PEDS Questions Exam 4

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother?

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?

"The treatment for the disorder will be a surgical procedure." Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.

The nurse is caring for a 9-month-old with cryptorchidism noted on the medical record. In which manner will the nurse assess this condition?

Palpate the scrotum for the testes Cryptorchidism occurs when the male gonads (testes) have not descended into the scrotum. Either one or both of the testes may not be in the scrotum. In most infants, the testes descend by the time the male is 1 year old. The nurse assesses the client's status by palpation of the scrotum.

When examining the abdomen of a child, which technique would the nurse use last?

Palpation Palpation should be the last part of the abdominal examination. Inspection, auscultation, and percussion should be done before palpation.

The nurse is caring for a child admitted with congenital aganglionic megacolon. Which clinical manifestation would likely have been noted in the child with this diagnosis?

Persistent constipation Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Prolonged bleeding is a manifestation of hemophilia. A chronic cough is noted in the child with cystic fibrosis. Irregular breathing occurs in children with seizures.

The nurse is caring for a 12-year-old client with nephrotic syndrome. The client confides that they feel like a "freak" compared to their peers because of their weight, edema, and moon face. Which response by the nurse is most appropriate?

"Let's put you in touch with some other clients who are also having the same body changes." It is important to introduce the client to other adolescents with chronic renal conditions so they do not feel so isolated. Adolescents need interaction with peers. Telling the client that this is a temporary condition, that their real friends do not care about their appearance, and they are beautiful in their own way dismisses the client's concerns and does not offer solutions. Nephrotic syndrome is a chronic condition, so telling the client the condition is temporary also is inaccurate.

The father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?

"Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy." Antibiotics are only used for bacterial infections, not viral infections unless a secondary bacterial infection develops from the virus. Treatment for viral infections is aimed at treating the client's symptoms.

A parent is angry about the adolescent's diagnosis of osteosarcoma. The parent is telling the adolescent that if he hadn't played football last year and broken his leg, this would not have happened. What is the nurse's best response to the parent's statement?

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." Osteosarcoma does not result from bone injuries but may be diagnosed when there is a fracture secondary to bone weakening from the tumor. Playing sports has no effect on development of osteosarcoma.

The parents of a 3-year-old child report he was exposed to pertussis 2 days ago. They are concerned and ask the nurse how long it will take until he becomes ill if he indeed contracted the infection. What response by the nurse is indicated?

"The signs of disease will be noted in 1 to 3 weeks." Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The disease is caused by Bordetella pertussis. The incubation period is 6 to 21 days, usually 7 to 10 days.

The parents state they are afraid to have their child vaccinated and ask the nurse for more information. Which response by the nurse is most appropriate?

"Vaccinations are very effective at preventing serious disease and infection." Nurses should provide education about the effectiveness of vaccines to prevent serious diseases at every visit. Although state-required vaccinations are needed for the child to attend school (some states allow medical, religious, and philosophical exemptions), this statement does not address the parents' concern. The child may not acquire the disease because others are vaccinated, but this statement could give the parents a false sense of security. Although most vaccinations do not have serious side effects, the nurse cannot ensure the child will not have a serious reaction to the vaccine.

A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test?

Checking with the parents for any allergies It is important to double-check whether the girl has any allergies. The test is contraindicated in children allergic to shellfish or iodine. Adequate hydration is also important, but the check for allergies is a priority. Only females of reproductive age must be screened for pregnancy. An enema is not necessary at all institutions.

The pediatric nurse knows that there are a number of anatomic and physiologic differences between children and adults. Which statement about the immune systems of infants and young children is true?

Children have an immature immune response. Infants and young children are more susceptible to infection due to the immature responses of their immune systems. Cellular immunity is generally functional at birth; humoral immunity develops after the child is born. Newborns have a decreased inflammatory response. Young infants lose the passive immunity from their mothers, but disease protection from immunizations is not complete.

A nurse is caring for a 4-year-old male child brought to the emergency department (ED) for symptoms of influenza. The parents state the child has "had high fevers for the past 3 days even though we have been giving our child acetaminophen and they do not really want to eat or drink anything and has been very sleepy." Client opens eyes to voice, follows simple commands, and skin is very warm, ruddy, and dry. Vital signs: 101.5°F (38.6°C); heart rate, 138 beats/min; oxygen saturation, 95% on room air. Laboratory values: white blood cell (WBC) count, 43 × 103 cells/mm3 (43 × 109/l); hemoglobin, 10 mg/dl (100 g/l); hematocrit, 32% (0.32); platelets, 20,000/ml (20 × 109/l); neutrophil bands, 48/mcl (0.05 × 109/l); lymphoblasts, 33 (NA).

Complete the following sentence(s) by choosing from the lists of options. The nurse should first address risk for bleeding by implementing bleeding precautions

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102°F (38.9°C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect?

Scarlet fever Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F (38.9°C). Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.

The nurse is preparing to administer acetaminophen to a 4-year-old child to provide comfort. Which precaution is specific to antipyretics?

Ensure proper dose and interval. It is very important to ensure that the proper dose is given at the proper interval because an overdose can be toxic to the child. Concerns with allergies and taking the entire, prescribed dose are precautions when administering antibiotics and all medications. Drowsiness is not a side effect of antipyretics.

A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply.

Exposure to blood and body fluids through sexual contact Sharing contaminated needles Transfusion of contaminated blood Perinatally from mother to fetus Through breastfeeding HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding. It cannot be contracted by using the same bathroom. It must be direct contact.

A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect?

Gastroenteritis Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.

A nurse is providing education to parents of a child diagnosed with vesicoureteral reflux (VUR). Which would be included in the parental education?

This occurs when there is backflow of urine into the bladder and sometimes the kidneys. The cause of VUR is a backflow of urine into the bladder and possibly kidneys. This disorder can occur if there is an obstruction, but this is not always the case. The way to determine if a child has VUR is typically by a VCUG diagnostic test. There are five different grades to VUR and it is treated according to the cause and degree of VUR.

The adoptive parents of a child who is 7 years old and HIV positive are concerned about telling their child about his condition. What information can be provided by the nurse?

When providing health information to a child of this age it should be simplistic and at the child's level of understanding. When children have a chronic condition they often realize that they have special concerns even before they are fully able to understand them. Information should be provided that is developmentally appropriate. Excessive information and details should be limited. Children who have this type of information may experience anger, depression, and difficulty in school.

Which instructions should a nurse give to a client who has a history of urinary tract infections to prevent recurrence? Select all that apply.

Wipe from front to back. Encourage fluids throughout the day. Finish all antibiotics prescribed. Teaching caregivers to wipe from front to back, encouraging fluids, and finishing all prescribed medications are vital principles in the prevention of recurring UTIs. The use of bubble bath is contraindicated because it can be a source of infection.

The nurse is caring for a 3-year-old female child in the emergency room for nausea, vomiting and diarrhea. The nurse reviews the Nurses' Notes from 1600. For each finding, click to specify if the finding indicates the child's condition has improved, had no change, or has declined.

Improved: temperature, blood pressure, level of consciousness, LOC. No Change: mucous membranes, oral intake. Declined: None

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time?

Improving hydration Preoperatively, the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.

The nurse is caring for a 3-year-old female child in the emergency room for nausea, vomiting and diarrhea. The emergency room nurse reviews the health care provider's orders. Which order(s) will the nurse perform at this time? Select all that apply.

Insert IV catheter. Administer Normal Saline 250 ml bolus followed by continuous infusion at 40 ml/hr. Obtain weight. Strict intake and output (I&O).

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first?

a child with erythema infectiosum experiencing fatigue and confusion A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

A pregnant client who is HIV positive asks the nurse if she will be able to breastfeed the newborn. Which response by the nurse is most appropriate?

"Breastfeeding will increase your newborn's risk of contracting HIV." HIV can be transmitted by breastfeeding. A newborn who received the recommended plan of drug treatment has a reduced risk for contracting the infection. Contracting HIV is not an absolute for this newborn. The client should be discouraged from breastfeeding to limit exposure to the newborn. Breastfeeding does provide immunity when the mother is free of infection but not in this scenario. Telling the mother to speak to the health care provider is not the best response as the nurse is able to provide this education to the client.

The nurse is caring for a 3-year-old female child in the emergency room for nausea, vomiting and diarrhea. The nurse reviews the Admission Notes from 1320 and analyzes the Laboratory Results. For each finding, click to specify if the finding indicates no dehydration, some dehydration or moderate to severe dehydration.

No dehydration: None Some dehydration: blood pressure, slightly sunken eyes, sticky mucous membranes, lethargic but arousable. Moderate to severe dehydration: None

The student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken first?

Obtain blood cultures. When treating a child suspected of having an infection, the blood cultures must be obtained first. The administration of antibiotics may impact the culture's results. A urine specimen may be obtained but is not the priority action. Intravenous fluids will likely be included in the plan of care but are not the priority action.

The nurse is examining a 7-year-old with suspected appendicitis. Which physical findings would indicate the possibility of appendicitis?

Persistent, right lower quadrant pain with rebound tenderness With appendicitis, symptoms typically do not come and go. They are usually persistent and intensify with time. With appendicitis, maximal tenderness occurs in the area of the McBurney point in the right lower quadrant, not the left. There is pain upon palpation with rebound tenderness. Pain is usually in the right lower quadrant, not the left, and is persistent. There is pain on palpation with rebound tenderness. Pain typically occurs in the right lower quadrant and is persistent and intensifies with time.

The nurse working in a hospital is caring for an 8-year-old female child with a stage 4 glioblastoma who is admitted to hospice care after having a seizure at home. Complete the diagram by dragging from the choices below to specify what condition the child is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the child's progress.

Potential Conditions: imminent death Actions to Take: Implement palliative care and obtain a do-not-resuscitate (DNR) order. Parameters to Monitor: Pain score and agonal breathing

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?

Prepare the infant for surgery. In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception.

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

Projectile vomiting During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased and urination is infrequent.

What information should be included in the teaching plan for a child with varicella?

Remind the child not to scratch the lesions. Varicella lesions appear first on the scalp. They spread to the face, the trunk, and to the extremities. There may be various stages of the lesions present at any one time. The lesions are intensely pruritic. The teaching plan for varicella should include that the child not scratch the lesions. Opening the lesions gives access for secondary infection to occur and causes scarring. Acetaminophen, not aspirin, should be administered for fever due to the link with Reye syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. Warm baths cause more itching and dry the skin.

The nurse is caring for a 4-year-old child who has undergone an appendectomy. The child is unwilling to use the incentive spirometer. Which approach is appropriate to elicit the child's cooperation?

"Can you blow this cotton ball across the tray?" Children are more likely to cooperate with interventions if play is involved. The nurse can encourage deep breathing by playing games. Asking the child to cough is less likely to engage them. Telling the child they might get pneumonia is not age appropriate and is unhelpful. Threatening to call the doctor is unhelpful and inappropriate. Remember, however, that the incentive spirometer works on the principle of the amount of air inhaled, not exhaled. Having the child take a deep breath prior to blowing the cotton ball is a beginning step.

The parents ask the nurse how to prevent their child from becoming sick. Which response by the nurse is most appropriate?

"Handwashing is an effective way to prevent infection." Proper handwashing is the best method to reduce chances of acquiring an infection. Although multivitamins may help provide the body with needed nutrients and covering a cough can prevent the spread of infection to others, neither of these will directly prevent the child from contracting an infectious disorder. Parents should be educated that bacteria and viruses are not visible and the bathroom and kitchen should be cleaned on a routine basis to avoid bacterial/viral transmission.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?

Risk for infection When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

A toddler has a fever. The parent calls the clinic wanting to know the appropriate dosage of acetaminophen to give the child. The parents say the child weighs 26 lb (11.8 kg). What is the lowest dose the nurse would instruct the parent to administer to the child?

118 mg The normal range for the dosage of acetaminophen is 10 to 15 mg/kg. The child weighs 11.8 kg. Using the lowest dose at 10 mg/kg, the child would need 118 mg. At 12 mg/kg, the dose would be 142 mg. At 14 mg/kg, the dose would be 165 mg. The highest dose at 15 mg/kg would equal 177 mg.

The physician has ordered ibuprofen 150 mg every 6 hours as needed for a 3-year-old child for a fever greater than 38°C (100.4°F). The label of the ibuprofen bottle reads "ibuprofen oral suspension 100 mg/5 ml." How much ibuprofen liquid will the nurse administer if the child's temperature goes above 38°C (100.4°F)? Record your answer using one decimal place.

7.5 The dose ordered (150 mg) is divided by the available dosage (100 mg) then multiplied by 5 mL.

Urinary tract infections are usually successfully treated by what means?

Administering antibiotics UTIs may be treated with antibiotics (usually sulfamethoxazole or ampicillin) at home. Fluids are encouraged, but they do not treat the infection. Bladder irrigations and diuretics are not used in the treatment of urinary tract infections.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?

Effortless vomiting just after the child has eaten The child with GER usually gains weight and feeds well. It must be determined if there are underlying symptoms or complications that might suggest GERD. In the child with GERD, almost immediately after feeding, the child vomits the contents of the stomach. The vomiting is effortless, not projectile in nature. The child with GERD is irritable and hungry, but may refuse to eat. Aspiration after vomiting may lead to respiratory concerns, such as apnea, wheezing, cough, and pneumonia. Failure to thrive and lack of normal weight gain occurs. Symptoms seen in the older child may include heartburn, nausea, epigastric pain, and difficulty swallowing. Forceful vomiting with the child wanting to eat shortly after vomiting is associated with pyloric stenosis. Severe constipation with ribbon-like stools would be indicative of Hirschsprung disease. Bouts of diarrhea with failure to gain weight is associated with Crohn disease.

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this?

Encourage the child to take all the antibiotics if diagnosed with strep throat. Encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community with whom the child came in contact unless they are symptomatic. Ibuprofen does not cure strep throat, and strep infection is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.

The mother of a newborn with a cleft lip reports she is having a hard time looking her baby. What is the best action by the nurse?

Encourage the mother to provide care for her infant. Providing care to the infant is the best means for the mother to begin bonding with her baby. Activities such as feeding, diapering and bathing will be helpful. Encouraging the mother to avoid looking at the cleft lip will not assist her in the process of accepting it. While surgery will be performed it will not take place for a few months. making it vital that she begin bonding with her infant. Telling the parent she will get used to it minimizes her concerns and is not the most therapeutic response by the nurse.

Which interventions will the nurse include when caring for a child with an infectious disorder? Select all that apply.

Ensure immunization status is current. Use appropriate personal protective equipment. Provide information about disease transmission. Educate the child and family about infection control. Nursing interventions for care of children with infectious disorders center around preventing disease through immunization and preventing further spread by practicing good infection control measures. Educating parents about infection control measures and teaching them about how the particular infectious agent is spread remains critical to preventing the spread of disease once the child leaves the hospital. Although antibiotics are used for bacterial infections, antibiotics are not needed for other types of infections (viral, fungal, etc.).

What is the leading cause of neonatal sepsis and death?

Group B streptococcus Sepsis is a systemic overresponse to infection. It is very serious and can produce septic shock and death. In infants under the 3 months of age the most causative agents are group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen, a full septic work-up is done. Neonates have the poorest outcomes from sepsis. Neisseria meningitidis is one cause of sepsis in older children. The Epstein-Barr virus is a herpes virus that causes mononucleosis. The cytomegalovirus is a common herpes virus. It is spread through bodily fluids and is not necessarily a concern unless the person is immunocompromised or is pregnant.

Parents bring their 5-year-old child to the pediatrician's office for reports of difficulty defecating, distended abdomen, abdominal and rectal pain, decreased appetite, liquid stool-soiled underwear, and increased frequency of urinary tract infections (UTIs). For each assessment finding, click to specify if the finding indicates Hirschsprung disease, encopresis, or intussusception.

Hirschsprung Disease: difficulty defecating, distended abdomen, abdominal pain, decreased appetite, liquid stool-soiled underwear. Encopresis: difficulty defecating, distended abdomen, abdominal pain, rectal pain, decreased appetite, liquid stool-soiled underwear, increased urinary tract infections (UTIs). Intussusception: difficulty defecating, distended abdomen, abdominal pain, decreased appetite, liquid stool-soiled underwear.

A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? Select all that apply.

IV fluid administration monitor of intake and output daily weight assessment Rotavirus is viral in nature. Antibiotic therapy is not used in the care and treatment of a viral infection. Antidiarrhea medications are not utilized as they are not effective. Intake and output will be observed. Daily weight will aid in the determination of hydration status. IV fluids may be indicated in the rehydration process.

A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case?

Intussusception Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance. Volvulus with malrotation and necrotizing enterocolitis typically occur in the first 6 months of life and do not match the symptoms described above. Short-bowel/short-gut syndrome typically occurs when a large portion of the intestine has been removed due to a previous disease or trauma.

An infant with bladder exstrophy is awaiting surgical repair. What is the priority nursing intervention for the nurse to complete in the care for this infant?

Keep the bladder moist and covered with a sterile bag. Bladder exstrophy is a condition where the infant is born with the bladder exposed outside the skin on the abdomen. It can only be corrected by surgery. A priority nursing intervention is to cover the bladder with a sterile plastic bag and keep it moist. This will help protect the bladder and prevent infection. The nurse will also apply a protective barrier cream to the skin around the bladder to help prevent skin breakdown. In addition, the nurse will sponge-bathe the infant rather than immerse the infant in water to prevent pathogens from the water possibly entering the bladder. The nurse will change soiled diapers frequently to prevent cross-contamination from stool to urine.

A school-aged child with cancer is receiving chemotherapy. Which nursing action would best promote the oral comfort of a child receiving chemotherapy?

Keeping the child's lips moist with petroleum jelly to prohibit cracking The mouth of a child receiving chemotherapy can become very inflamed and painful. It is important for the nurse to assess the oral cavity for redness, lesions, and plaques frequently. If the child is NPO, ice chips can be used to provide hydration to the mucosa. It is important to use a soft-bristle toothbrush when brushing the teeth. Excessive pressure on the gums will cause bleeding. If the gums are very inflamed, the child may use a saltwater solution or commercial mouthwash to keep the mouth clean. Instruct the child that this may cause burning. If burning or stinging occurs then discontinue the practice and provide solutions with pain medication. Using a petroleum product on the lips will provide hydration to the lips and keep them from being irritated or cracking. Drinking cold or hot foods will cause more pain in the mouth and may cause further irritation. Acidic fruit juices will cause increased pain and irritation in the mouth and may cause more inflammation.

A 15-year-old boy has been diagnosed with an osteosarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area?

Lungs Metastasis occurs early with bone tumors because of the extensive vascular system in bones. Metastasis to the lungs is very common; as many as 25% of adolescents will have lung metastasis already by the time of initial diagnosis. When this is present, the adolescent usually has noticed a chronic cough, dyspnea, and chest pain in addition to chronic leg pain. Other common sites of metastasis are brain and other bone tissue.

A parent contacts the oncology clinic nurse with concerns about mucositis following chemotherapy. Which are appropriate interventions for the nurse to include? Select all that apply.

Serve soft foods rather than hard or crunchy foods. Encourage rinsing the mouth with lukewarm water. Have the child drink fluids as often as possible to remain hydrated. Use a soft toothbrush and swish with an antibiotic mouthwash. Encourage serving soft foods such as mashed potatoes and pudding rather than hard ones, such as toast or crunchy cereal, to avoid abrasions to tender gum lines. Encourage rinsing the mouth with lukewarm water about 3 times a day for comfort and to encourage healing. Have the child drink as much fluid as possible to remain hydrated, which helps to keep the lips from cracking. Use a soft toothbrush and swish an antibiotic mouthwash if sores are present. Avoid acidic foods such as orange juice, which can sting if sores are present. Keep lips well lubricated with petroleum jelly or a commercial product to prevent lips from cracking.

To prevent further urinary tract infections in a preschooler, what measures would you teach her mother?

Teach her to wipe her perineum front to back after voiding. Escherichia coli can be easily spread from the rectum to the urinary meatus and cause infection if girls do not take precautions against this.

A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which situation would require immediate attention by the nurse?

The child does not have intravenous access. An intravenous pyelogram is an X-ray study of the upper urinary tract in which a radio opaque dye is injected into a peripheral vein, requiring intravenous access. The other choices are not a priority for this client.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting?

The child has been sexually abused, maybe on the fishing trip. Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse (child mistreatment) and should be further explored.

The nurse is caring for a 3-year-old female child in the emergency room for nausea, vomiting and diarrhea. The nurse reviews the Nurses' Notes from 1400. Complete the following sentence(s) by choosing from the lists of options.

The child is at highest risk for developing shock as evidenced by blood pressure and change in level of consciousness

The nurse is caring for a 6-year-old child for a routine physical but schedules a follow-up when concerns of recent change with enuresis arise. The nurse is reviewing the nurses' notes and urinalysis results with the health care provider. Complete the following sentence(s) by choosing from the lists of options.

The child is most likely experiencing secondary enuresis as evidenced by new parental separation This child was reliably dry at the previous visit but progressed to enuresis in the past 2 weeks. The nurse will examine all findings to determine a potential cause. Secondary enuresis occurs when a child has been dry for 6 months and begins experiencing wetting.This child began kindergarten during the timeframe the issue presented. A stressful events, such as a parental separation, is a known cause of secondary enuresis. Glomerulonephritis is inflammation of the glomeruli with differing symptoms than those of this child.A urinary tract infection (UTI) is a cause for secondary enuresis; however, the client does not have a UTI as evidenced by the urinalysis and denial of burning on urination.All of the urinalysis results are all within normal ranges.

A client has just completed a renal biopsy. Which manifestation should be given priority attention?

The child is not voiding. The presence of voiding is a priority after a renal biopsy to prevent blood clotting and blocked urine flow. The other choices are not of a priority nature.

A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse?

The foreskin is needed for repair. Hypospadias occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circumcised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair. Once the hypospadias is repaired, a circumcision can be performed as part of the procedure. Hypospadias repair is usually done after the newborn is 1 year or older. Meatal stenosis has to do with the urethral opening diameter, not the placement. Circumcision or hypospadias repair does not affect the functioning of the renal system so neither would predispose the newborn to renal failure.

The parents of a 10-year-old with HIV have never told their child that he has the virus. The child asks the nurse why he is "on so many medications." What action should the nurse take?

The nurse should encourage the child to talk with his parents about his medications. Generally, children older than 6 years of age will eventually need to have their diagnosis disclosed to them in an age-appropriate manner. They begin to ask questions and often seem to sense that something is going on other than what they've been told so far. Encouraging discussion with the parents is the best first step.

The nurse is caring for a 3-year-old female child in the emergency room for nausea, vomiting and diarrhea. The nurse reviews the Nurses' Notes from 1400 and the Laboratory Results from admission. Complete the following sentence(s) by choosing from the lists of options.

The nurse should first insert an IV catheter followed by administer IV fluid bolus of normal saline

The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? Select all that apply.

The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." All close contacts who are younger than 7 years of age and who are unimmunized or underimmunized should have pertussis immunization initiated or the series completed according to the recommended dosing schedule. Fluids should be increased in order to help thin secretions and prevent dehydration during the infection. The parents are correct in removing their PPE at the door and washing their hands when leaving the room, and wearing a mask. All antibiotics should be finished in order to treat the infection adequately and prevent immunity to antibiotics.

An 8-year-old client presents with sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the child's health history, the nurse learns that the child had strep throat 9 days ago. Which condition does the nurse suspect?

acute glomerulonephritis Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described with this client. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old child. Nephrosis is altered glomerular permeability apparently due to an autoimmune process or a T-lymphocyte dysfunction that results in fusion of the glomeruli membrane surfaces, which, in turn, leads to abnormal loss of protein in urine. The highest incidence is at 3 years of age. In addition to proteinuria, a major symptom of nephrosis is edema, which is absent in this case.

After teaching the parents of a child with chickenpox (varicella zoster), the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time?

after the lesions have crusted Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.

A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves:

bacteria. Neonatal sepsis can be caused by viruses such as herpes simplex or enteroviruses and by protozoa (e.g., oxoplasma gondii). However, bacteria are typically the culprits.

The nurse is providing care to a child with leukemia. When assessing the child, which signs and symptoms would the nurse likely find? Select all that apply.

bruising anorexia sore throat lymphadenopathy Clinical and diagnostic features of leukemia include fatigue, weakness, pallor, fever, bruising, bleeding (e.g., petechiae or purpura), weight loss, anorexia, swollen gums, sore throat, recurrent infections, flu-like symptoms, abdominal pain, nausea, vomiting, bone pain, lymphadenopathy, splenomegaly, hepatosplenomegaly, elevated leukocyte count, decreased hemoglobin, and platelet counts.

The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). In educating the parents, the nurse would recommend that the child avoid:

caffeine Caffeine is an irritant to the bladder and should be avoided. Liberal fluid intake and cranberry juice should be encouraged. The child should wear cotton underwear to avoid perineal irritation.

The nurse is providing care to a child with an intussusception. The child has a bowel movement, and the nurse inspects the stool. How will the nurse document the stool's appearance?

currant jelly-like The child with intussusception often exhibits currant jelly-like stools that may or may not be positive for blood. Greasy stools are associated with celiac disease. Clay-colored stools are observed with biliary atresia. Bloody stools can be seen with several gastrointestinal disorders, such as inflammatory bowel disease.

The nurse is caring for a 3-year-old female child in the emergency room for nausea, vomiting and diarrhea. The nurse reviews the Admission Notes from 1320 and Laboratory Results. Which finding(s) requires immediate follow-up? Select all that apply.

diarrhea temperature blood pressure nausea and vomiting Young children are at high risk for dehydration, which can lead to electrolyte imbalances that can become life-threatening if interventions are not implemented promptly. Young children are at high risk for dehydration because they have a greater portion of water in their bodies; their high metabolic rates require more water; and their kidneys do not conserve water as well as adult kidneys. Persistent diarrhea can cause dehydration in young children. A temperature of 102.3°F (39.5°C) indicates an infection and requires immediate follow-up. The client's blood pressure of 76/46 mm Hg is lower than normal range for a child of this age (normal range systolic blood pressure 80 to 120 mm Hg) and is an indication of dehydration. Persistent nausea and vomiting can cause dehydration and fluid and electrolyte imbalances quickly in young children, which can be life-threatening. The child's potassium level of 3.6 mEq/l (3.6 mmol/l) is within normal limits. The child's oxygen saturation of 96% on room air is within normal limits (95% to 100%). The child's respiratory rate of 30 breaths/min is within normal limits (normal range for years of age is 20 to 30 breaths/min).

A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The parent informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The health care provider diagnoses the child with erythema infectiosum. The nurse tells the parent that this is also known as:

fifth disease. Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities. Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen, or back that is followed by a pattern of small lesions. It is self-limiting and can be treated with steroid creams. Rosacea is a chronic inflammatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious.

The nurse is caring for a 2-year-old child with a gastrointestinal infection resulting in 4 to 5 liquid stools per day over the past 3 days. Based on this information, which important concern(s) will the nurse address in the child's care? Select all that apply.

fluid deficiency risk: dehydration diarrhea and loss of electrolytes the risk for skin maceration in the perineum Four to five loose stools per day are considered diarrhea. The child is at risk for fluid and electrolyte deficiency given the length of time and number of stools per day. The risk for skin maceration can occur in the perianal area because of the prolonged skin exposure to liquid stools. The child does not have malnutrition. Malnutrition is defined as a condition that results from a nutrient deficiency or overconsumption. Parental presence to care for the child can be addressed after the immediate needs of the child are addressed.

The nurse is caring for a child on a pediatric unit who has hemodialysis three times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child?

grilled chicken, apple slices, and flavored water Since hemodialysis is usually performed only every other day, larger amounts of waste products build up in the child's blood; therefore, the child must follow a stricter diet between hemodialysis treatments, though dietary restrictions are usually lifted while the child is actually undergoing the treatment. Since the kidneys are not functioning, foods high in sodium and potassium should be limited.

The nurse is performing an assessment on a child. Which finding indicates to the nurse the child is at an increased risk for a urinary tract infection (UTI)?

holding urine while at school One cause of urinary tract infections (UTIs) in children is not urinating frequently enough at school. Cleaning the perineal area from front to back limits contamination of fecal material with the urethra. Drinking plenty of fluids (preferably water) daily helps encourage elimination, which limits UTIs. Washing the genital area with water daily does not increase the chance of a UTI.

The nurse is caring for a neonate who is suspected of having sepsis. Which assessment finding is indicative of sepsis?

hypothermia Hypothermia is a sign of sepsis in neonates. A rash on the face is a symptom of scarlet fever. An edematous neck is a sign of diphtheria. Paroxysmal coughing is a symptom of pertussis.

A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child?

infection symptoms The neutrophils are the primary means of fighting bacterial infection. When the neutrophil count is very low, the child has the potential to have an overwhelming bacterial infection. The child is at the greatest risk when the neutrophil count is less than 500/mcl (0.50 ×109/l). The nurse's priority would be to assess for signs and symptoms of infection. A bacterial infection can be life-threatening for this child. This child would be placed in neutropenic precautions. This is a form of isolation where the child is protected from health care workers and outside visitors. Among other precautions, no plants would be allowed in the room, raw fruits or vegetables would not be consumed unless washed under running water and lightly scrubbed, and the child should have no rectal examinations or medications and not experience a urinary catheterization. To prevent an infection, the nurse would administer broad spectrum antibiotics. The vital signs should be assessed every 4 hours, and alterations could indicate more problems than just infection. Mucositis occurs when there is an ulcerated oral mucosa. It should be assessed but is not the priority. Bleeding would be more related to low platelet count and not neutrophils.

The nurse has developed a plan of care for a 12-month-old child hospitalized with dehydration as a result of rotavirus. Which intervention will the nurse include in the plan of care?

maintaining the intravenous (IV) fluid rate as prescribed The nurse should maintain an IV line and administer the IV fluid as ordered to maintain fluid volume. High-carbohydrate fluids like fruit juice, fruit flavored drinks, and popsicles should be avoided because they are low in electrolytes, increase simple carbohydrate consumption, and can decrease stool transit time. Milk products should be avoided during the acute phase of illness as they may worsen diarrhea.

The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning?

urine output of 10 ml over 3 hours Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output.

When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect?

mucositis Mucositis, or ulcers of the gum line and mucous membranes of the mouth, is a frequent side effect of methotrexate. Cushingoid facial appearance and weight gain are associated with the use of prednisone. Paresthesias are associated with vincristine.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease?

mumps Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis (whooping cough) is a respiratory disorder that causes severe paroxysmal coughing, which produces a whooping sound. Measles is recognized by Koplik spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very pruritic and is seen on the hands, feet, and folds of the skin.

The nurse is providing care to a child with acute kidney injury. What assessment is priority for the nurse to determine if this child is developing hyperkalemia?

pulse rate and rhythm Hyperkalemia occurs when the potassium levels rise above normal laboratory values. Although it varies among laboratories, a normal potassium range is generally between 3.5 and 5 mEq/l (3.5 and 5 mmol/l). When the potassium levels rise, the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm, because potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmia occurs or the heart starts to fail.

Which finding leads the nurse to suspect that a child is experiencing moderate dehydration?

sunken fontanels (fontanelles) A child with moderate dehydration exhibits sunken fontanels (fontanelles). Severe dehydration would be characterized by dusky extremities, skin tenting, and hypotension.

The nurse is caring for a 4 year-old female child admitted for pyelonephritis. Which assessment finding(s) in the nurses' note at 0630 require immediate follow up by the nurse? Select all that apply.

temperature 102.4°F (38.6°C) respiratory rate 38 breaths/min difficult to arouse labored respirations heart rate 162 beats/min Urosepsis is a complication that may occur in a child with pyelonephritis and is characterized by tachypnea, rapid or labored breathing, extreme tachycardia, fever greater than 101.4°F (38.0°C), lethargy (difficult to arouse), change in mental status, vomiting, pale skin, and urine output less than 0.5ml/kg/hr. Temperatures greater than 101.4°F (38.0°C) may indicate urosepsis and require prompt follow up and treatment.Lethargy or difficult to arouse is an ominous clinical sign present in urosepsis and requires urgent follow up and intervention.Tachypnea is present in urosepsis and sepsis.Labored respirations is present in urosepsis, requiring immediate follow up. Extreme tachycardia is present in urosepsis and requires prompt follow up and intervention to maintain perfusion. Cloudy urine is an expected finding in pyelonephritis and does not require immediate follow up. The cloudiness is due to the infection and white blood cells present in the urine.Decreased skin turgor is an expected finding in pyelonephritis due to dehydration. Because this is an expected finding and IV fluids are being administered to address the dehydration, this finding does not require immediate follow up. Pain with urination is expected in pyelonephritis due to the inflammation in the kidneys.Dry mucous membranes is common in dehydration, which occurs during pyelonephritis.

A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition?

testicular torsion A hydrocele is a collection of fluid that collects in the fold of the scrotum, requiring no treatment. A varicocele is an abnormal dilation (dilatation) of the veins of the spermatic cord. Testicular torsion is evidenced by severe scrotal pain, nausea, and vomiting and is a surgical emergency. Testicular infection is not indicated.

A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema?

weight, daily The classic sign of nephrotic syndrome is edema. It is usually generalized, but may be manifested as ascites or be periorbital depending on the seriousness of the disease. The easiest way to determine edema is by weighing the child. The child should be weighed on the same scale, at the same time daily, and with the same amount of clothing. The abdomen would only need to be measured if ascites was suspected or known. Measuring urine output will not determine edema, although it should be done to determine if urine is being produced in adequate amounts. Measuring the amount of protein in the urine will also not determine edema. The measurement is important to determine the progress of the disease, however.