Test 3

In addition to presenting symptoms, which laboratory finding indicates nephrosis? A. Hypoalbuminemia B. Low specific gravity C. Decreased hemoglobin level D. Decreased hematocrit

A. Hypoalbuminemia

3) When newborns have been on formula for 36-48 hours, they should have a: A. Screening for PKU B. Vitamin K injection C. Test for necrotizing enterocolitis D. Heel stick for blood glucose level

A. Screening for PKU

A nurse assists with admitting a child with a diagnosis of acute-stage Kawasaki disease. When obtaining the child's medical history, which clinical manifestation is likely to be reported?

Conjunctival hyperemia

When caring for the child with Kawasaki disease, the nurse should know which of the following? a. Aspirin is contraindicated. b. Principal area of involvement is the joints. c. Child's fever is usually responsive to antibiotics within 48 hours. d. Therapeutic management includes administration of gamma globulin and salicylates.

D

The primary goal to be included in the plan of care for a child who has cerebral palsy is to:

Maximize the child's assets and minimize the limitations.

A nurse is caring for a child who has cerebral palsy. Which of the following medications should the nurse expect to administer to treat painful muscle spasms? Select all that apply. A. Baclofen (Lioresal) B. Diazepam (Valium) C. Oxybutynin chloride (Ditropan) D. Methotrexate (Rheumatrex) E. Prednisone (Deltasone)

A. Baclofen (Lioresal) B. Diazepam (Valium)

A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin breakdown? Select all that apply. A. Alternating air pressure mattress B. Turn and reposition every 2 hours C. Abdominal and foot massages every 2 hours D. Sit in chair for 30 minutes each shift E. Range of motion every 4 hours

A Alternating air pressure mattress B Turn and reposition every 2 hours

A nurse is caring for a child recently diagnosed with cerebral palsy. The parents of the child ask the nurse about the disorder. The nurse bases the response to the parents on the understanding that cerebral palsy is:

A chronic disability characterized by a difficulty in controlling the muscles

A nurse is instructing the mother of a child with cystic fibrosis (CF) about the appropriate dietary measures. Which of the following meals best illustrates the most appropriate diet for a client with cystic fibrosis?

A piece of fried chicken and a loaded baked potato

1. Which conditions are caused by left-sided heart failure? (Select all that apply.) a. Hypertensive disease b. Crackles heard c. Enlarged liver and spleen d. Confusion e. Pulmonary hypertension f. Dependent edema g. S3/S4 gallop h. Cough worsens at night

A, B, D, G, H Left-sided failure occurs with decrease in contractility of the heart or an increase in afterload. Most of the signs will be noted in the respiratory system. Right-sided failure occurs with problems from the pulmonary vasculature on. Signs will be noted before the right atrium or ventricle. DIF: Cognitive Level: Knowledge REF: p. 768, Charts 37-1 and 37-2 OBJ: Learning Outcome 10 TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation) MSC: Integrated Process: Nursing Process (Assessment)

HF is due to : A. Congenital cardiac defect B. Abnormal mechanical contractions C. Endocarditis D. Volume overload

A. Congenital cardiac defect C. Endocarditis D. Volume overload

Why is treatment of Kawasaki Disease so imperative within the first 10 days? A. To prevent acquired heart disease B. To prevent further damage to the liver C. To prevent signs and symptoms from progressing D. To prevent the occurrence of Reyes syndrome

A. To prevent acquired heart disease

Nursing care of the child with Kawasaki disease is challenging because of: a. the child's irritability. b. predictable disease course. c. complex antibiotic therapy. d. the child's ongoing requests for food.

ANS: A Patient irritability is a hallmark of Kawasaki disease and the most challenging problem. A quiet environment is necessary to promote rest. The diagnosis is often difficult to make, and the course of the disease can be unpredictable. Intravenous gamma globulin and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to eat. Soft foods and fluids should be offered to prevent dehydration.

A nurse is caring for a toddler who has acute otitis media. Which of the following is a priority action for the nurse to take? A. Provide emotional support to the family B. Educate the family on the care of the child C. Prevent clinical complications D. Administer analgesics

D. Administer analgesics

You are assessing a 5-year-old who has been admitted with an acute respiratory infection. You review the chart and see the child has cystic fibrosis. What is the priority for assessment? a. Opening and maintain a patent airway b. Giving antibiotics to the child c. Checking levels of pancreatic enzymes d. Modifying the child's diet

a. Opening and maintain a patent airway

Which of the following should be the major consideration when selecting toys for a child who is mentally retarded? a. Safety b. Age appropriateness c. Ability to provide exercise d. Ability to teach useful skills

a. Safety Rationale: Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are mentally retarded.

You are the nurse caring for a 3 year old patient with Kawasaki Disease. What medications should you expect to find? a. methotrexate b. aspirin and intravenous immune globulin c. digoxin d. IV tetracycline and furosemide

b. aspirin and intravenous immune globulin

Prevention of Rheumatic Fever can best be accomplished by: a. Keeping children with a fever home from school b. Sending children with sore throats home from school c. Having sore throats cultured as soon as possible d. Treating all colds with antibiotics

c. Having sore throats cultured as soon as possible

The genetic testing of a child with Down syndrome showed that the disorder was caused by chromosomal translocation. The parents ask about further genetic testing. Based on the nurse's knowledge of genetics, the most appropriate recommendation is a.no further genetic testing of the family is indicated. b. the child should be retested to confirm the diagnosis of Down syndrome. c. the mother should be tested if she is over age 35. d. the parents can be tested, since it might be hereditary.

d. the parents can be tested, since it might be hereditary.

Spironolacctone (Aldactone) is prescribed for a client with chronic cirrhosis and ascites. The nurse should monitor the client for which of the following medication-related side effects? A. Tachycardia B. Hyperkalemia C. Constipation D. Jaundice

B. Hyperkalemia

The nurse is caring for a 4 year old with cerebral palsy. Which nursing intervention will help ready the child for rehabilitative services? A. Patching one of the eyes to strengthen the muscles B. Providing suckers and pinwheels to strengthen tongue movement C. Providing musical tapes to provide auditory training D. Encouraging paly with a video game to improve muscle coordination

B. Providing suckers and pinwheels to strengthen tongue movement

Which phase includes red eyes, high fever, strawberry tongue and rash on main trunk of the body? a. First Phase b. Second Phase c. Third Phase

a. First Phase

A 4 year old is brought into the emergency department by his mother. She reports that he has had an uncontrollable fever for five days. You, the nurse, notice that his lips are cracking, swelling of the hands and feet, erythema of the soles and palms, and a generalized rash. What do you expect the diagnosis from the doctor to be? a. Kawasaki Disease b. Meningitis c. Rheumatic Fever d. Shingles

a. Kawasaki Disease

The nurse teaches the mother of a young child with Duchenne's muscular dystrophy about the disease and it's management. Which of the following statements by the mother indicates successful teaching? a. My son will probably be unable to walk independently by the time he is 9 to 11 years old. b. Muscle relaxants are effective for some children; I hope they help my son. c. When my son is a little bit older, he can have surgery to improve his ability to walk. d. I need to help my son be as active as possible to prevent progression of the disease.

a. My son will probably be unable to walk independently by the time he is 9 to 11 years old.

Which of the following interventions is most appropriate for helping parents to cope with a child newly diagnosed with bronchopulmonary dysplasia? a. Teach cardiopulmonary resuscitation b. Refer them to support groups c. Help parents identify necessary lifestyle changes d. Evaluate and assess parents; stress and anxiety levels

a. Teach cardiopulmonary resuscitation

Why is diagnosing Kawasaki disease so difficult? (Select all that apply) a. There is no specific test to diagnose Kawasaki disease b. Diagnosis is primarily ruling out all other diseases that cause similar signs and symptoms c. Treatment needs to occur within a 10 day window

a. There is no specific test to diagnose Kawasaki disease b. Diagnosis is primarily ruling out all other diseases that cause similar signs and symptoms c. Treatment needs to occur within a 10 day window

Mark, a 9 year old with Down syndrome, is mainstreamed into a regular third grade for part of the school day. His mother asks the school nurse about programs, such as Cub Scouts, that he might join. The nurse's recommendation should be based on which of the following? a. Programs like Cub Scouts are inappropriate for children who are mentally retarded. b. Children with Down syndrome have the same need for socialization as other children. c. Children with Down syndrome socialize better with children who have similar disabilities. d. Parents of children with Down syndrome encourage programs, such as scouting, because they deny that their children have disabilities.

b. Children with Down syndrome have the same need for socialization as other children. Rationale: Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children, such as group outings, Cub Scouts, and Special Olympics.

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of which of the following? a. Microcephaly b. Down syndrome c. Cerebral palsy d. Fragile X syndrome

b. Down syndrome Rationale: These are characteristics associated with Down syndrome.

The nurse is planning a diet for an eight-year old with cystic fibrosis (CF). which of the following dietary requirements should be considered? a. High protein, high fat and high calories. b. High protein, low fat and high calories. c. Low protein, low fat and low carbohydrates. d. High protein, high fat and low carbohydrates.

b. High protein, low fat and high calories.

The most important measure to include in the nursing management for a child with cystic fibrosis would be to? a. Promote optimal nutrition with a high-protein, low-fat diet b. Administer only water-soluble vitamins c. Administer pancreatic enzymes before each meal d. Encourage lots of fluids, especially fruit juices

c. Administer pancreatic enzymes before each meal

The child with Down syndrome should be evaluated for which of the following before participating in some sports? a. Hyperflexibility b. Cutis marmorata c. Atlantoaxial instability d. Speckling of iris (Brushfield spots)

c. Atlantoaxial instability Rationale: Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done.

When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is which of the following? a. Hypospadias b. Pyloric stenosis c. Congenital heart disease d. Congenital hip dysplasia

c. Congenital heart disease Rationale: Congenital heart malformations, primarily septal defects, are the most common congenital anomaly in Down syndrome.

Which of the following orgnaisms is responsible for the development of Rheumatic Fever? a. Streptococeal pneumonia b. Haemophilus Influenza c. Group A B-Hemolytic Streptococcus d. Staphylococcus aureus

c. Group A B-Hemolytic Streptococcus

The nurse is discussing sexuality with the parents of an adolescent girl with moderate cognitive impairment. Which of the following should the nurse consider when dealing with this issue? a. Sterilization is recommended for any adolescent with cognitive impairment. b. Sexual drive and interest are limited in individuals with cognitive impairment. c. Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct. d. Sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused.

c. Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct. Rationale: Adolescents with moderate cognitive impairment may be easily persuaded and lack judgment. A well-defined, concrete code of conduct with specific instructions for handling certain situations should be laid out for the adolescent.

A nurse is caring for a child who has Muscular Dystrophy. For which of the following findings should the nurse asses? (select all that apply) a. Purposeless, involuntary, abnormal movements b. Spinal defect and saclike protrusion c. Muscular weakness in lower extremities d. Unsteady, wide-based gait or waddling gait e. Upward slant to the eyes

c. Muscular weakness in lower extremities d. Unsteady, wide-based gait or waddling gait

What is one of the major physical characteristics of the child with Down syndrome? a. Excessive height b. Spots on the palms c. Inflexibility of the joints d. Hypotonic musculature

d. Hypotonic musculature Rationale: Hypotonic musculature is one of the major characteristics.

An 8-year-old has been diagnosed with moderate cerebral palsy (CP). The child recently began participation in a regular classroom for part of the day. The child's mother asks the school nurse about joining the after-school Scout troop. The nurse's response should be based on knowledge that a. most activities such as Scouts cannot be adapted for children with CP. b. after-school activities usually result in extreme fatigue for children with CP. c. trying to participate in activities such as Scouts leads to lowered self-esteem in children with CP. d. after-school activities often provide children with CP with opportunities for socialization and recreation.

d. after-school activities often provide children with CP with opportunities for socialization and recreation.

The major goal of therapy for children with cerebral palsy (CP) is a. reversing degenerative processes that have occurred. b. curing the underlying defect causing the disorder. c. preventing spread to individuals in close contact with the children. d. recognizing the disorder early and promoting optimal development.

d. recognizing the disorder early and promoting optimal development.

A 2-week-old infant with Down syndrome is being seen in the clinic. The mother tells the nurse that the infant is difficult to hold. "The baby is like a rag doll and doesn't cuddle up to me like my other babies did." The nurse interprets the infant's behavior as a a. sign of maternal deprivation. b. sign of detachment and rejection. c. sign of autism associated with Down syndrome. d. result of the physical characteristics of Down syndrome.

d. result of the physical characteristics of Down syndrome.

Which laboratory results does the nurse expect in the client with heart failure? (Select all that apply.) a. Hemoglobin, 14.2 g/dL; hematocrit (Hct), 32.8% b. Serum sodium, 130 mEq/L c. Serum potassium, 4.0 mEq/L d. Serum creatinine, 1.0 mg/dL e. Proteinuria f. Microalbuminuria

A, B, E, F The hematocrit is low (should be 42.6%), indicating a dilutional ratio of RBCs to fluid. The serum sodium is low because of hemodilution. Microalbuminuria and proteinuria are present, indicating a decrease in renal filtration. This is an early warning sign of decreased compliance of the heart. DIF: Cognitive Level: Application REF: N/A for Application and above OBJ: Learning Outcome 14 TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential) MSC: Integrated Process: Nursing Process (Evaluation)

What can a nurse do for a child with HF: A. Provide skin care B. Position the HOB to 90 degrees C. Keep a cool environment D. Document the urine every 3 hours

A. Provide skin care

Which of the following symptoms should an infant exhibit with HF: A. tachypnea B.decreased appeitite C.nocturia D.Back pain

A. tachypnea B.decreased appeitite

SELECT ALL THAT APPLY. The nurse is caring for a child with Kawasaki disease in the acute phase. Which of the following clinical manifestations would the nurse expect to observe? a. Osler nodes b. Cervical lymphadenopathy c. Strawberry tongue d. Chorea e. Erythematous palms f. Polyarthritis

B, C, E Clinical manifestations of Kawasaki disease in the acute phase include cervical lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic fever.

A nurse is caring for a toddler who has rhinitis, cough, and diarrhea for 2 days. Upon assessment it is noted that the tympanic membrane has an orange discoloration and decreased movement. Which of the following is an appropriate statement for the nurse to make? A. "your child has an ear infection that requires antibiotics" B. "your child could experience transient hearing loss" C. "your child will need to be on a decongestant until this clears up" D. "your child will need to have a myringotomy"

B. "your child could experience transient hearing loss"

2) An infant's PKU test is positive. The nurse's priority is to: A. Provide PKU education to the family members B. Change the infant's formula to Lofenlac C. Obtain an order for packed red cells D. Monitor vital signs every 30 minutes

B. Change the infant's formula to Lofenlac

A client with advanced cirrhosis has been diagnosed with hepatic encephalopathy. The nurse expects to assess for: A. Malaise B. Hand tremors C. Weight loss D. Stomatitis

B. Hand tremors

A 16 month old child diagnosed with Kawasaki Disease (KD) is very irritable,refuses to eat, and exhibits peeling skin on the hands and feet. Which of the following would the nurse interpret as the priority? a) applying lotions to the hands and feet b) offering foods the toddler likes c) placing the toddler in a quiet environment d) encouraging the parents to get some rest

C One of the characteristics of children with KD is irritability. They are often inconsolable.Placing the child in a quiet environment may help quiet the child and reduce the workload of the heart. The child's irritability takes priority over peeling of the skin.

When a child with nephrotic syndrome is confined to bed, what is an appropriate nursing intervention? A. Restrain the child as necessary. B. Discourage parents from holding the child. C. Adjust activities to child's tolerance level. D. Perform passive range-of-motion exercises daily.

C. Adjust activities to child's tolerance level.

A nurse is caring for a 2 year old child who has had 3 ear infections in the past 5 months. The nurse should know that the child is at risk for developing which of the following as a long-term complication? A. Balance difficulties B. Prolonged hearing loss C. Speech delays D. Mastoiditis

C. Speech delays

When assessing the development of a 15 month old child with cerebral palsy, which of the following milestones would the nurse expect a toddler of this age to have achieved? A. Walking up steps B. Using a spoon C. Coping a circle D. Putting a block in a cup

D. Putting a block in a cup

A new mother has some questions about (PKU). Which of the following statements made by a nurse is not correct regarding PKU? A. A Guthrie test can check the necessary lab values. B. The urine has a high concentration of phenylpyruvic acid C. Mental deficits are often present with PKU. D. The effects of PKU are reversible.

D. The effects of PKU are reversible.

Appropriate interventions to facilitate socialization of the cognitively impaired child include which of the following? a. Provide age-appropriate toys and play activities. b. Provide peer experiences, such as scouting, when older. c. Avoid exposure to strangers who may not understand cognitive development. d. Emphasize mastery of physical skills because they are delayed more often than verbal skills.

b. Provide peer experiences, such as scouting, when older. Rationale: The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to those of other children such as group outings, Boy and Girl Scouts, and Special Olympics.

A 3-year-old has cerebral palsy (CP) and is hospitalized for orthopedic surgery. The child's mother states the child has difficulty swallowing and cannot hold a utensil to self-feed. The child is slightly underweight for height. What is the most appropriate nursing action related to feeding? a. Bottle-feed or tube-feed the child with a specialized formula until sufficient weight is gained. b. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing. c. Place the child in a well-supported, semireclining position to make use of gravity flow. d. Place the child in a sitting position with the neck hyperextended to make use of gravity flow.

b. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing.

A child is admitted to the hospital with suspected Rheumatic Fever. Which of the following does NOT confirm the diagnosis? a. Reddened rash visible over trunk and extremities b. History of sore throat that is self-limiting in the past c. A negative antistreptolysin O titer d. An unexplained fever

c. A negative antistreptolysin O titer

Fragile X syndrome is which of the following? a. Chromosomal defect affecting only females b. Chromosomal defect that follows the pattern of X-linked recessive disorders c. Second most common genetic cause of mental retardation d. Most common cause of noninherited mental retardation

c. Second most common genetic cause of mental retardation Rationale: Fragile X syndrome is the second most common cause of mental retardation after Down syndrome.

The nursing care plan for a toddler diagnosed with Kawasaki Disease should be based on the high risk for development of which problem? a. hypertension b. seizures c. coronary artery aneurysms d. stroke

c. coronary artery aneurysms

Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include which of the following? a. Delay feeding solid foods until the tongue thrust has stopped. b. Modify diet as necessary to minimize the diarrhea that often occurs. c. Provide calories appropriate to child's age. d. Use a cool-mist vaporizer to keep mucous membranes moist.

d. Use a cool-mist vaporizer to keep mucous membranes moist. Rationale: The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections. A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions.

Cerebral palsy (CP) may result from a variety of causes. It is now known that the most common cause of CP is a. birth asphyxia b. neonatal diseases c. cerebral trauma d. prenatal brain abnormalities

d. prenatal brain abnormalities