final peds exam practice questions

ALLOPURINOL USE

used to prevent tumor lysis syndrome

APPENDECTOMY An adolescent client scheduled for an emergency appendectomy is to be transferred directly from the emergency department to the operating room. Which statement by the client should the nurse interpret as most significant? A. "All of a sudden, it does not hurt at all." B. "The pain is centered around my waist." C. "I feel like I am going to throw up." D. "It hurts when you press on my stomach."

A. "All of a sudden, it does not hurt at all." Sudden relief of pain in a client with appendicitis may indicate that the appendix has been ruptured. Rupture relieves the pressure within the appendix but spreads the infection to the peritoneal cavity. Periumbilical pain, vomiting, and abdominal tenderness on palpation are all common findings associated with appendicitis.

SUBMERSION The nurse is caring for a lethargic 4 year old who is a victim of a near drowning accident. The nurse should first: A. administer oxygen B. institute rewarming C. prepare for intubation D. start an IV infusion

A. administer oxygen Near-drowning victims typically suffer hypoxia and mixed acidosis. The priority is to restore oxygenation and prevent further hypoxia. Here, the client has blunted sensorium but is not unconscious; therefore, delivery of supplemental oxygen with a mask is appropriate. Warming protocols and fluid resuscitation will most likely be needed to help correct acidosis, but these interventions are secondary to oxygen administration. Intubation is required if the child is comatose, shows signs of airway compromise, or does not respond adequately to more conservative therapies.

DEHYDRATION What signs or symptoms suggest that an infant with diarrhea is dehydrated? Select all that apply. A. tacky mucous membranes B. sucken anterior fontanelle C. salty saliva D. restlessness E. increased urine output

A. tacky mucous membranes B. sucken anterior fontanelle D. restlessness Diarrhea in infants is a serious condition as it can proceed rapidly to dehydration. Clinical signs of dehydration are irritability and restlessness, weakness, stupor, loss of body weight, poor skin turgor, and sunken fontanelles. The urine output is decreased in dehydrated infants. The saliva decreases with dehydration and is not salty.

LEUKEMIA A 10 year old with leukemia is taking immunosuppressive drugs. To maintain health, the nurse should instruct the child and parents to: A) continue with immunizations B) not receive any live attenuated vaccines C) receive vitamin and mineral supplements D) stay away from peers

B) not receive any live attenuated vaccines Children who are immunosuppressed should not receive any live attenuated vaccines. Children who are immunosuppressed and are given live attenuated vaccines, and oral polio vaccine can develop severe forms of the disease for which they are being immunized, which can result in death.

NEPHROTIC SYNDROME A child with nephrosis is taking prednisone. The nurse should teach the caregivers to report which adverse effects? Select all that apply. A. increased urinary output B. hematemesis C. respiratory infection D. bleeding gums E. vision problems

B. hematemesis C. respiratory infection E. vision problems Adverse effects of steroid therapy include edema of the face and trunk, increased susceptibility to infection, gastric and intestinal mucosal bleeding, sodium and water retention, and hypertension. Steroid therapy can also cause vision problems. Urinary output is decreased due to the retention of sodium. Bleed gums do not result from steroids.

IJA - NAPROXEN What information should the nurse include when developing the teaching plan for the parents of a child with juvenile idiopathic arthritis who is being treated with naproxen? A. Anti-inflammatory effect will occur in approximately 8 weeks. B. Within 24 hours, the child will have anti-inflammatory relief. C. The nurse should be called before giving the child any over-the-counter medications. D. If a dose is forgotten or missed, that dose is not made up.

C. The nurse should be called before giving the child any over-the-counter medications. The first group of drugs typically prescribed is the NSAID drugs, including naproxen. Once therapy is started, it takes hours or days for relief of pain to occur. However, it takes 3 to 4 weeks for the anti-inflammatory effects to occur, including reduction in swelling and less pain with movement. Naproxen is included in only a few over-the-counter medications, but aspirin is in several. The family should check with the nurse before giving any over-the-counter medications. Toxicity or GI bleeding may occur when NSAIDs are combined. The missed dose will need to be made up to maintain the serum level and to maintain therapeutic effectiveness of the drug.

POST OP CLEFT LIP/ PALATE On the second postoperative day after repair of a cleft palate, what should the nurse use to feed a toddler? A. cup B. straw C. rubbed-tipped syringe D. large - holed nipple

A. cup A cup is the preferred drinking or eating utensil after repair of a cleft palate. At the age when repair is done, the child is ordinarily able to drink from a cup. Use of a cup avoids having to place a utensil in the mouth, which would increase the potential for injury at the suture lines.

SUBMERSION The nurse is admitting a toddler with the diagnosis of near-drowning in a neighbor's heated swimming pool to the emergency department. The nurse should assess the child for: A. hypothermia B. hypoxia C. fluid aspiration D. cutaneous capillary paralysis

B. hypoxia Hypoxia is the primary problem because it results in brain cell damage. Irreversible brain damage occurs within 4 to 6 minutes of submersion. Hypothermia occurs rapidly in children and infants because of their large body surface area. Hypothermia is more of a problem when the child is in cold water. Although fluid aspiration occurs in most drownings and results in atelectasis and pulmonary edema, further aggravating hypoxia, hypoxia is the primary problem. Cutaneous capillary paralysis is not a problem.

APPENDECTOMY When developing the plan of care for a school-age child with a suspected diagnosis of appendicitis who has severe abdominal pain, which measures should the nurse expect to include in the child's plan of care? A. application of a heating pad B. insertion of a rectal tube C. application of an ice bag D. administration of an IV narcotic

C. application of an ice bag. Application of an ice bag may help to relieve pain by decreasing circulation to the area. A heating pad is contraindicated because heat may increase circulation to the appendix, possibly leading to rupture. Rectal tubes are contraindicated because they stimulate bowel motility and can exacerbate abdominal pain. Also, they would be ineffective because accumulation of gas in the lower bowel is not likely to be the cause of the child's discomfort. Because narcotics can mask the child's symptoms, such as pain and discomfort, and they also decrease bowel motility, they are not given until after a definitive diagnosis has been made.

LEUKEMIA Which statement should the nurse use to describe to the parents why their child with leukemia is at risk for infections? A) "Abnormal platelets lead to bruising and bleeding." B) "There are insufficient number of circulating WBCs." C) "The number of RBCs is inadequate for carrying oxygen." D) "Immature WBCs are incapable of handling an infectious process."

D) "Immature WBCs are incapable of handling an infectious process." In leukemia, there is an increase in the number of immature WBCs, but they are unable to fight infection. Lack of mature WBCs puts a child with leukemia at risk for infection. The major morbidity and mortality factor associated with leukemia is infection resulting from the presence of granulocytopenia. Decreased RBCs are not directly caused by infection. While platelets play a role in the body's response to infection, bleeding does not directly cause infections.

CRYTOPCHIDISM A father brings his 4 week old son to the clinic for a checkup, stating that he believes his son's testicles are missing. Which explanation would be most appropriate? A. "Although the testes should have descended by now, it is not a cause of worry." B. "It does appear that one of the testes has not descended. I will palpate his scrotum to check whether both testes are present." C. "The testes are present in the scrotal sac at birth, but surgery can remedy the situation." D. "Although the testes normally descend by age 1, I can understand your concerns."

D. "Although the testes normally descend by age 1, I can understand your concerns." Normally, the testes descend by age 1, failure to do so may indicate a problem with patency or a hormonal imbalance. By age 4 weeks, descent may not have occurred. However, telling the father that lack of descent is not a cause for worry is inappropriate and uncaring. Additionally, a statement such as this may be false reassurance. By acknowledging the fathers concern, the nurse indicates acceptance of his feelings. If the testes have not descended, then they will not be palpable in the scrotal sac. Surgery is not discussed until after a full assessment is completed.

AGN A 15 year old has been diagnosed with acute glomerulonephritis and has been in the hospital for 1 day. Which finding requires immediate action? A. large amount of generalized edema B. urine specific gravity of 1.030 C. large amount of albumin in the urine D. 24 hour output of 1,500 ml

B. urine specific gravity of 1.030 An adolescent with acute glomerulonephritis has a high urine specific gravity related to oliguria caused by inflammation of the glomeruli. The client will have periorbital edema, but not the generalized edema that occurs in nephrotic syndrome. In glomerulonephritis, there is some albumin in the urine, but there are large amounts of red blood cells, giving the urine a brown color. The urine in glomerulonephritis is scanty, averaging about 400 mL in 24 hours, which leads to fluid volume excess and hypertension.

FEBRILE SEIZURE Which statement obtained from the nursing history of a toddler should alert the nurse to suspect that the child has had a febrile seizure? A. The child has had a low-grade fever for several weeks. B. The family history is negative for convulsions. C. The seizure resulted in respiratory arrest. D. The seizure occurred when the child had a respiratory infection.

D. The seizure occurred when the child had a respiratory infection. Most febrile seizures occur in the presence of an upper respiratory infection, otitis media, or tonsillitis. Febrile seizures typically occur during a temperature rise rather than prolonged fever. There appears to be increased susceptibility to febrile seizures within families. Infrequently, febrile seizures may lead to respiratory arrest.

NEPHROTIC SYNDROME Which statement by the parent of a toddler diagnosed with nephrotic syndrome indicates that the parent has understood the nurse's teaching about this disease? A. "my child really likes chips and bologna. I guess we will have to find something else." B. "We will have to encourage lots of fluids. Did you say about 4 L every day?" C. "We worry about the surgery. Do you think we should do direct donation of blood?" D."We understand the need for antibiotics. I just wish the antibiotics could be given by mouth."

A. "my child really likes chips and bologna. I guess we will have to find something else." Children with nephrotic syndrome usually require sodium restriction. Because potato chips and bologna are high in sodium, the mother's statement about finding something else reflects understanding of this need. Although fluid intake is not restricted in children with nephrotic syndrome, 4 L is an excessive amount for a toddler. The typical fluid requirement for a toddler is 115 ml/kg. Surgical intervention and antibiotic therapy are not parts of the treatment plan for nephrotic syndrome.

GASTROENTERITIS A child undergoes rehydration therapy after having diarrhea and dehydration. A nurse is teaching the child's parents about dietary management after rehydration. The nurse understands that the teaching plan has been successful when the parents tell the nurse that they will follow which type of diet? A. regular B. clear liquid C. full liquid D. soft

A. regular Dietary management following rehydration for diarrhea and mild dehydration would include offering the child a regular diet. Following rehydration, there is no need for the child to be on a special diet, such as a clear liquid, full liquid, or soft diet.

APPENDECTOMY What should be the priority assessment for an adolescent on return to the nursing unit after an appendectomy? A. the dressings on the surgical sites B. IV fluid infusion site C. NG tube function D. amount of pain

A. the dressings on the surgical site The priority assessment after an appendectomy would be the dressing over the surgical site to determine whether there is any drainage or bleeding. If the procedure was done laparoscopically, there may be more than one incision. Any surgical dressings should be clean, dry, and intact. Once the dressing has been assessed, the nurse should assess the IV infusion site, assess the NG tube to be sure it is functioning, and finally determine the degree of pain the client is experiencing.

IRON DEFICIENCY ANEMIA Which foods should the nurse encourage a parent to offer to a child with iron deficiency anemia? A) rice cereal, whole milk, yellow vegetables B) potatoes, peas, and chicken C) macaroni, cheese, and ham D) pudding, green vegetables, and rice

B) potatoes, peas, and chicken Potatoes, peas, chicken, green vegetables, and fortified cereal contain significant amounts of iron and therefore would be recommended. Milk and yellow vegetables are not good iron sources. Rice by itself also is not a good source of iron. Macaroni, cheese, and ham are not high in iron. While pudding and green vegetables contain some iron, the better diet has protein and iron from the chicken and potato.

CONCUSSION The parents of a child in a coma with a serious head injury ask the nurse if the child is going to be ok. Which response by the nurse would be most appropriate? A) "children usually do not do very well after head injuries like this." B) "children usually recover rapidly from head injuries." C) "it is hard to tell this early, but we will keep you informed of the progress." D) "that is something you will have to talk to the doctor about."

C) "it is hard to tell this early, but we will keep you informed of the progress." As a rule, children demonstrate more rapid and complete recovery from coma than do adults. However, it is extremely difficult to predict a specific outcome. Reassuring the parents that they will be kept informed helps open lines of communication and establish trust. Telling the parents that children do not do well would be extremely negative, destroying any hope that the parents might have. Telling the parents that children recover rapidly may give the parents false hopes. Telling the parents to talk to the doctor ignores the parent's concerns and interferes with trust building.

LEUKEMIA Which medication prescription to help relieve pain in a child with leukemia should the nurse question? A) hydromorphone B) acetaminophen with codeine C) ibuprofen D) acetaminophen with hydrocodone

C) ibuprofen Ibuprofen prolongs bleeding tiem and is contraindicated in clients with leukemia. Nonnarcotic drugs other than as ibuprofen or aspirin, such as acetaminophen, may be prescribed to control pain and may be used in combination with codeine or hydrocodone if pain is more severe. Hydromorphone may also be used for severe pain.

DEHYDRATION Which finding would most likely alert to the nurse to the possibility that a preschooler is experiencing moderate dehydration? A. deep, rapid respirations B. diaphoresis C. absence of tear formation D. decreased urine specific gravity

C. absence of tear formation The absence of tears is typically found when moderate dehydration is observed as the body attempts to conserve fluids. Other typical findings associated with moderate dehydration include a dry mouth, sunken eyes, poor skin turgor, and an increased pulse rate. Deep, rapid respirations are associated with severe dehydration. Decreased perspiration, not diaphoresis, would be seen with moderate dehydration. The specific gravity of urine increases with decreased output in the presence of dehydration.

LEUKEMIA After teaching the parents of a child newly diagnosed with leukemia about the disease, which description if given by the parents best indicates understanding the nature of leukemia? A) "The disease is an infection resulting in increased WBC production." B) "The disease is a type of cancer characterized by an increase in immature WBCs." C) "The disease is an inflammation associated with enlargement of the lymph nodes." D) "The disease is an allergic disorder involving increased circulating antibodies in the blood."

B) "The disease is a type of cancer characterized by an increase in immature WBCs." Leukemia is a neoplastic, or cancerous, disorder of blood-forming tissues that is characterized by a proliferation of immature WBCs. Leukemia is not an infection, inflammation, or allergic disorder.

AGN a 10 year old with glomerulonephritis reports a headache and blurred vision. the nurse should immediately: A. put the client to bed B. obtain client's BP C. contact the HCP D. administer acetaminophen

B. obtain client's BP Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the HCP before confirming the cause of the symptoms would not facilitate his treatment. Putting the client to bed may help treat an elevated blood pressure, but first, the nurse must establish that high blood pressure is the cause of the symptoms. Administering acetaminophen for high BP is not recommended.

MENINGITIS Which sign should lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation? A) hemorrhagic skin rash B) edema C) cyanosis D) dyspnea on exertion

A) hemorrhagic skin rash DIC is characterized by skin petechiae and a purpuric skin rash caused by spontaneous bleeding into the tissues. An abnormal coagulation phenomenon causes the condition. Heparin therapy is often used to interrupt the clotting process. Edema would suggest a fluid volume excess. Cyanosis would indicate decreased tissue oxygenation. Dyspnea on exertion would suggest respiratory problems, such as pulmonary edema.

LEUKEMIA After doing well for a period of time, a child with leukemia develops an overwhelming infection. The child's death is imminent. Which statement offers the nurse the best guide in making plans to assist the parents in dealing with their child's imminent death? A) Knowing the prognosis is poor helps prepare relatives for the death of children. B) Relatives are especially grieved when a child does well at first but then declines rapidly. C) Trust in healthcare personnel is most often destroyed by a death that is considered untimely. D) It is more difficult for relatives to accept the death of an older child than that of a toddler.

B) Relatives are especially grieved when a child does well at first but then declines rapidly.It has been found that parents are more grieved when optimism is followed by a defeat. The nurse should recognize this when planning various ways to help the parents of a dying child. It is not necessarily true that knowing about a poor prognosis for years helps prepare parents for a child's death. Death is still a shock when it occurs. Trust in healthcare personnel is not necessarily destroyed when a death is untimely if the family views the personnel as having done everything they could. It is not more difficult for parents to accept the death or an older child than that of a younger child.

CONCUSSION When developing the plan of care for a child who is unconscious after a serious head injury, in which position should the nurse expect to place the child? A) prone with hips and knees slightly elevated B) lying on the side, with the HOB elevated C) lying on the back, in trendelenburg position D) in the semi-fowler's position, with arms at the side

B) lying on the side, with the HOB elevated The unconscious child is positioned to prevent aspiration of saliva and minimize ICP. The HOB should be elevated, and the child should be in either the semiprone or the side-lying position. Lying prone with hips and knees slightly elevated increases ICP, as does lying on the back in the Trendelenburg position. The semi-Fowler's position with arms at side is not the best choice.

SICKLE CELL ANEMIA A transfusion of packed RBCs has been prescribed for a 1 year old with sickle cell anemia. The infant has a 25 gauge IV infusing dextrose with sodium and potassium. Using SBAR method of communication, the nurse contacts the HCP and recommends: A) starting a second IV with a 22 gauge catheter to infuse NS with the blood. B) using the existing IV, but changing the fluids to NS for the transfusion. C) replacing the IV with a 22 gauge catheter to infuse the prescribed fluids. D) starting a second IV with a 25 gauge catheter to infuse NS with the transfusion

B) using the existing IV, but changing the fluids to NS for the transfusion. The best evidence indicates that a catheter as small as a 27 gauge may safely be used for transfusion in children, but blood must be infused with NS, not dextrose. A 1 year old should be able to maintain blood glucose for the 2 hour duration of infusion without the need for a second IV.

SICKLE CELL DISEASE The nurse explains to the parents of a 1 year old child admitted to the hospital with sickle cell crisis that the local tissue damage the child has on admission is caused by which factor? A) autoimmune reaction complicated by hypoxia B) lack of oxygen in the RBCs C) obstruction to circulation D) elevated serum bilirubin concentration

C) obstruction to circulation Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is abnormality in structure of the RBCs. Sickle cell is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.

MENINGITIS Nursing care management of the child with bacterial meningitis includes which interventions? Select all that apply A) administration of IV antibiotics B) IV fluids at 1.5 times maintenance C) decreasing environmental stimuli D) neuro checks every 4 hours E) administration of IV anticonvulsants

A) administration of IV antibiotics C) decreasing environmental stimuli D) neuro checks every 4 hours Antibiotics are indicated for the treatment of bacterial meningitis. Clients with bacterial meningitis often have increased ICP. It is necessary to maintain adequate hydration. However, infusing fluids at 1.5 times maintenance can increase ICP; further risking neuro damage due to cerebral edema. Most children with meningitis are sensitive to sound, light, and stimulation. Decreasing environmental stimuli and keeping the room dim and quiet are essential. Frequent neuro checks are necessary to monitor any changes in the child's LOC. Anticonvulsants are not indicated unless the child experiences seizures as a result of meningitis.

MENINGITIS The nurse is monitoring an infant with meningitis for signs of increased ICP. The nurse should assess the infant for which signs or symptoms? Select all that apply A) irritability B) headache C) mood swings D) bulging fontanelle E) emesis

A) irritability D) bulging fontanelle E) emesis Irritability, bulging fontanelle, and emesis are all signs of increased ICP in an infant. A headache may be present in an infant; however, the infant has no way of communicating this to the parent. A headache is an indication of increased ICP in a verbal child. An infant cannot exhibit mood swings; this is indicative of increased ICP in a child or adolescent.

POST OP CLEFT LIP / PALATE After teaching the parent of an infant who has had a surgical repair for a cleft lip about the use of elbow restraints at home, the nurse determines that the teaching has been successful when the parents make which statements? A. "We will keep the restraints on continuously except when checking the skin under them for redness." B. "We will keep the restraints on during the day while he is awake, but take them off at night when he goes to bed." C. "After we get home, we will not have to use the restraints because our child does not suck on his hands or fingers." D. "We will be sure to keep the restraints on all the time until we come see the care provider for a follow up visit."

A. "We will keep the restraints on continuously except when checking the skin under them for redness." To keep the infant from disturbing the suture line by placing fingers or other objects in the mouth, either intentionally or accidentally, the restraints should be in place at all times. They should be removed for a short period, however, so that the underlying skin can be checked for any redness or breakdown. While the restraints are removed, the parents should be instructed to manually restrain the hands and arms.

IRON SUPPLEMENTS Which action indicates that the parents of a 12-month-old with iron deficiency anemia understand how to administer iron supplements? Select all that apply. A) They administer iron supplements in combination with fruit juice. B) They administer iron supplements with meals. C) They report dark stools. D) They brush the child's teeth after administering the iron supplements. E) They decrease dietary intake of foods fortified with iron.

A) They administer iron supplements in combination with fruit juice. D) They brush the child's teeth after administering the iron supplements. Parent teaching concerning a child with iron deficiency anemia should include directions about giving iron combined with fruit juice, in divided doses, between meals, and with a dropper for a 12 month old or through a straw for older toddlers. Iron stains teeth, so brushing teeth after administering liquid iron through a dropped or straw are necessary to prevent staining the teeth. Iron should not be given with milk, antacids, or tea and should be administered on an empty stomach. Iron will cause the stools to become black or green, which is normal and does not need to be reported. However, light-colored stools indicate the iron is not being absorbed and should be reported.

CONCUSSION A 10 year old with a severe head injury is unconscious and has coarse breath sounds, a temperature of 39 degrees C (102.2 degrees F), a heart rate of 70 BPM, a blood pressure of 130/60, an an ICP of 36. Which action should the nurse perform first? A) administer prescribed IV mannitol. B) suction the child C) encourage the parent to talk to the child. D) administer prescribed rectal acetaminophen.

A) administer prescribed IV mannitol. an ICP greater than 15 is abnormal. this child's vital signs indicate increased ICP. Mannitol is an osmotic diuretic and will decrease the child's ICP. Encouraging the parent to talk to the child may be comforting, but will not decrease the ICP. The priority for this child is decreasing the ICP to avoid further brain injury. The fever is likely due to the head injury and will not decrease with acetaminophen. A cooling blanket is the most effective means of reducing a fever in a client with a head injury.

NEPHROTIC SYNDROME The charge nurse is reviewing the laboratory results of a child admitted with nephrotic syndrome with a nurse new to the pediatric unit. The nurse is aware that teaching is required when the new nurse states that an expected finding in nephrotic syndrome is: A. hyperalbuminemia B. elevated triglycerides C. elevated cholesterol D. proteinuria

A. hyperalbuminemia The child with nephrotic syndrome would present with hypoalbuminemia due to a decrease of albumin in the bloodstream and to the increase in the glomerular permeability. Nephrotic syndrome is characterized by edema, massive proteinuria, hypoalbuminemia, hypoproteinemia, hyperlipidemia, and altered immunity.

MENINGITIS A 3 month old infant with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the highest priority? A.) instituting droplet precautions B.) administering acetaminophen C.) obtaining history information from the parents D.) orienting the parents to the pediatric unit

A.) instituting droplet precautions Instituting droplet precautions is the priority for a newly admitted infant with meningococcal meningitis. Acetaminophen may be occurred, but administering it does not take priority over instituting droplet precautions. Obtaining history information and orienting the parents to the unit do not take priority.

SICKLE CELL DISEASE The nurse is teaching the parents of a child with sickle cell disease. To instruct them on how to prevent sickle cell crisis, the nurse should include which instructions? A) Exercise in cool temperatures. B) Drink at least 2 quarts of water a day. C) Avoid contact sports. D) Take anti-inflammatory meds before exercising.

B) Drink at least two quarts of water a day. Increasing fluid intake and being well hydrated will help prevent cell stasis in the small vessels. Restricting fluids causes stasis of RBCs and promotes obstruction and increases the chances of sickling with hypoxia and pain to the part involved. Clients with sickle cell should avoid exercising in cool temperatures or swimming in cold water. While contact sports are not recommended because of bleeding risks, they do not cause sickle crisis. Taking an anti-inflammatory medication before exercising does not prevent sickle cell crisis.

LEUKEMIA Which problem is the highest risk for a chid with leukemia whose lab values are as follows: WBC 6,500mm (6.5x10_9), platelet count 40,000uL, and HCT 41.2%? A) activity intolerance B) bleeding C) impaired tissue perfusion D) infection

B) bleeding A normal platelet count is 150,000 to 400,000. A platelet count of 40,000 is low and puts the child at risk for bleeding, bruising, and injury. Hematocrit of 41.2% is normal, therefore the child will have adequate oxygenation and tissue perfusion. The WBC count of 6,500 is normal, therefore, the child has no increase in risk of infection.

LEUKEMIA A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which signs and symptoms require the most immediate nursing intervention? A) fatigue and anorexia B) fever and petechiae C) swollen lymph glads and lethargy D) enlarged liver and spleen

B) fever and petechiae Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal WBCs and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to RBC suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable, but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.

SICKLE CELL DISEASE A nurse is caring for an infant whose screening test reveals a potential diagnosis of sickle cell disease. Which of the following tests should be performed to distinguish if the infant has the trait or the disease? A) sickle solubility test B) hemoglobin electrophoresis C)complete blood count D)transcranial doppler

B) hemoglobin electrophoresis The hemoglobin electrophoresis test should be performed to distinguish if the infant has the trait or the disease. The sickle solubility test is a screening tool that detects the presence of abnormal hemoglobin, but does not distinguish between the trait and the disease. A CBC tests for anemia. It indicates the average size of the RBCs, and the amount of hgb in the RBCs. It will not distinguish between sickle cell disease and sickle cell trait. The transcranial doppler is performed to assess intracranial vascular flow and detect the risk for CVA.

MENINGITIS When interviewing the parents of a 2 year old child, a history of which illnesses should lead the nurse to suspect pneumococcal meningitis? A) bladder infection B) middle ear infection C) fractured clavicle D) septic arthritis

B) middle ear infection Organisms that cause bacterial meningitis, such pneumonocci or meningococci, are commonly spread in the body by vascular dissemination from a middle ear infection. The meningitis may also be a direct extension from the paranasal and mastoid sinuses. The causative organism is a pneummococcus. A chronically draining ear is also frequently found. Bladder infections commonly are caused by E.coli, unrelated to the development of pneummococcal meningitis. Pneumococcal meningitis is unrelated to a fractured clavicle or to septic arthritis, which is commonly caused by staph aureus, group A strep, or haemophilus influenzae.

SUBMERSION The parents of a child tell the nurse that they feel guilty because their child almost drowned. Which remark by the nurse would be most appropriate? A. "I can understand why you feel guilty, but these things happen." B. "Tell me a little bit more about your feelings of guilt." C. "You should not have taken your eyes off of your child." D. "You should focus on the fact that your child will be all right."

B. "Tell me a little bit more about your feelings of guilt." Guilt is a common parental response. The parents need to be allowed to express their feelings openly in a nonthreatening, nonjudgmental atmosphere. Telling the parents that these things happen does not allow them to verbalize their feelings. Telling the parents that they should not have taken their eyes of the child blames them, possibly further contributing to their guilt. Telling the parents that they should not feel guilty denies the parent's feelings of guilt and is not appropriate. Telling the parents that they are lucky the child will be okay is not removing the feelings of guilt.

APPENDECTOMY A 10 year old male is 24 hours postappendectomy. He is awake, alert, and oriented. He tells the nurse that he is experiencing pain. He has a prescription for morphine 1 to 2 mg PRN for pain. What is the priority nursing action in managing the child's pain? A. Change the child's position in bed. B. Obtain vital signs with a pain score. C. Administer 1 mg morphine as prescribed. D. Perform a head to toe assessment.

B. Obtain vital signs with a pain score. The child is in pain and needs intervention, but before the nurse can determine how to proceed, it is essential to know the client's pain score to determine the appropriate morphine dose. In addition, the nurse cannot evaluate the effectiveness of the pain medication if there is no pain score prior to administering the medication. Changing the child's position and administering pain medication may be helpful to relieve the child's pain, but the nurse must first know the severity of the pain before determining the appropriate intervention. The nurse must perform a head-to-toe assessment, but it is not the priority in managing the child's pain.

APPENDECTOMY The nurse prepares to teach an adolescent scheduled for an appendectomy about what to expect. The adolescent says, "I would rather look this up on the internet." The nurse should: A. explain that completing a hospital checklist is required by the hospital. B. help the client find information on the Internet C. provide the client with written information instead D. explain that information found on the Internet cannot be trusted.

B. help the client find information on the Internet Part of providing client-centered care is to honor the clients preferred method of learning. The nurse should help the adolescent find accurate information about the procedure. By assisting with the information search, the nurse can verify learning. Teaching straight from a checklist does not encourage customization. If the client has requested to use the internet, it is unlikely that written information will be read. While it is true that some information on the internet is not accurate, the nurse can take this opportunity to help the client learn how to determine if a source is reliable.

MENINGITIS During the acute stage of meningitis, a 3 year old child is restless and irritable. Which intervention would be most appropriate to the institute? A.) limiting conversation with the child B.) keeping extraneous noise to a minimum C.) allowing the child to play in the bathtub D.) performing treatments quickly

B.) keeping extraneous noise to a minimum A child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light. Therefore, extraneous noise should be minimized and bright lights avoided as much as possible. There is no need to limit conversations with the child. However, the nurse should speak in a calm, gentle, reassuring voice. The child needs gentle and calm bathing. Because of the acuteness of the infection, sponge baths would be more appropriate than tub baths. Although treatments need to be completed as quickly as possible to prevent overstressing the child, they should be performed carefully and at a pace that avoids sudden movements to prevent startling the child and subsequently increasing ICP.

AGN which question should the nurse ask first when obtaining a history from the mother of a 10 year old with a fever, malaise, and swelling around the eyes? A. "Has the child had a sore throat recently?" B. "Is the child playing with friends as usual?" C. "Does the child urinate as much as usual?" D. "Is the urine pale in color?"

C. "Does the child urinate as much as usual?" Most likely, the nurse suspects that the child is exhibiting signs and symptoms of glomerulonephritis, such as periorbital edema and fever. Other signs and symptoms include loss of appetite, dark-colored urine, pallor, headaches, and abdominal pain. To confirm this suspicion, the nurse would ask about the child's urinary elimination patterns. Typically, the child with glomerulonephritis experiences a decrease in urine output. Asking about any recent sore throat would provide additional information to confirm the suspicion of glomerulonephritis, because the most common type of is acute poststreptococcal glomerulonephritis, which follows a strep throat by 10 to 14 days. Frequently, the children have only mild cold symptoms and do not realize they have a strep infection. Asking whether the child plays with friends as usual is important and gives the nurse information about how the child feels in general. However, this is a general question that would be appropriate to ask later on in the history. Although asking the mother about the color of the child's urine is important, the nurse needs to determine whether there is any change in in the child's urinary output first.

DEHYDRATION A nurse is caring for a 10 month old, weighing 8 kg, who was admitted for dehydration. The infant has vomited five times in the last 3 hours and has had no wet diapers in the last 8 hours. The nurse informs the healthcare provider. Which prescription should the nurse question? A. Begin an IV line of D5W 0.45% normal saline at 40mL/h. B. NPO while vomiting persists. C. Begin an IV line, and then administer a fluid bolus of dextrose 25%. D. Weigh all diapers, strict Intake and output measurements.

C. Begin an IV line, and then administer a fluid bolus of dextrose 25% The infant is in need of a fluid bolus. A fluid bolus should consist of an isontonic fluid such as normal saline or lactated ringers. D25% is not an appropriate bolus for dehydrated children because it could cause a fluid shift that may result in cerebral edema and death; thus, the nurse should question the prescription.