Recommended Pediatric Success Questions Exam #1

3. High-pitched cry. A high-pitched cry is often indicative of increased ICP in infants

The nurse is caring for a 6-month-old infant with a diagnosis of hydrocephalus. Which of the following signs best indicates increased ICP in this child? 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite.

CHF

The nurse is caring for a 9-month-old who was born with a CHD. Assessment reveals an HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of ___________________.

4. Send the spinal fluid and blood cultures to the laboratory. Cultures of spinal fluid and blood should be obtained, followed by administration of intravenous antibiotics.

The nurse is caring for a child who is being admitted with a diagnosis of meningitis. The child's plan of care includes the following: administration of intravenous antibiotics, administration of maintenance intravenous fluids, placement of a Foley catheter, and obtaining cultures of spinal fluid and blood. Select the procedure the nurse should do first. 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fluids. 3. Placement of a Foley catheter. 4. Send the spinal fluid and blood cultures to the laboratory.

2. Pulses. Checking for pulses, especially in the canulated extremity, would assure perfusion to that extremity and is the priority post procedure.

A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

3. Nonresponse to intravenous antibiotics. If a patient does not respond to an appropriate antibiotic within 48 hours, surgery may be indicated. This is the correct answer.

A 10-year-old with osteomyelitis has been on intravenous antibiotics for 48 hours. The child is allergic to amoxicillin. Vital signs are: T 101.8°F (38.8°C), BP 100/60, P 96, R 24. Which of the following is the primary reason for surgical treatment? 1. Young age. 2. Drug allergies. 3. Nonresponse to intravenous antibiotics. 4. Physician preference.

2. The patient is in the tripod position and has diminished breath sounds and a muffled cough. When children are sitting in the tripod position, that is an indication they are having difficulty breathing. The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds indicate that there is fluid in the lungs and are indicative of a worsening condition. A muffled cough indicates that the child has some subglottic edema. This child has several signs and symptoms of a worsening respiratory condition

A 15-month-old is brought to the ER. The parents tell the nurse that the child has not been eating well and has had an increased respiratory rate. Which of the following assessments is of greatest concern? 1. The patient is lying down and has moderate retractions, low-grade fever, and nasal congestion. 2. The patient is in the tripod position and has diminished breath sounds and a muffled cough. 3. The patient is sitting up and has coarse breath sounds, coughing, and fussiness. 4. The patient is restless, crying, has bilateral wheezes and poor feeding.

3. "We will do a lateral neck x-ray of the soft tissue." A lateral neck x-ray is the method used to diagnose epiglottitis definitively. The child is at risk for complete airway obstruction and should always be accompanied by a nurse to the x-ray department.

A 3-year-old female is admitted to the ER with drooling, difficulty swallowing, sore throat, and a fever of 39°C (102.2° F). The physician suspects epiglottitis. The parents ask the nurse how the physician will know for sure if their daughter has epiglottitis. Which is the nurse's best response? 1. "A simple blood test will tell us if your daughter has epiglottitis." 2. "We will swab your daughter's throat and send it for culture." 3. "We will do a lateral neck x-ray of the soft tissue." 4. "The diagnosis is made based on your daughter's signs and symptoms."

4. The child should be given 1/2 teaspoon honey four to five times per day. Warm fluids, humidification, and honey are best treatments for a URI.

A 3-year-old is seen in the physician's office for a dry, hacking cough that is preventing the child from sleeping. The child is diagnosed with a URI. Which of the following interventions is most appropriate for this patient? 1. The child should be given cough suppressants at night. 2. The child should be given a cough expectorant every 4 hours. 3. The child should be given cold and flu medication every 8 hours. 4. The child should be given 1/2 teaspoon honey four to five times per day.

2. "As your child ages and grows, the CP can manifest in different ways, and different muscle groups can need more assistance." CP can be manifested in different ways as the child grows. It does not progress, but its clinical manifestations may change.

A 3-year-old male with CP has just been fitted for braces and is beginning physical therapy to assist with ambulation. His parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse's best response: 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child ages and grows, the CP can manifest in different ways, and different muscle groups can need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

1, 2, 3, 4 1. Edema, numbness or tingling, and pain are early signs of compartment syndrome. 2. Edema, numbness or tingling, and pain are early signs of compartment syndrome. 3. Edema, numbness or tingling, and pain are early signs of compartment syndrome. 4. A weak pulse is a late sign of compartment syndrome.

A 6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. Which of the following are early signs of compartment syndrome in this child? Select all that apply. 1. Edema. 2. Numbness. 3. Severe pain. 4. Weak pulse. 5. Anular rash

1. Chickenpox or flu. Both chickenpox and influenza are viral in nature, so consider stopping the aspirin because of the danger of Reye syndrome.

A 6-year-old is receiving aspirin therapy for KD. Exposure to what illnesses should be a cause to discontinue therapy and substitute dipyridamole (Persantine)? 1. Chickenpox or flu. 2. E. coli or staphylococcus. 3. Mumps or streptococcus A. 4. Streptococcus A or staphylococcus.

3. Albuterol. Albuterol is the quick-relief bronchodilator of choice for treating an asthma attack.

A 7-year-old female with asthma is playing a soccer game in gym class. During the game the child begins to cough, wheeze, and have difficulty catching her breath. The school nurse is called to the soccer field. Which of the following should the nurse administer to provide quick relief? 1. Prednisone. 2. Singulair. 3. Albuterol. 4. Flovent.

2. Perform a neuromuscular assessment. The nurse looks for the source of the pain by performing a neuromuscular assessment

A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do first? 1. Give more pain medication. 2. Perform a neuromuscular assessment. 3. Call the surgeon for orders. 4. Tell the child to wait another hour for the medication to work.

1, 2, 3 1. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 2. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 3. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation.

A child has been diagnosed with KD. The parents are asking questions about the child's outcome. The nurse explains the most serious complications. Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

4. The prevention of aspiration pneumonia. The most valuable information the nurse can give the parents is how to prevent aspiration pneumonia from occurring in the future

A pediatric client with severe cerebral palsy is admitted to the hospital with aspiration pneumonia. What is the most beneficial educational information that the nurse can provide to the parents? 1. The signs and symptoms of aspiration pneumonia. 2. The treatment plan for aspiration pneumonia. 3. The risks associated with recurrent aspiration pneumonia. 4. The prevention of aspiration pneumonia.

3. "Administer the amoxicillin until all the medication is gone." It is essential that all the medication be given.

A physician prescribes 10 days of amoxicillin to treat a 6-year-old male with an ear infection. The nurse is reviewing discharge instructions with the parent. Which information should be included in the discharge instructions? 1. "Administer the amoxicillin until the child's symptoms subside." 2. "Administer an over-the-counter antihistamine with the antibiotic." 3. "Administer the amoxicillin until all the medication is gone." 4. "Allow your child to administer his own dose of amoxicillin."

4. The child is swallowing excessively. Excessive swallowing is a sign that the child is swallowing blood. This should be considered a medical emergency, and the physician should be contacted immediately. The child is likely bleeding and will need to return to surgery.

A school-age child is admitted to the hospital for a tonsillectomy. The nurse caring for this patient is assessing the child 8 hours after surgery. During the nurse's assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations should be of most concern to the nurse? 1. The child's heart rate and blood pressure are elevated. 2. The child complains of having a sore throat. 3. The child is refusing to eat solid foods. 4. The child is swallowing excessively.

3. A private room that is dark and quiet with minimal stimulation. A quiet private room with minimal stimulation is ideal as the child with meningitis should be in a quiet environment to avoid cerebral irritation.

A toddler is being admitted to the hospital with a diagnosis of bacterial meningitis. Select the best room assignment for the patient. 1. A semiprivate room with a roommate who also has bacterial meningitis. 2. A semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. A private room that is dark and quiet with minimal stimulation. 4. A private room that is bright and colorful and has developmentally appropriate activities available.

4. Check under the straps at least two to three times daily for red areas. Checking under straps frequently is suggested to prevent skin breakdown.

An infant is in a Pavlik harness for treatment of DDH. While instructing the parents on preventing skin breakdown, the nurse should stress which of the following? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas.

2. Apical pulse rate. The apical pulse rate is ordered because digoxin decreases the HR, and if the HR is <60 digoxin should not be administered.

An infant with CHF is receiving digoxin to enhance myocardial function. What should the nurse assess prior to administering the medication? 1. Yellow sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

3. Squatting. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow.

During play, a toddler with a history of TOF might assume which of the following positions? 1. Sitting. 2. Supine. 3. Squatting. 4. Left lateral recumbent.

3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" Asking specific questions will give the nurse the information needed to determine the level of care for the child.

The emergency room nurse is caring for a 5-year-old child who fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which of the following statements is a priority for the nurse at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" 4. "Why was he not wearing a helmet?"

2. They reflect that the patient is not compliant with taking her enzymes. If the patient were not taking her enzymes, the result would be a large amount of undigested food, azotorrhea, and steatorrhea in the stool. CF patients must take digestive enzymes with all meals and snacks. Pancreatic ducts become clogged with thick mucus that blocks the flow of digestive enzymes from the pancreas to the duodenum. Therefore, patients must take digestive enzymes to aid in absorption of nutrients. Often, teens are noncompliant with their medication regimen because they want to be like their peers.

The nurse caring for a female pediatric client with CF sends a stool for analysis. The results show an excessive amount of azotorrhea and steatorrhea. What does the nurse realize about the laboratory values? 1. They reflect that the patient is not compliant with taking her vitamins. 2. They reflect that the patient is not compliant with taking her enzymes. 3. They reflect that the patient is eating too many foods high in fat. 4. They reflect that the patient is eating too many foods high in fiber.

3. Asymmetry of gluteal and thigh folds. In DDH, asymmetrical thigh and gluteal folds are frequently present.

The nurse is assessing a 2-week-old for signs of DDH. The nurse should expect the infant to have which of the following? 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone.

2. 1 cc/kg/hr Normal pediatric urine output is 1 cc/kg/hr

The nurse is caring for a 1-year-old who has been diagnosed with CHF. Treatment began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear and equal bilaterally, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr 2. 1 cc/kg/hr 3. 30 cc/hr 4. 1 oz/hr

3. "Pain medication is necessary to promote comfort." Pain medication promotes comfort and ultimately decreases ICP.

The nurse is caring for a 2-year-old male in the PICU with a head injury. The child is comatose and unresponsive at this time. The parents ask if he needs pain medication. Select the nurse's best response. 1. "Pain medication is not necessary as he is unresponsive and cannot feel pain." 2. "Pain medication may interfere with his ability to respond and may mask any signs of improvement." 3. "Pain medication is necessary to promote comfort." 4. "Although pain medication is necessary for comfort, we use it cautiously as it increases the demand for oxygen."

3. "My child will have fewer ear infections if he has his tonsils removed." Removing children's tonsils may not have any effect on their ear infection. Children who have repeated bouts of tonsillitis can have ear infections secondary to the tonsillitis, but there is no indication in this question that the child has a problem with tonsillitis.

The nurse is caring for a 22-month-old male who has had repeated bouts of otitis media. The nurse is educating the parents about otitis media. Which of the following statements from the parents indicates they need additional teaching? 1. "If I quit smoking, my child may have less chance of getting an ear infection." 2. "As my child gets older, he should have fewer ear infections, because his immune system will be more developed." 3. "My child will have fewer ear infections if he has his tonsils removed." 4. "My child may need a speech evaluation."

2. "Your daughter's defect is small and will likely close on its own by the time she is 2 years old." Usually a VSD will close on its own within the first year of life

The nurse is caring for a 3-month-old with a VSD. The physicians have decided not to repair it surgically. The parents express concern that this is not best for their child and ask why their daughter will not have an operation. The nurse's best response to the parents is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your daughter's defect is small and will likely close on its own by the time she is 2 years old." 3. "It is common for the physicians to wait until an infant develops respiratory distress before they do the surgery because of the danger." 4. "With a small defect like this, we will wait until the child is 10 years old to do the surgery."

2. Identify her parents and state her own name. Asking the 3-year-old to identify her parents and state her name is a developmentally appropriate way to assess orientation.

The nurse is caring for a 3-year-old female with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to: 1. Name the president of the United States. 2. Identify her parents and state her own name. 3. State her full name and phone number. 4. Identify the current month but not the date.

2. Beta blocker. The beta blocker not only affects the heart and lungs but also blocks the beta sites in the liver, reducing the amount of glycogen available for use, causing hypoglycemia. The lower HR and BP also suggest ingestion of a cardiac medication.

The nurse is caring for a 4-year-old female with a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of what drug? 1. Calcium channel blocker. 2. Beta blocker. 3. ACE inhibiter. 4. ARB.

4. "Tell me your thoughts about G-tubes." An open-ended question will encourage family members to share what they know and potentially clear any misconceptions.

The nurse is caring for a 5-year-old male with CP. His weight is in the fifth percentile, and he has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube put in. Which of the following would be the nurse's best response? 1. "A G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for your family." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

4. "Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving." Posturing is a reflex that often indicates that the child is receiving too much stimulation.

The nurse is caring for a 9-year-old female who is unconscious in the PICU. The child's mother has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response. 1. "I think your daughter hears you, and she is attempting to reach out to you." 2. "Your child is responding to you; please continue trying to stimulate her." 3. "It appears that your child is having a seizure." 4. "Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving."

4. Apply direct pressure 1 inch above the puncture site. Applying direct pressure 1 inch above the puncture site will localize pressure over the vessel site.

The nurse is caring for a child who has undergone cardiac catheterization. During the recovery phase, the nurse notices the dressing is saturated with bright red blood and a 6-inch circle of blood on the crib sheet. The nurse's first action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

1. "After initial surgery to close the defect, most children experience no neurological dysfunction." Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction.

The nurse is caring for a neonate who has just been diagnosed with a meningocele. The parents ask what to expect. Which of the following is the nurse's best response? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

1. Hypokalemia. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR, slow for her age, also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk for digoxin toxicity.

The nurse is caring for a preschool female diagnosed with CHF. She is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse suspects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.

1. Immunoglobulin G and aspirin. High-dose immunoglobulin G and salicylate therapy for inflammation are the current treatment for KD.

The nurse is caring for a school-aged boy with KD. A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen.

1, 4, 5, 6, 7. 1. Rocking by the parents will comfort the infant and decrease demands. 4. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. 5. An infant sucking the fists could indicate hunger. 6. Change bed linens only when necessary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the child.

The nurse is caring for an infant with CHF. The following are interventions to decrease cardiac demands on the infant. Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

2. "Babies with myelomeningocele are at risk for hydrocephalus, which can show up with an increase in head circumference." Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference.

The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby's head circumference. Select the nurse's best response: 1. "We measure all babies' heads to ensure that their growth is on track." 2. "Babies with myelomeningocele are at risk for hydrocephalus, which can show up with an increase in head circumference." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up with an increase in head circumference." 4. "Many infants with myelomeningocele have microcephaly, which can show up with a decrease in head circumference."

2. "Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside." Parents should be encouraged to remain with their child for mutual comfort

The nurse is preparing to assess a 6-year-old male with altered consciousness in the PICU. His parents ask if they can stay during his morning assessment. Select the nurse's best response. 1. "Your child is more likely to answer questions and cooperate with any procedures if you are not present." 2. "Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside." 3. "It is our policy to ask parents to leave during the first assessment of the shift." 4. "Many children fear that their parents will be disappointed if they do not do well with procedures, so we recommend that no parents be present at this time."

2. "She should avoid being in a car at night." The rhythmic reflection of other car lights can trigger a seizure in some children

The nurse is providing discharge instructions to the parents of a 13-year-old girl who has been diagnosed with epilepsy. Her parents ask if there are any activities that she should avoid. Select the nurse's best response. 1. "She should avoid swimming, even with a friend." 2. "She should avoid being in a car at night." 3. "She should avoid any strenuous activities." 4. "She should not return to school right away as her peers will likely cause her to feel inadequate."

1, 2, 3 1. There is an association between myelomeningocele and congenital clubfoot. 2. There is an association between some forms of cerebral palsy and congenital clubfoot. 3. There is an association between diastrophic dwarfism and congenital clubfoot.

The nurse tells the parent that other conditions can be associated with congenital clubfoot? Select all that apply. 1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism. 4. Breech position in utero. 5. Prematurity. 6. Fetal alcohol syndrome.

1. "I should administer two quick puffs of the albuterol inhaler using a spacer." The parent should always give one puff at a time and should wait 1 minute before administering the second puff.

The parent of a pediatric client with asthma is talking to the nurse about administering the child's albuterol inhaler. Which statement by the parent leads the nurse to believe that the parent needs further education on how to administer the medication? 1. "I should administer two quick puffs of the albuterol inhaler using a spacer." 2. "I should always use a spacer when administering the albuterol inhaler." 3. "I should be sure that my child is in an upright position when administering the inhaler." 4. "I should always shake the inhaler before administering a dose."

1. Sign language may be a very beneficial way to help children with CP communicate. Sign language may help the child with CP communicate and ultimately decrease frustration. Children with CP may have difficulty verbalizing because of weak tongue and jaw muscles. They may be able to have sufficient motor skills to communicate with their hands.

The parents of a 12-month-old with CP ask the nurse if they should teach their child sign language because he has not begun any vocalization yet. The nurse bases her response on which of the following? 1. Sign language may be a very beneficial way to help children with CP communicate. 2. Sign language may cause confusion and further delay verbalization. 3. Most children with CP will have great difficulty learning sign language. 4. Sign language may be beneficial, but it would be best to wait until the child is closer to the preschool age.

1. Place the food on the tip of the tongue, as the child will be less likely to choke. The food should be placed far back in the mouth to avoid tongue thrust.

The parents of a 2-year-old with CP are learning how to feed their child and avoid aspiration. When reviewing the teaching plan, the nurse should question which of the following? 1. Place the food on the tip of the tongue, as the child will be less likely to choke. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

3. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. This child is exhibiting signs of severe asthma. This child should be seen first. The child no longer has wheezes and now has diminished breath signs.

There are several children in the ER waiting area who all have asthma. The nurse has only one room left in the ER. Based on the following information, which child should be seen first? 1. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%. 2. A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92%. 3. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. 4. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%.

1. CHD. CHD is found often in children with Down syndrome.

A child born with Down syndrome should be evaluated for what associated cardiac manifestation? 1. CHD. 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy

3. Self-consciousness about appearance. Children this age are very conscious of their appearance and of fitting in with their peers, so they might be very resistant to wearing a brace.

A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that duration? 1. Pain from the brace. 2. Difficulty in putting the brace on. 3. Self-consciousness about appearance. 4. Not understanding what the brace is for.

1, 2, 4, 5 1. General postoperative nursing interventions include assessing for pain. 2. Specific to scoliosis surgery, logrolling is the means of changing positions. 4. It is essential to check neurological status in a patient who just had scoliosis surgery. 5. General postoperative nursing interventions include assessing vital signs.

A 13-year-old just returned from surgery for scoliosis. What nursing interventions are appropriate in the first 24 hours? Select all that apply. 1. Assess for pain. 2. Logroll to change positions. 3. Get the teen to the bathroom 12 to 24 hours after surgery. 4. Check neurological status. 5. Monitor blood pressure.

1, 2, 4, 5 1. In a recent fracture, the nurse should assess pain and provide treatment. 2. Pain, pallor, and weak or absent pulses are all signs of compartment syndrome. 4. Weak or absent pulse is a sign of compartment syndrome, so monitoring capillary refill is important in assessment. 5. Pain, pallor, and weak or absent pulses are signs of compartment syndrome. Pain should be treated.

63. Nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes which of the following? Select all that apply. 1. Assess pain. 2. Assess pulses. 3. Elevate extremity above the level of the heart. 4. Monitor capillary refill. 5. Provide pain medication as needed.

2. Severe diaper rash. A child with severe diaper rash has potential for infection if the interventionist makes the standard groin approach.

A 1-year-old child is being prepared for a cardiac catheterization procedure. Which of the following findings about the child might delay the procedure? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

2. The infant has tachypnea. Tachypnea is an early sign of distress and is often the first sign of respiratory illness in infants.

A 2-month-old is seen in the pediatrician's office for his 2-month well-child checkup. The nurse is assessing the patient and reports to the physician that the child is exhibiting early signs of respiratory distress. Which of the following would indicate an early sign of distress? 1. The infant is breathing shallowly. 2. The infant has tachypnea. 3. The infant has tachycardia. 4. The infant has bradycardia

3. COA. With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lower-than-expected BP and weak pulses in the lower extremities.

In which of the following CHDs would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. AS. 3. COA. 4. TOF.

1. Call for additional help, and prepare to administer mannitol. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respirations. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP.

The emergency room nurse is caring for an unconscious 6-year-old girl who has had a severe closed-head injury and notes the following changes in her vital signs. Her heart rate has dropped from 120 to 55, her blood pressure has increased from 110/44 to 195/62, and her respirations are becoming more irregular. After calling the physician, which of the following should the nurse expect to do? 1. Call for additional help, and prepare to administer mannitol. 2. Continue to monitor the patient's vital signs, and prepare to administer a bolus of isotonic fluids. 3. Call for additional help, and prepare to administer an antihypertensive. 4. Continue to monitor the patient, and administer supplemental oxygen

4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration. The child is placed in the prone position to avoid any pressure on the defect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fluids are begun after the surgery.

The nurse is caring for a newborn infant who has just been diagnosed with a myelomeningocele. Which of the following is included in the child's plan of care? 1. Place the child in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the child in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. 3. Place the child in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

3. Check the neurocirculatory status of the foot. Checking the neurocirculatory status of the foot is the highest priority.

The parent of a 3-week-old states that the infant was recasted this morning for clubfoot and has been crying for the past hour. Which of the following interventions should the nurse suggest the parent do first? 1. Give pain medication. 2. Reposition the infant in the crib. 3. Check the neurocirculatory status of the foot. 4. Use a cool blow-dryer to blow into the cast to control itching

2. "An infection from a scratched mosquito bite carried the infection through the bloodstream to the bone." Infection through the bloodstream is the most likely cause of osteomyelitis in a child.

The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. What is the nurse's best response? 1. "Direct inoculation of the bone from stepping barefoot on a sharp stick." 2. "An infection from a scratched mosquito bite carried the infection through the bloodstream to the bone." 3. "The blood supply to the bone was disrupted because of the child's diabetes." 4. "An infection of the upper respiratory tract."

1. "Take your child outside in the night air for 15 minutes." The night air will help decrease subglottic edema, easing the child's respiratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider.

The parent of a pediatric client calls the ER. The parent reports that the child has had a barky cough for the last 3 days and it always gets worse at night. The parent asks the nurse what to do. Which is the nurse's best response? 1. "Take your child outside in the night air for 15 minutes." 2. "Bring your child to the ER immediately." 3. "Give your child an over-the-counter cough suppressant." 4. "Give your child warm liquids to soothe the throat."

1, 3, 4, 5. 1. Children with CF have difficulty absorbing nutrients because of the blockage of the pancreatic duct. Pancreatic enzymes cannot reach the duodenum to aid in digestion of food. These children often require up to 150% of the caloric intake of their peers. The nutritional recommendation for CF patients is high-calorie and high-protein. 3. Exercise is effective in helping CF patients clear secretions. 4. Minimizing pulmonary complications is essential to a better outcome for CF patients. Compliance with CPT, nebulizer treatments, and medications are all components of minimizing pulmonary complications. 5. Medication compliance is a necessary part of maintaining pulmonary and gastrointestinal function.

What does the therapeutic management of CF patients include? Select all that apply. 1. Providing a high-protein, high-calorie diet. 2. Providing a high-fat, high-carbohydrate diet. 3. Encouraging exercise. 4. Minimizing pulmonary complication. 5. Encouraging medication compliance.

3. Prostaglandin E. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery.

Which medication should the nurse give to a patient who is diagnosed with transposition of the great vessels? 1. Ibuprofen. 2. Betamethasone. 3. Prostaglandin E. 4. Indocin.

1, 2, 3, 5 1. Pain in an extremity leads to resistance to movement. 2. Pain is frequently severe in osteomyelitis. 3. Fever is present in the acute phase of the illness. 5. Redness and swelling occur because of the infection.

Which of the following would the nurse assess in a child diagnosed with osteomyelitis? Select all that apply. 1. Unwillingness to move affected extremity. 2. Severe pain. 3. Fever. 4. Following a closed fracture of an extremity. 5. Redness and swelling at the site.

4. "I will mix the digoxin in some of his formula to make it taste better for him." If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate.

Which statement by the mother of an infant boy with CHF who is being sent home on digoxin indicates she needs further education on the care of her child? 1. "I will give him the medication at regular 12-hour intervals." 2. "If he vomits, I will not give him a make-up dose." 3. "If I miss a dose, I will not give an extra dose, but keep him on his same schedule." 4. "I will mix the digoxin in some of his formula to make it taste better for him."