to her during the feedings c. Give Amelia a pacifier during the feedings d. Encourage Amelia to sleep during the feedings

C

A 3 year old is admitted for croup and moderate respiratory distress. Which of the following should be included in the plan of care? a. Encourage bed rest b. Limit fluids to prevent pulmonary edema c. Administer oral steroids d. Administer oral antibiotics

C

A child is diagnosed with influenza. Management includes which recommendation? a. Clear liquid diet for hydration b. Aspirin to control fever c. Oseltamivie (Tamiflu) d. Antibiotics to prevent bacterial infection

C

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of this medication? a. Prevent reflux b. Prevent hematemesis c. Reduce gastric acid production d. Increase gastric acid production

C

A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that melena, the passage of black, tarry stools, suggests bleeding from which area? a. Perianal or rectal area b. Hemorrhoids or anal fissures c. Upper gastrointestinal (GI) tract d. Lower GI tract

C

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber? (Select all that apply.) a. White rice b. Avocados c. Whole grain breads d. Bran pancakes e. Raw carrots

C, D, E

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? (Select all that apply.) a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone

C, D, E

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

D

How is chronic otitis media with effusion (OME) differentiated from acute otitis media (AOM)? a. A fever as high as 40° C (104° F) b. Severe pain in the ear c. Nausea and vomiting d. A feeling of fullness in the ear

D

A 10 month old is admitted to the hospital with dehydration and metabolic acidosis. What is the most common cause of dehydration and acidosis in infants? a. Early introduction of solid foods b. Inadequate perianal hygiene c. Tachypnea d. Diarrhea

D

A 15 kg child in acute renal failure has fluid running at half maintenance. The nurse knows the IV is running at the correct rate when the pump says which of the following? a. 90 ml/hr b. 50 ml/hr c. 45 ml/hr d. 25 ml/hr

D

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. What does this finding suggest? a. Diabetic coma b. Brainstem injury c. Upper respiratory tract infection d. Leaking of cerebrospinal fluid (CSF)

D

A four year old child is brought to the emergency department. The child has "froglike" croaking sounds on inspiration and is drooling. The child insists on sitting upright and appears in distress. The priority nursing action is a. Examine the child's oropharynx and report the assessment to the provider b. Make the child lay down and rest quietly c. Auscultate the child's lungs and prepare for placement of a mist tent d. Notify the health care provider immediately and be prepared to assist with intubation

D

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it a. Liquefies secretions b. Improves oxygenation c. Promotes ventilation d. Soothes inflammed mucous membranes

D

A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte loss. Which type of dehydration is this infant experiencing? a. Isotonic b. Isosmotic c. Hypotonic d. Hypertonic

D

A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions? a. WBC <1; specific gravity 1.008 b. WBC <2; specific gravity 1.025 c. WBC >2; specific gravity 1.016 d. WBC >2; specific gravity 1.030

D

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent would indicate a correct understanding of the teaching? a. "I will keep my child on a clear liquid diet for the next 24 hours." b. "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." c. "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

D

A three month old with biliary atresia is admitted to the pediatric floor. The mother asks why her infant is so irritable and restless. Which of the following is the nurse's best response? a. "The liver is enlarged and placing pressure on her abdomen causing pain. I will give her some pain medication." b. "Your baby is probably restless because of being confined to a crib and not being held and cuddled. c. "Your baby just needs more stimulation. Let's put a music toy in the crib." d. "Your baby may be feeling itchy. I can give some medication to help."

D

Which is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

c