Peds study guide- Exam 2
An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. Instructions to the parent should include which of the following?
Administer all of the prescribed medication.
When teaching a patient who will be taking tetracycline, which of the following instructions should the nurse share?
Avoid direct sunlight and tanning beds while on this medication."
An infant's parents ask the nurse about preventing otitis media (OM). Which of the following should be recommended?
Avoid tobacco smoke.
After surgery for pyloric stenosis, the nurse could anticipate that the infant will:
Be fed clear liquids within 6 hours
When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics?
Cephalosporins
Which of the following clinical manifestations would be the most suggestive of acute appendicitis?
Colicky, cramping, abdominal pain around the umbilicus
The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate which of the following?
Complete obstruction
An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires the following isolation:
Contact Precautions.
The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion the nurse should instruct her to:
Cover the skin with a shirt or gown before percussing.
A 10 year old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition?
Decreased wheezing
A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which of the following may be tolerated the best?
Easily digested foods
The nurse must suction a child with a tracheostomy. Interventions should include:
Ensuring that each pass of the suction catheter take no longer than 5 seconds.
A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child is which of the following?
Essential because it will be an adjustment
While teaching a 10 year-old child about their impending heart surgery, the nurse should
Explain the surgery using a model of the heart
A newborn's failure to pass meconium within the first 24 hours after birth may indicate which of the following?
Hirschsprung disease
SELECT ALL THAT APPLY The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. Which of the following instructions should the nurse include?
Hold the infant in the prone position after a feeding. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.
The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration?
Infusing the drug over at least 1 hour
An infant with tetralogy of Fallot is experiencing a tet attack involving cyanosis and dyspnea. Which position should the infant be placed in?
Knee-chest
A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the MOST APPROPRIATE nursing action?
Let the mother hold the child and direct the cool mist over the child's face.
Cystic fibrosis (CF) may affect single or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is which of the following?
Mechanical obstruction caused by increased viscosity of mucous gland secretions
The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the MOST APPROPRIATE nursing action?
Move the infant to a room with another child with RSV.
Which of the following should the nurse do first after noting that a child with Hirschsprung disease has a fever and watery explosive diarrhea?
Notify the physician immediately
A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should do which of the following?
Notify the physician immediately and be prepared to assist with a tracheostomy or intubation. This child is exhibiting signs of respiratory distress and possible epiglottitis.
The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion because of which of the following?
Object may be lodged in esophagus.
When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects?
Oral candidiasis and dry mouth
While assessing a child with pyloric stenosis, the nurse is likely to note which of the following?
Projectile vomiting Projectile vomiting is a key symptom of pyloric stenosis. Regurgitation is seen more commonly withGER. Steatorrhea occurs in malabsorption disorders such as celiac disease. "Currant jelly"stools are characteristic of intussusception.
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37 C (98.6 F). The nurse suspects mild croup and should recommend which of the following?
Provide fluids that the child likes and use comfort measures.
A 7-year-old child with acute diarrhea has been rehydrated with oral rehydration solution (ORS). The nurse should recommend that the child's diet be advanced to include which of the following?
Regular diet
Which of the following nursing diagnoses is appropriate for a patient who has started aminoglycoside therapy?
Risk for injury (hearing loss)
Which of the following tests aids in the diagnosis of cystic fibrosis (CF)?
Sweat test, stool for fat, chest x-ray films A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF.
Which antibiotic is contraindicated for the treatment of infections in infants and young children?
Tetracyn (tetracycline)
The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indication that the child may be experiencing airway obstruction?
The child is leaning forward, with the chin thrust out.
Which of the following statements best describes Hirschsprung disease?
The colon has an aganglionic segment.
A toddler's mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse's response should be based on which of the following?
The location needs to be confirmed by x-ray examination.
Which of the following parameters would the nurse monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)?
Vomiting, Thickened feedings are used with GER to stop the vomiting. Therefore, the nurse would monitor the child's vomiting to evaluate the effectiveness of using the thickened feedings
When caring for a child after a tonsillectomy, the nurse should do which of the following?
Watch for continuous swallowing.
The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breast-feeding and provides all the care except for the medication administration. The nurse includes in the care plan:
ensuring that the mother has time away from the infant.
The parents of a 3-year-old admitted for recurrent diarrhea are upset that the practitioner has not told them what is going on with their child. The priority intervention for this family is to:
help the family develop a written list of specific questions to ask the practitioner.
The administration of prednisone to children with nephrosis creates the problem of:
increased risk of infection
Abdominal circumferences are monitored on a child with progressive abdominal distention secondary to a bowel obstruction. The appropriate procedure for assessment includes:
marking the point of measurement with a pen.
The nurse is caring for a child diagnosed with nephrosis. Symptoms that are characteristic of nephrosis include (select all that apply)
massive proteinuria edema
Cystic fibrosis may affect single or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is:
mechanical obstruction caused by increased viscosity of mucous gland secretions. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas.
A 13-year-old child with cystic fibrosis (CF) is a frequent patient on the pediatric unit. This admission, she is sleeping during the daytime and unable to sleep at night. A beneficial strategy for this child would be to:
negotiate a daily schedule that incorporates hospital routine, therapy, and free time.
A priority nursing responsibility in the care of a child with Wilms' tumor is to:
omit abdominal palpation during daily assessments. Don't do it!
Traditionally, congenital heart defects have been divided into acyanotic or cyanotic defects. Based on the nurse's knowledge of congenital heart defects, this system is:
problematic, because acyanotic heart defects may have cyanosis. The classification is problematic. Children with traditionally named acyanotic defects may be cyanotic, and children with traditionally classified cyanotic defects may appear pink, although they may eventually become cyanotic.
A patient is in an urgent-care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment?
A beta2 agonist such as albuterol (Proventil)
A patient is admitted with a fever of 102.8 F (39.3 ° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain urine and blood cultures and to administer an antibiotic intravenously stat (now). The nurse will complete these orders in which sequence?
Blood and urine cultures, ampicillin dose
A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is which result?
Bronchitis and chemical pneumonia
SELECT ALL THAT APPLY. The nurse who is administering aminoglycoside therapy must monitor the patient closely for signs of toxicity as manifested by which of the following?
Electrocardiogram changes, Dizziness, Rising serum creatinine level
The mother of an 8 year old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen (Motrin IB) is not effective. Which instruction should the nurse provide to the mother?
Encourage the child to lie on the right side.
Which of the following is a parasite that causes acute diarrhea?
Giardia lamblia
The beneficial effect of performing surgery for patent ductus arteriosus
Increased pulmonary vascular congestion
What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (CF)?
Meconium ileus
A child with acute streptococcal pharyngitis should be treated with antibiotics to prevent:
acute rheumatic fever.
You are notified that a 9-year-old boy with nephrotic syndrome is being admitted. Only semiprivate rooms are available. The best roommate would be:
an 8-year-old boy with a fractured femur.
The nurse is doing a prehospitalization orientation for a girl, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that after the surgery, the child will be in the intensive care unit. This explanation is:
an appropriate part of the child's preparation.
The nurse is admitting a 7-year-old child to the pediatric unit for abdominal pain. To determine what the child understands about the reason for hospitalization, the nurse should:
ask the child why he came to the hospital today.
A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. This medication should be administered:
before CPT. Bronchodilators should be given before CPT to open bronchi and make expectoration easier.
Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39o C (102.2o F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner would instruct the parents to use:
benzocaine ear drops for topical pain relief.
Daily weights are obtained in children with nephrosis to monitor:
changes in the amount of edema
Acute salicylate (ASA, aspirin) poisoning results in:
disorientation and loss of consciousness.
Prevention of rheumatic fever can best be accomplished by:
having sore throats cultured as soon as possible
Nursing interventions to maintain a patent airway in a newborn should include:
positioning neonate supine while sleeping.
An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to:
prevent RSV infection. Synagis is a monoclonal antibody specific for RSV. Monthly administration is initiated to prevent infection with RSV.
When administering digoxin (Lanoxin) to an infant, the medication should be withheld and the physician notified if the:
pulse rate is below 100 beats/min
The nurse observes flaring of nares in a newborn. This should be interpreted as:
sign of respiratory distress.
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates:
soothing inflamed mucous membrane.
Among the following pediatric clients, who should be assessed first by the nurse?
the child with 2 episodes of inconsolable crying while the knees are drawn over the abdomen and plays between the episodes--- indicates appendicits
One of the goals for children with asthma is to prevent respiratory infection. The reason for this goal is that respiratory infection can
trigger an episode or aggravate an asthmatic state.
During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and anorexia. The nurse's best advice to the patient would be which of the following?
"Drink a full glass of water with each dose."
A newborn's failure to pass meconium within 24 hours after birth may indicate which of the following?
Aganglionic Mega colon or Hirschsprung disease
The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks?
Albuterol (Proventil) nebulizer solution, Epinephrine, Aminophylline IV infusion
The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which of the following is appropriate to relieve the abdominal discomfort during the evaluation?
Allow child to assume position of comfort.
Which of the following nursing diagnoses would be inappropriate for the infant with gastroesophageal reflux(GER)?
Altered oral mucous membranes
The mother of a hospitalized 2 year old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make?
Antibiotics are not indicated unless a bacterial infection is present."
A 4-year-old child will be having cardiac surgery next week. The child's parents call the hospital, asking about how to prepare her for this. The nurse's reply should be based on knowledge that:
Children who are prepared experience less fear and stress during hospitalization.
A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The child's mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which of the following?
Continue to give ORS frequently in small amounts.
The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which type of cephalosporin is most appropriate for this infection?
First generation
The nurse is assessing an infant with Hirschsprung's disease. The nurse can expect the infant to:
Have a scaphoid-shaped abdomen
Which is a clinical manifestation of acetaminophen poisoning?
Hepatic involvement
Which of the following conditions is often associated with severe diarrhea?
Metabolic acidosis
A child with pyloric stenosis is having excessive vomiting. Which of the following is a potential complication?
Metabolic alkalosis
The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? SELECT ALL THAT APPLY
Place the infant in a private room. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.
A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first?
Stop the antibiotic infusion.
Tepid water or sponge baths are indicated for hyperthermia in children. The nurse should:
Stop the bath if the child begins to chill.
When caring for a child with probable appendicitis, the nurse should be alert to recognize which of the following as a sign of perforation?
Sudden relief from pain
A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections?
Sulfonamides
SELECT ALL THAT APPLY. During antibiotic therapy, the nurse should monitor closely for signs and symptoms of a hypersensitivity reaction. Which of the following may be an indication of a hypersensitivity reaction?
Wheezing, Shortness of breath, Swelling of the tongue, tching
When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?
The penicillin will cause an enhanced anticoagulant effect of the warfarin.
When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?
Tinnitus and hearing loss
The mother of a 20-month-old child tells the nurse that the child has a barking cough at night. The child's temperature is 37° C (98.6° F). Based on the nurse's knowledge of upper respiratory infections, this is a symptom of croup. The nurse should recommend to:
Try a cool-mist vaporizer at night and watch for signs of difficulty breathing. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief.
Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident? Choose all that apply.
Unfamiliar environment, Strange smells, Inadequate knowledge of condition and routine
A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers should the nurse give to the patient?
"The bronchodilator should be taken first."
The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent?
"The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response?
"The combined effect of both antibiotics is greater than each of them alone."
After receiving a nebulizer treatment with a beta-agonist, a patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response?
"This is an expected adverse effect. Let me take your pulse."
The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily which of the following?
The mother's presence will reduce anxiety and ease child's respiratory efforts.
Which of the following is a high-fiber food that the nurse could recommend for a child with chronic constipation?
Popcorn
A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. The purpose of the NG tube is which of the following?
Prevent abdominal distention
