Peds Questions Exam 2

Fever is a common symptom in osteomyelitis. A) True B) False

A) True

Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than: A) 185mg/dL B) 250mg/dL C) 280mg/dL D) 330mg/dL

B) 250mg/dL

The nurse is caring for a 3-year old who had an appendectomy 2 days ago. When taking the child's temperature, the nurse notes that the child has a temperature of 101.8 degrees. The nurse notes the child's breath sounds are slightly diminished in the right lower lobe. Which of the following actions is more appropriate for this patient? A) Teach the child how to use an incentive spirometer B) Encourage the child to blow bubbles C) Obtain an order for intravenous antibiotics D) Obtain an order for acetaminophen

B) Encourage the child to blow bubbles

Parents have been giving their child correction doses through a child's insulin pump for elevated ketones. If blood glucose remains high after 1-2 doses, what should parents do next? A) Give child long-action insulin B) Give correction dose with pen device C) Change pump infusion set and check infusion site

B) Give correction dose with pen device

What is thought to trigger the development of type 1 diabetes? A) Bacterial Infection B) Viral Infection C) Summer Months

B) Viral Infection

Which of the following is a risk factor specifically for developing Slipped Capital Femoral Epiphysis (SCFE)? A) Male B) Preschooler C) Overweight D) African-American

C) Overweight

The nurse uses the five P's to assess ischemia in a child with a fracture. Which of the following findings is considered a late and ominous sign? A) Petaling B) Posturing C) Paresthesia D) Positioning

C) Paresthesia

The leading cause of chronic illness in children is: A) Asthma B) Pertussis C) Tuberculosis D) Cystic fibrosis

A) Asthma

When the hormone Aldosterone is secreted, the kidneys reabsorb: A) Sodium B) Potassium C) Magnesium

A) Sodium

Which of the following is a late sign of increased intracranial pressure in an infant or child? Select all that apply. A) Headache B) Seizures C) Bradycardia D) Papilledema E) Increased sleepiness F) Decreased consciousness G) Lethargy

C) Bradycardia D) Papilledema F) Decreased consciousness

Which of the following is a common clinical manifestation of juvenile hypothyroidism? A) Insomnia B) Diarrhea C) Dry Skin D) Rapid Growth

C) Dry Skin

Which child may need extra fluids to prevent dehydration? Select all that apply. A) 7-day old receiving phototherapy B) 6-month old with newly diagnosed pyloric stenosis C) 2-year old with pneumonia D) 2-year old with full thickness burns to the chest, back and abdomen E) 13-year old who has just started her menses

A) 7-day old receiving phototherapy B) 6-month old with newly diagnosed pyloric stenosis C) 2-year old with pneumonia D) 2-year old with full thickness burns to the chest, back and abdomen

A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggest which of the following? A) Asthma B) Pneumonia C) Bronchiolitis D) Foreign body in trachea

A) Asthma

Which of the following is characteristic of fractures in children? A) Fractures rarely occur at the growth plate site because it absorbs shock well. B) Rapidity of healing is inversely related to the age of the child. C) Pliable bones of growing children are less porous than those of the adult. D) Periosteum of a child's bone is thinnner, is weaker, and has less osteogenic potential compared with the adult.

B) Rapidity of healing is inversely related to the age of the child.

A nurse is working with a child who has had a bone age evaluation. Which explanation of the test should the nurse give? A) "The bone age will give you a diagnosis of your child's short stature." B) "If the bone age is delayed, the child will continue to grow taller." C) "The x-ray of the bones is compared with that of the age-appropriate, standardized bone age." D) "If the bone age is not delayed, no further treatment is needed."

C) "The x-ray of the bones is compared with that of the age-appropriate, standardized bone age."

Early detection of hypothyroidism is essential in preventing what in infants? A) Short stature B) Accelerated growth C) Cognitive impairment D) Obesity

C) Cognitive impairment

The nurse is assessing a child to rule out one of the croup syndromes in the emergency department. The child has rapid respiration, retractions, sitting in a tripod position and is drooling. Examining the child's throat using a tongue depressor might precipitate which of the following? A) Sore throat B) Inspiratory stridor C) Complete obstruction D) Respiratory tract infection

C) Complete obstruction

Which of the following is a clinical manifestation of increased intracranial pressure in children? A) Low-pitched cry B) Sunken fontanel C) Diplopia, blurred vision D) Increased blood pressure

C) Diplopia, blurred vision

If beta cells make insulin, what do alpha cells make? A) Growth Hormone B) TSH-Thyroid Stimulation Hormone C) Glucagon

C) Glucagon

An important assessment for the nurse to perform in identifying cleft palate is to: A) Assess the sucking ability of the infant B) Assess the color of the lips C) Palpate the palate with a gloved finger D) All of the above

C) Palpate the palate with a gloved finger

The nurse is preparing a community outreach program for adolescents about the characteristic differences between Type 1 and Type 2 diabetes mellitus (DM). Which of the following concepts should the nurse include? A) Type I DM has an abrupt onset B) Type 1 DM is often controlled with oral glucose agents C) Type 1 DM occurs primarily in Caucasians D) Type 2 DM always requires insulin therapy E) Type 2 DM frequently has a familial history F) Type 2 DM occurs in people who are overweight

A) Type 1 DM has an abrupt onset C) Type 1 DM occurs primarily in Caucasians E) Type 2 DM frequently has a familial history F) Type 2 DM occurs in people who are overweight

The parents of a 6-year old being evaluated for appendicitis tells the nurse that the physician diagnosed their child as having a positive Rovsing sign. The ask the nurse what this means. Select the nurse's best response. A) Your child's physician should answer that question. B) A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated. C) A positive Rovsing sign means pain is felt when the physician removes the hand from the abdomen. D) A positive Rovsing sign means pain is felt in the right lower quadrant when the child coughs.

B) A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated.

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures and antimicrobial agents. The nurse knows that antibiotic therapy should begin: A) Once the diagnosis is confirmed. B) As soon as medication is received from the pharmacy and labs have been drawn. C) After the child's fluid and electrolyte balance is stabilized. D) As soon as the practitioner is notified of the culture results.

B) As soon as medication is received from the pharmacy and labs have been drawn.

In caring for a neonate with unrepaired myelomeningocele, which of the following considerations need to be made? Select all that apply. A) Keep myelomeningocele dry B) Avoid diaper use C) Limit dressing changes to once daily D) Prone positioning to sleep E) Encourage lactation via breast pumping

B) Avoid diaper use D) Prone positioning to sleep E) Encourage lactation via breast pumping

Which of the following statements best describes a subdural hematoma? A) Bleeding occurs between the dura and the skull. B) Bleeding occurs between the dura and cerebrum. C) Bleeding is generally arterial, and brain compression occurs rapidly. D) The hematoma commonly occurs in the parietotemporal region.

B) Bleeding occurs between the dura and the cerebrum.

Intranasal administration of desmopressin acetate (DDAVP) is used to treat: A) Hypopituitarism B) Diabetes Insipidus C) SIADH D) Acute Adrenocortical Insufficiency

B) Diabetes Insipidus

The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. When taking the child's temperature, the nurse notes that the child has a temperature of 101.8 degrees F (38.8 degrees C). The nurse notes the child's breath sounds are slightly diminished in the right lower lobe. Which of the following actions is more appropriate for this patient? A) Teach the child how to use an incentive spirometer not developmentally appropriate B) Encourage the child to blow bubbles C) Obtain an order for intravenous antibiotics D) Obtain an order for acetaminophen

B) Encourage the child to blow bubbles

A child with cystic fibrosis is receiving recombinant human deoxyribonuclease. This drug: A) Is given subcutaneously B) May cause voice alterations C) May cause mucus to thicken D) Is not indicated for children younger than 12 years

B) May cause voice alterations

A pathophysiological mechanism responsible for symptoms associated with laryngeal tracheal bronchitis (LTB) is: A) Inflammation of the bronchiole smooth muscle associated with bronchospasms B) Obstruction of the respiratory passages by edema and inflammation C) Narrowing of the respiratory airway associated with an allergic reaction D) Destruction of laryngeal tissues by thick tenacious mucous

B) Obstruction of the respiratory passages by edema and inflammation

A mother brings her baby to the emergency department stating that the baby no longer makes tears when crying but is having multiple soaked diapers per day. Which assessment by the nurse takes priority? A) Last bowel movement B) Palpation of fontanels C) Prenatal history D) Time of last meal

B) Palpation of fontanels

An 8-year old with Type I Diabetes is complaining of a headache and dizziness and is visibly perspiring. The nurse, after obtaining a blood sugar, should do which of the following? A) Administer glucagon intramuscularly. B) Provide the child juice. C) Administer rapid-acting insulin. D) Provide the child with 8oz of water or calorie-free liquid.

B) Provide the child juice.

There are several children in the ER waiting area who all have asthma. Which child should be seen first? A) 5-year old who is speaking in complete sentences, is pink in color, is wheezing bilaterally and has an oxygen saturation of 93% B) 9-year old who is quiet, pale, wheezing bilaterally with oxygen saturation of 92% C) 12-month old who has a mild cry, pale in color, diminished breath sounds, and has oxygen saturation of 93% D) 16-year old who is speaking in short sentences, wheezing, sitting upright, oxygen saturation of 93%

C) 12-month old who has a mild cry, pale in color, diminished breath sounds, and has oxygen saturation of 93%

Of the following children, the one who is most likely to be hospitalized for treatment of croup is: A) A 2-year old child whose croupy cough worsens at night B) A 5-year old child whose croupy cough worsens at night C) A 2-year old child using accessory muscles to breathe D) A child with respiratory stridor during the physical examination

C) A 2-year old child using accessory muscles to breathe

A child is admitted to the pediatric unit after sustaining a linear occipital skill fracture and subdural hematoma following a fall. Which of the following is the priority nursing action? A) Assess for CSF rhinorrhea B) Continuous O2 sat monitoring C) Assess LOC D) Pain management

C) Assess LOC

A 6-year old child is 4 hours post-op tonsillectomy and is getting ready to be discharged home. She is awake, alert, complaining of pain. She is swallowing frequently. Your first action as the nurse would be: A) Suction the back of her throat to determine if she is having any post-op bleeding. B) Assess her pain on the Faces scale, then provide her with the ordered pain medication. C) Call the surgeon. D) Share with parents this is normal and discuss how they can treat the child's sore throat when they are at home.

C) Call the surgeon.

Parents bring a 7-year-old to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. The priority nursing intervention is: A) Send the child to radiology so that an x-ray film can be taken. B) Initiate an intravenous line and administer morphine for the pain. C) Calmly ask the child to point to where the pain is worst and to wiggle fingers. D) Have the parents hold the child so that the nurse can examine the arm thoroughly.

C) Calmly ask the child to point to where the paoin is worst and to wiggle fingers.

Which of the following is a physiologic effect of immobilization on children? A) Metabolic rate increases. B) Venous return improves, since child is in supine position. C) Circulatory stasis can lead to thrombus and embolus formation. D) Bone calcium increases, releasing excess calcium into the body (hypercalcemia).

C) Circulatory stasis can lead to thrombus and embolus formation.

A school-aged child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is which of the following? A) Explain that analgesia is contraindicated with a head injury. B) Have parents describe the child's previous experiences with pain. C) Consult with the practitioner about what analgesia can be safely administered. D) Teach parents that analgesia is unnecessary when child is fully awake and alert.

C) Consult with practitioner about what analgesia can be safely administered.

The nurse is caring for a 9-month old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. The provider is sending the child home. Which of the following is likely to be included in the discharge teaching? A) Administer Immodium as needed B) Administer Kaopectate as needed C) Continue breastfeeding per routine D) The infant may return to day care 24 hours after antibiotics have been started

C) Continue breastfeeding per routine

You are caring for a 7-year-old boy who returned from surgery 6 hours ago. He has a cast on his right leg for a fractured right femur. He is complaing of increased pain, even after receiving IV morphine 30 minutes ago. Your first action is to: A) Reposition and reassess after one hour. B) Let the medication work a little longer. Recheck child in another 30 minutes. C) Do a complete neurvascular assessment. D) Turn on the child's favorite movie to help distract him from his pain.

C) Do a complete neurovasculr assessment.

A 6-week old infant is admitted to the hospital with possible hypertrophic pyloric stenosis. Which symptom is most descriptive of pyloric stenosis in infants? A) Abdominal peristaltic waves passing from right to left. B) Appears hungry. Small emesis after every feeding. C) Emesis usually occurs after a feeding and is projectile. D) Decreased interest in feedings with weight loss.

C) Emesis usually occurs after a feeding and is projectile.

In an 8-month old infant admitted with pertussis, the nurse should particularly assess the: A) Living conditions of the infant B) Labor and delivery history of the mother C) Immunization status of the infant D) Alcohol and drug intake of the mother

C) Immunization status of the infant

An appropriate nursing intervention when caring for an unconscious child would be which of the following? A) Avoid using narcotics or sedatives to provide comfort and pain relief. B) Change the child's position infrequently to minimize the chance of ICP. C) Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. D) Give tepid sponge baths to reduce fevers about 101F because antipyretics are contraindicated.

C) Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema.

The nurse in the pediatric clinic receives a call from the parent of a 5-year old and states that the child has been having diarrhea for 24 hours. The parent explain that the child vomited twice 2 hours ago and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response. A) You can offer clear diet soda such as Sprite and Ginger Ale. B) Pedialyte is really the best thing for your child, who, if thirsty enough, will eventually drink it. C) Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it. Try offering small amounts in a spoon, medicine cup or syringe. D) It really does not matter what your child drinks as long as it is kept down. Try offering small amounts of fluids in medicine cups.

C) Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it. Try offering small amounts in a spoon, medicine cup or syringe.

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. The nurse includes in the teaching: A) Surgical therapy is indicated B) Place in prone position for sleep after feeding C) Thicken feedings and enlarge the nipple hole D) Reduce frequency of feeding by encouraging larger volumes of formula

C) Thicken feedings and enlarge the nipple hole

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The patient asks how long she will have to wear the brace. The appropriate answer is: A) For as long as you have been told. B) Most preadolescents use the brace for 6 months. C) Until your vertebral column has reached skeletal maturity. D) It will be necessary to wear the brace for the rest of your life.

C) Until your vertebral column has reach skeletal maturity.

A parent calls the nurse expressing concerns. Over the last few days, their child has been experiencing headaches, joint pain and increased urination. The child has recently been started on human recombinant growth hormone. The nurse's best response is: A) "These are normal responses to the medication. His body will adjust over time." B) "How often is he receiving his medication?" C) "What locations have you been giving his injections?" D) "Let's set up and appointment for your provider to see your child today."

D) "Let's set up an appointment for your provider to see your child today."

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent: A) Otitis media B) Diabetes insipidus C) Nephrotic syndrome D) Acute rheumatic fever

D) Acute rheumatic fever

Which of the following is a nursing intervention to reduce the risk of increasing intracranial pressure in an unconscious child? A) Suction child frequently B) Turn head side to side every hour C) Provide environmental stimulation D) Avoid activities that cause pain

D) Avoid activities that cause pain

Tony is 3.5 years old and his brother, John, is 6 months old. Both children are brought to the clinic by their mother because of vomiting, loose stools and fever. The nurse assesses the children and determines that they are mildly dehydrated. The mother asks what to do about breast-feeding John. The nurse should recommend: A) Stop breast-feeding for 24 hours B) Stop breast-feeding until diarrhea stops C) Bottle feed glucose water, alternating it with breast-feeding D) Continue breast-feeding and give an oral rehydration solution to replace diarrheal losses

D) Continue breast-feeding and give an oral rehydration solution to replace diarrheal losses

Signs of hyperglycemia include: A) Tremors, sweating, headache B) Hunger, nausea, lethargy C) Confusion, slurred speech, anxiety D) Blurred vision, weakness, polyphagia

D) Blurred vision, weakness, polyphagia

Which of the following is considered a cardinal sign of diabetes mellitus? A) Nausea B) Seizures C) Impaired Vision D) Frequent Urination

D) Frequent Urination

A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses the airway, breathing and circulation. The next nursing action should be which of the following? A) Place on side. B) Take blood pressure. C) Stabilize neck and spine. D) Check scalp and back for bleeding.

C) Stabilize neck and spine.

A corticosteroid has been ordered to treat inflammation in a child with Juvenile Idiopathic Arthritis. Which of the following is an important part of education for parents related to this medication? A) Inflammation will decrease within 1-2 days. B) Child will not run a fever while on this medication. C) Child's height will increase if on this medication for an extended period of time. D) Do not discontinue the medication abruptly.

D) Do not discontinue this medication abruptly.

A 6-year old child with Type 1 diabetes has been well controlled throughout the school year. The parents should expect with the summer months that: A) The child will continue to be well controlled B) The child may exhibit more hyperglycemic episodes C) The child may exhibit more hypoglycemic episodes D) The child will not need to monitor the glucose levels

C) The child may exhibit more hypoglycemic episodes

A 7-year old is tested for diabetes insipidus (DI). Six hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale with a low specific gravity. The most likely reason for this is which of the following? A) 24 hours is too early to evaluate effects of fluid restriction B) The urine should be concentrated, and it is unlikely the child has DI C) The child may have been sneaking fluids and needs closer observation D) In DI, fluid restriction does not cause urine concentration

D) In DI, fluid restriction does not cause urine concentration

Which of the following physical signs would you likely see in a child with an acute upper airway obstruction? A) Inspiratory Crackles B) Unilateral Lung Expansion C) Dullness to Percussion D) Inspiratory Stridor

D) Inspiratory Stridor

A child with hypopituitarism is being started on growth hormone therapy. Nursing considerations should be based on knowledge of which of the following? A) Replacement therapy requires daily subcutaneous injections. B) Hormone supplementation will be required throughout child's lifetime. C) Treatment is consider successful if children attain full stature by adolescence.

A) Replacement therapy requires daily subcutaneous injections.

Retraction is defined as: A) Sinking in of soft tissues during the respiratory cycle B) Proliferations of tissue near the terminal phlanges C) An increase in end-expiratory pressure D) Contraction of the sternocleidomastoid muscles

A) Sinking in of soft tissues during the respiratory cycle

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. The most appropriate initial action by the school nurse is which of the following? A) Stay with the child and make sure emergency medical services are called. B) Notify parent and regular practitioner. C) Notify parent that the child should go home. D) Stay with child, offering calm reassurance.

A) Stay with the child and make sure emergency medical services are called.

An invagination of one portion of the bowel into another is called: A) Intussusception B) Pyloric Stenosis C) Tracheoesophageal Fistula D) Hirschsprung Disease

A) Intussusception

What is the earliest recognizable clinical manifestation of cystic fibrosis? A) Meconium ileus B) History of poor intestinal absorption C) Foul-smelling, frothy, greasy stools D) Recurrent pneumonia and lung infections

A) Meconium ileus

The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident. More, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest which of the following? A) Neurologic health B) Severe brain damage C) Decorticate posturing D) Decerebrate posturing

A) Neurologic health

The mother asks about giving Tony food after he is rehydrated from diarrhea. Which of the following is the most appropriate recommendation? A) Offer a regular diet B) Offer a regular diet except high-protein foods C) Give clear liquids for the next 24 hours D) Start the BRAT diet (bananas, rice, apples and tea or toast)

A) Offer a regular diet

The typical treatment plan for Legg Calve Perthes Disease (LCPD) includes which of the following? A) Physical activity restrictions. B) Immediate surgical correction. C) Four to six weeks of IV antibiotics. D) Traction and corticosteroids.

A) Physical activity restrictions.

All of the following children have been brought to the ED with dehydration. You are receiving a report from the previous nurse. Which of the following patients would be priority for the nurse to assess? A) Abbott, a 12 year old, is brought in after playing in an all day soccer tournament in 90 degree weather. Abbott is described as thirsty and somewhat irritable with his parent, but he is otherwise reported as being tired and cooperative. B) Bethany, a 6 year old who weights 55 pounds, was somewhat lethargic when she first arrived at the ED. She has just finished receiving her second 500mL NS bolus and is reported alert and interactive. C) Caleb, a 2 year old with a canker sore for the past 2 days, is reported by his parent to be reluctant to eat or drink. Caleb is irritable and resistant to being examined. Caleb had a large void and his specific gravity was 1.022. D) Daphne, a 4 month old infant, has had moderate to severe diarrhea for the past week, but no fever. Her parent states Daphne has been less interested in her bottle and has been sleeping most of the day.

D) Daphne, a 4-month old infant, has had moderate to severe diarrhea for the past week, but no fever. Her parent states Daphne has been less interested in her bottle and has been sleeping most of the day.

Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestation is which of the following? A) Hyperactivity of sweat glands B) Hypoactivity of autonomic nervous system C) Atrophic changes in mucosal wall of intestines D) Mechanical obstruction caused by increased viscosity of mucous gland secretions

D) Mechanical obstruction caused by increased viscosity of mucous gland secretions

A child with pyloric stenosis is having excessive vomiting. Which of the following is a potential complication? A) Hyperkalemia B) Hyperchloremia C) Metabolic Acidosis D) Metabolic Alkalosis

D) Metabolic Alkalosis

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as which of the following? A) Eye trauma B) Indication of brain death C) Severe brainstem damage D) Neurosurgical emergency

D) Neurosurgical emergency

The nurse is caring for an immobilized preschool child. Which of the following is MOST helpful during this period of immobilization. A) Encourage wearing pajamas. B) Let child have few behavioral limitations. C) Keep child away from other immobilized children if possible. D) Take child for a "walk" by wagon outside the room.

D) Take child for a "walk" by wagon outside the room.

Adam, a usually healthy 2 month old was brought to the pediatrician's office by his mother for excessive vomiting for 2 days. On examination, you note that he is irritable and has not gained any weight since his last checkup. His mother states that he "throws up after every feeding." Adam's physical examination and diagnostic procedures confirm a diagnosis of GERD. In discussing treatment of GERD, which of the following is not the most appropriate, immediate intervention to discuss with Adam's mother? A) Thicken feedings with rice cereal B) Do not feed more frequently than every 3 hours C) Avoid placing the child supine after feedings D) Use medications to control Adam's symptoms

D) Use medications to control Adam's symptoms