Peds Final Exam

A 15-year-old male complains of persistent scrotal pain, edema, and nausea since being hit in the groin by a baseball 3 hours ago. Which is the priority action by the nurse? A. Applying an ice pack to alleviate the pain B. Documenting the swelling and discoloration C. Administering pain medications as ordered D. Ensuring that the teen is assessed by the physician immediately

*D. Ensuring that the teen is assessed by the physician immediately The nurse should suspect testicular torsion, which requires emergent interventions to prevent testicular death. Ice should never be applied because of the decreased circulation. Documentation of signs and administration of pain medications are both correct but are not the highest priority tasks.

2. The nurse is preparing an 18-month-old for discharge following treatment for dehydration secondary to diarrhea. What instruction would the nurse most likely include in the discharge teaching? a). "Encourage a bland diet." b). "Implement clear liquids." (starvation stools may result) c). "Provide plenty of 100% fruit juice." d). "Offer flavored gelatin if hungry."

*a). "Encourage a bland diet." It is not b because starvation stools may result

20. The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge? *a). "I can't believe it. We're not unclean, poor people." b). "We'll have to get that special shampoo." c). "Everybody in the house will need to be checked." d). "That explains his complaints of itching on his neck."

*a). "I can't believe it. We're not unclean, poor people."

100. What condition is the leading cause of chronic illness in children? a). Asthma b). Cystic fibrosis c). Tuberculosis d). Pertussis

*a). Asthma

8. The nurse is teaching the parent of a child with chronic renal failure on high-potassium foods that should be restricted. Which foods will the nurse include in this teaching? Select all that apply. a). Bananas, carrots, nuts, and milk b). Peaches, broccoli, and red meat c). Oranges, potatoes, wheat, and bran d). Spinach, chicken, fish, and green beans

*a). Bananas, carrots, nuts, and milk

14. The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? a). Calling the doctor if the child gets a sore throat b). Keeping a written copy of the treatment plan c). Writing down phone numbers and appointments d). Using acetaminophen if the child needs an analgesic

*a). Calling the doctor if the child gets a sore throat (It is a sign of potential infection and the child's immune system is impaired, so it must be evaluated by a physician immediately)

38. What therapeutic intervention is most appropriate for a child with b-thalassemia major? a). Frequent blood transfusions b). Supplemental iron c). Adequate hydration d). Oxygen therapy

*a). Frequent blood transfusions (lots of RBCs are being destroyed= anemia so they need blood)

26/46. After chemotherapy is begun for a child with acute leukemia, prophylaxis to prevent acute tumor lysis syndrome includes which therapeutic intervention? a). Hydration b). Oxygenation c). Corticosteroids d). Pain management

*a). Hydration

36/41. What pain medication is contraindicated in children with sickle cell disease (SCD)? a). Meperidine (Demerol) b). Hydrocodone (Vicodin) c). Morphine sulfate d). Ketorolac (Toradol)

*a). Meperidine (Demerol)

21. A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition? a). Mumps b). Infectious mononucleosis c). Poliomyelitis d). Herpes zoster

*a). Mumps

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

*a). Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

86. What structural defects constitute tetralogy of Fallot? a). Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b). Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy c). Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy. d). Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

*a). Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

54/55. A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock? a). Restlessness b). Rapid capillary refill c). Increased temperature d). Increased blood pressure

*a). Restlessness Shock means that inadequate oxygenated blood is getting to the rest of the body; therefore, there would be a decreased/prolonged capillary refill, decreased temp. (because less oxygenated or warm blood is getting to the extremities), and decreased BP.

25. When teaching about Turner's syndrome, what should the nurse include? a). Timing and use of growth hormone b). Use of hormone therapy to prevent infertility c). Long-term effects of decreased intellectual ability d). Treatment for gynecomastia

*a). Timing and use of growth hormone (Growth hormone is used once the child has fallen below the 5th percentile on the growth charts. Hormone therapy will be used to initiate puberty, not to prevent infertility).

10. A 9-year-old child is diagnosed with von Willebrand's Disease (vWD) with the following characteristics: decreased quantities of all sizes of von Willebrand's factor (vWF) multimers and decreased activity of von Willebrand's factor. The nurse identifies this as which type of vWD as being involved? a). Type I b). Type II c). Type III d). Type IIIB

*a). Type I Type 1: Insufficient amounts/quantities of vWF Type 2: Quality of vWF is poor Type 3: Total absence of vWF

51. An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. What approach should the nurse implement? a). Avoid discussing the seriousness of the condition. b). Answer questions with straightforward honesty. c). Explain that although the amputation is difficult, it will cure the cancer. d). Help the adolescent accept the amputation as better than a long course of therapy.

*b). Answer questions with straightforward honesty.

74. What statement best represents infectious mononucleosis? a). A short course of ampicillin is used when pharyngitis is present b). Clinical signs and symptoms and blood tests are both needed to establish the diagnosis c). Herpes simplex type 2 is the principal cause. d). A complete blood count shows a characteristic leukopenia.

*b). Clinical signs and symptoms and blood tests are both needed to establish the diagnosis

67. What compensatory purpose does grunting have in pediatric patients with respiratory distress? a). Assists with ventilation. b). Helps keep the alveoli open. c). Increases the diameter of air passages. d). Opens the airway.

*b). Helps keep the alveoli open.

37. What statement is most descriptive of Meckel diverticulum? a). It is acquired during childhood. b). Intestinal bleeding may be mild or profuse. c). It occurs more frequently in females than in males. d). Medical interventions are usually sufficient to treat the problem.

*b). Intestinal bleeding may be mild or profuse.

1. A nurse manages the interdisciplinary care for an infant born with an omphalocele. What is an accurate description of the care for an omphalocele? a). At birth, protect the exposed bowel by gently manipulating it back into the abdominal cavity. b). Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities. c). Administer corticosteroids as prescribed—either oral prednisone or prednisolone or as IV distention. d). Insert an NG tube to decompress the stomach and to prevent gastric

*b). Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities.

42. A child with hemophilia A will have which abnormal laboratory result? a). PT (ProTime) b). PTT (partial thromboplastin time) c). Fibrinogen level d). Platelet count

*b). PTT (partial thromboplastin time) Hemophilia A is a condition that keeps your blood from clotting normally; therefore, the blood is thinner and bleeds easier. So, PTT (a blood test that looks at how long it takes for blood to clot) will be abnormal, most likely increased b/c it takes longer for blood to clot or bleeding to stop.

3. The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease? a). Normal growth patterns b). Perianal skin tags or fissures c). Increased hunger d). Abdominal tenderness

*b). Perianal skin tags or fissures

16. A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? a). Restricting the child's visitors b). Placing a "no abdominal palpation" sign above the child's bed c). Ensuring that the child be allowed nothing by mouth d). Preparing the child for chemotherapy

*b). Placing a "no abdominal palpation" sign above the child's bed

68. A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? a). Therapy is most successful if it is started during adolescence. b). Replacement therapy requires daily subcutaneous injections. c). Hormonal supplementation will be required throughout child's lifetime. d). Treatment is considered successful if children attain full stature by adolescence.

*b). Replacement therapy requires daily subcutaneous injections.

34. What description applies to fragile X syndrome? a). Chromosomal defect affecting only females b). Second most common genetic cause of cognitive impairment c). Most common cause of uninherited cognitive impairment d). Chromosomal defect that follows the pattern of X-linked recessive disorders

*b). Second most common genetic cause of cognitive impairment

40. What condition is an inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity? a). Fanconi syndrome b). Severe combined immunodeficiency syndrome (SCIDS) c). Acquired immunodeficiency syndrome (AIDS) d). Wiskott-Aldrich syndrome

*b). Severe combined immunodeficiency syndrome (SCIDS)

7. An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect? a). Kidney agenesis b).Acute glomerulonephritis c). Polycystic kidney d). Nephrosis

*b).Acute glomerulonephritis

93. In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind? a). Fats and proteins must be greatly curtailed. b). Most fruits and vegetables are not well tolerated. c). Diet should be high in calories, proteins, and unrestricted fats d). Diet should be low fat but high in calories and proteins.

*c). Diet should be high in calories, proteins, and unrestricted fats

23. The nurse is caring for a 1-year-old boy with Down syndrome. Which intervention would the nurse be least likely to include in the child's plan of care? a). Promoting annual vision and hearing tests b). Explaining developmental milestones to parents c). Educating parents about how to deal with seizures d). Describing the importance of a high-fiber diet

*c). Educating parents about how to deal with seizures

22. The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? a). Antiviral medications can be prescribed. b). Antibiotic therapy may be initiated. c). Encourage rest and relaxation. d). Range of motion to prevent contractures.

*c). Encourage rest and relaxation.

52. What is an important priority in dealing with the child suspected of having Wilms Meckel (tumor)? a). Intervening to minimize bleeding b). Monitoring temperature for infection c). Ensuring the abdomen is protected from palpation d). Teaching parents how to manage the parenteral nutrition

*c). Ensuring the abdomen is protected from palpation Wilms Meckel (tumor) is a rare kidney cancer. The tumor can rupture easily resulting in seeding and metastasis. So, if this disease is suspected or confirmed, the abdomen should not be palpated.

24. The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? a). Interrupted family process related to the child's diagnosis b). Deficient knowledge deficit related to the genetic disorder c). Grieving related to the child's poor prognosis d). Ineffective coping related to stress of providing care

*c). Grieving related to the child's poor prognosis

13. A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? a). The infant always keeps her eyes tightly closed. b). His daughter tugs and pulls at one ear. c). He has noticed one pupil appears white. d). His daughter's eye appears to be protruding.

*c). He has noticed one pupil appears white. (As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white).

19. The nurse is teaching a group of parents about head lice. Which statement is essential to include during the presentation? a). Discourage the children from going to sleepovers. b). Send your child to school even if you suspect head lice, but have the school nurse check the child. c). Head lice are becoming very resistant to treatment. d). Wash the bed linens in hot water to kill the lice.

*c). Head lice are becoming very resistant to treatment.

5. A nurse is performing an assessment on a child. What would be indicative of a potential for a urinary tract infection? a). Washing the genital area with water daily b). Not using cleansing towelettes routinely c). Holding urine while at school d). Not using soap when cleaning the urethral area

*c). Holding urine while at school

70. Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner? a). PPP results from a central nervous system (CNS) insult. b). PPP occurs more frequently in girls. c). PPP may be viewed as a variation in sexual development. d). PPP results from hormonal stimulation of the hypothalamic gonadotropin-releasing hormone (Gn-RH).

*c). PPP may be viewed as a variation in sexual development.

75. What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)? a). High calorie diet because of increased metabolic needs b). Home schooling to decrease the risk of infections c). Protection from sun and fluorescent lights to minimize rash d). Intensive exercise regimen to build up muscle strength and endurance

*c). Protection from sun and fluorescent lights to minimize rash

31. The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What should nursing care include? a). Feed glucose water only. b). Elevate the patient's head for feedings. c). Raise the patient's head and give nothing by mouth. d). Avoid suctioning unless the infant is cyanotic.

*c). Raise the patient's head and give nothing by mouth.

11. The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? a). Increased growth of long bones b). Enlarged mandibular growth c). Slightly yellow sclera d). Depigmented areas on the abdomen

*c). Slightly yellow sclera Jaundice is a common sign and symptom of sickle disease. Sickle cells do not live as long as normal red blood cells and, therefore, they are dying faster than the liver can filter them out. Bilirubin (which causes the yellow color) from these broken down cells builds up in the system causing jaundice.

49. What description identifies the pathophysiology of leukemia? a). Increased blood viscosity b). Abnormal stimulation of the first stage of coagulation process c). Unrestricted proliferation of immature white blood cells (WBCs) d). Thrombocytopenia from an excessive destruction of platelets

*c). Unrestricted proliferation of immature white blood cells (WBCs)

47/48. Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which therapeutic intervention? a). Restrict oral fluids. b). Institute strict isolation. c). Use good hand-washing technique. d). Give immunizations appropriate for age.

*c). Use good hand-washing technique.

18. An adolescent is recovering from surgery, radiation, and chemotherapy following a diagnosis of Ewing sarcoma. Which statement by the family indicates that reteaching is needed? a). "We will watch for signs of infection and report it to our health care provider." b). "We will remind our child to care for the skin following radiation." c). "Our child's friends shaved their heads in solidarity to show their support." d). "Our child is looking forward to playing football again."

*d). "Our child is looking forward to playing football again."

76. A child is admitted with extensive burns. The nurse notes burns on the child's lips and singed nasal hairs. The nurse should suspect what condition in the child? a). A chemical burn b). A hot-water scald c). An electrical burn d). An inhalation injury

*d). An inhalation injury

12. The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child? a). Blurred vision b). Nausea and vomiting c). Sudden onset of knee pain d). Bleeding from intravenous sites

*d). Bleeding from intravenous sites

32. What clinical manifestation should 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). Colicky, cramping, abdominal pain around the umbilicus

*d). Colicky, cramping, abdominal pain around the umbilicus

45. The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What information should the nurse recognize as important when discussing this with the family? a). BMT should be done at the time of diagnosis. b). Parents and siblings of the child have a 25% chance of being a suitable donor. c). If BMT fails, chemotherapy or radiotherapy will need to be continued. d). Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

*d). Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

15. A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? a). Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. b). Ask whether any family members or other close associates are ill. c). Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order. d). Have the parent bring the child to the pediatric oncology clinic as soon as possible.

*d). Have the parent bring the child to the pediatric oncology clinic as soon as possible.

50. What are the most common clinical manifestations of brain tumors in children? a). Fever and poor fine motor control b). Blurred vision and ataxia c). Hydrocephalus and clumsy gait d). Headaches and vomiting

*d). Headaches and vomiting

85/92. Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF? a). Hyperactivity of sweat glands b). Hypoactivity of autonomic nervous system c). Atrophic changes of mucosal wall of intestine d). Mechanical obstruction caused by increased viscosity of mucous gland secretions.

*d). Mechanical obstruction caused by increased viscosity of mucous gland secretions.

53. The majority of children in the United States with human immunodeficiency virus (HIV) infection acquired the disease by which means? a). Through sexual contact b). From a blood transfusion c). By using intravenous (IV) drugs d). Perinatally from their mothers

*d). Perinatally from their mothers

87. When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care? a). Aspirin is contraindicated b). The principal area of involvement is the joints. c). The child's fever is usually responsive to antibiotics within 48 hours. d). Therapeutic management includes administration of gamma globulin and salicylates

*d). Therapeutic management includes administration of gamma globulin and salicylates

84. A recommendation to prevent neural tube defects (NTDs) is the supplementation of what? a). Vitamin A throughout pregnancy b). Folic acid for all women of childbearing age c). Folic acid during the first and second trimesters of pregnancy d). Multivitamin preparations as soon as pregnancy is suspected

*b). Folic acid for all women of childbearing age

30/44. Chemotherapeutic agents are classified according to what feature? a). Side effects b). Effectiveness c). Mechanism of action d). Route of administration

*c). Mechanism of action

94. Which of the following is the first line of treatment for adolescent depression? a). Cognitive behavior therapy b). Psychotherapy c). Selective serotonin reuptake inhibitors (SSRIs) d). Antidepressants

*c). Selective serotonin reuptake inhibitors (SSRIs)

6. A child is having their urine checked for complaints of polyuria. When analyzing the results, what would positive glucose indicate? a). This may indicate a urinary tract infection. b). This determines the presence of sugar in the urine. c). This indicates renal disease. d). This determines the presence of bacteria in the urine.

*d). This determines the presence of bacteria in the urine. (because glucose feeds the bacteria)

57. The nurse should suspect a hearing impairment in an infant who fails to demonstrate which behavior? a). Startle or blink reflex to sound b). Eye contact when being spoken to c). Gesturing to indicate wants after age 15 months d). Babbling by age 12 months

d). Babbling by age 12 months

83. What is the purpose of a high-protein diet for a child with major burns? a). Promote growth b). Improve appetite c). Diminish risk of stress-induced hyperglycemia d). Minimize protein breakdown

d). Minimize protein breakdown