Final test Peds
A nurse is providing teaching to the parent of a child who is to have an electroencephalogram (EEG). Which of the following should be included in the teaching? A. decaffeinated beverages should be offered in the morning of the procedure B. do not wash your child's hair the night before the procedure C. withhold all foods the morning of the procedure D. give your child an analgesic the night before the procedure
A. decaffeinated beverages should be offered in the morning of the procedure
A nurse is teaching a group of parents about the risk factors for seizures. Which of the following should be included in the teaching? (select all that apply) A. febrile episodes B. hypoglycemia C. sodium imbalances D. low serum lead levels E presence of diptheria
A. febrile episodes B. hypoglycemia C. sodium imbalances
A nurse is caring for a child who just experienced a generalized seizure. Which of the following is the priority action for the nurse to take? A. maintain a side lying position B. monitor vital signs C. reorient the child to the environment D. assess for injuries
A. maintain a side lying position
A nurse is caring for a client who has suspected meningitis and a decreased level of consciousness. Which of the following actions by the nurse are appropriate? A. place the client on NPO status B. Prepare the client for a liver biopsy C. position the client dorsal recumbent D. put the client in a protective environment
A. place the client on NPO status
A nurse is caring for an adolescent who has sustained a closed head injury. Which of the following are clinical manifestations of intracranial pressure? (select all that apply) A. report of head ache B. alteration in pupillary response C. increased motor response D. increased sleeping E. increased sensory response
A. report of head ache B. alteration in pupillary response D. increased sleeping
An otherwise-healthy adolescent has meningitis and is receiving I.V. and oral fluids. The nurse should monitor this client's fluid intake because fluid overload may cause: 1. cerebral edema. 2. dehydration. 3. heart failure. 4. hypovolemic shock.
1. cerebral edema. Because of the inflammation of the meninges, the client is vulnerable to developing cerebral edema and increased intracranial pressure. Fluid overload won't cause dehydration. It would be unusual for an adolescent to develop heart failure unless the overhydration was extreme. Hypovolemic shock would occur with an extreme loss of fluid or blood.
In a pediatric client, what is an early sign of acute renal failure (ARF)? 1. Hypertension 2. Decreased urine output 3. Anemia 4. Hematuria
2. Decreased urine output A decreased urine output (oliguria) is an early sign of ARF. Hypertension and anemia occur later in ARF. Hematuria is rare.
When assessing a child for impetigo, the nurse expects which assessment findings? 1. Small, brown, benign lesions 2. Honey-colored, crusted lesions 3. Linear, threadlike burrows 4. Circular lesions that clear centrally
2. Honey-colored, crusted lesions In impetigo, honey-colored, crusted lesions develop once the pustules rupture. Small, brown, benign lesions are common in children with warts. Linear, threadlike burrows are typical in a child with scabies. Circular lesions that clear centrally characterize tinea corporis.
A child is diagnosed with pituitary dwarfism. Which pituitary agent will the physician probably prescribe to treat this condition? 1. corticotropin zinc hydroxide (Cortrophin-Zinc) 2. somatrem (Protropin) 3. desmopressin acetate (DDAVP) 4. vasopressin (Pitressin)
2. somatrem (Protropin) Somatrem is used to treat linear growth failure stemming from hormonal deficiency. Corticotropin zinc hydroxide is used to treat adrenal insufficiency and a variety of other conditions; DDAVP and vasopressin are used to treat diabetes insipidus.
A child, age 5, is to receive potassium added to the I.V. fluid. Before initiating this therapy, the nurse first should: 1. assess the child's apical pulse rate. 2. measure the blood pressure. 3. monitor fluid intake and output. 4. assess respiratory rate and depth.
3. monitor fluid intake and output. Potassium shouldn't be added to the I.V. fluid until the child regains adequate kidney function, as indicated by balanced fluid intake and output and certain diagnostic test results. The other options aren't related to potassium administration.
For a child with a Wilms' tumor, which preoperative nursing intervention takes highest priority? 1. Restricting oral intake 2. Monitoring acid-base balance 3. Avoiding abdominal palpation 4. Maintaining strict isolation
3. Avoiding abdominal palpation Because manipulating the abdominal mass may disseminate cancer cells to adjacent and distant sites, the most important intervention for a child with a Wilms' tumor is to avoid palpating the abdomen. Restricting oral intake and monitoring acid-base balance are routine interventions for all preoperative clients; they have no higher priority in one with a Wilms' tumor. Isolation isn't required because a Wilms' tumor isn't infectious.
he nurse has just administered a drug to a child. Which organ is most responsible for drug excretion in children? 1. Heart 2. Lungs 3. Kidneys 4. Liver
3. Kidneys The kidneys are most responsible for drug excretion in children. Less commonly, some drugs may be excreted via the lungs or liver. Drugs are never excreted by the heart in children or adults.
A nurse is developing an in-service about viral and bacterial meningitis. The nurse should include that the introduction of which of the following immunizations decreased the incidence of bacterial meningitis in children? (select all that apply) A. inactivated polio virus (IPV) B. pnuemococcal conjugate vaccine (PCV) C. diptheria and tetanus toxoids and acellular pertussis vaccine (DTaP) D. haemophilius influenza type B (Hib) vaccine E. trivalent inactivated influenza vaccine (TIV)
B. pnuemococcal conjugate vaccine (PCV) D. haemophilius influenza type B (Hib) vaccine
A child is diagnosed with nephrotic syndrome. When planning the child's care, the nurse understands that the primary goal of treatment is to:
reduce the excretion of urinary protein.
A child, age 5, is diagnosed with hyperphosphatemia secondary to chronic renal failure. When teaching the parents about diet therapy, the nurse should instruct them to eliminate which foods from the child's diet? 1. Meats 2. Carbohydrates 3. Fats 4. Dairy products
4. Dairy products Dairy products contain a significant amount of phosphorus and should be eliminated from the diet of a child with hyperphosphatemia to prevent this condition from worsening. Meats, carbohydrates, and fats are appropriate food choices for this child.
A toddler with bacterial meningitis is admitted to the inpatient unit. Which infection control measure should the nurse be prepared to use? 1. Reverse isolation 2. Strict hand washing 3. Standard precautions 4. Respiratory isolation
4. Respiratory isolation Because bacterial meningitis is transmitted by droplets from the nasopharynx, the nurse should prepare to use respiratory isolation. This includes wearing a gown and gloves during direct client care and ensuring that everyone who enters the child's room wears a mask. Reverse isolation is unnecessary; it's used for immunosuppressed clients who are at high risk for acquiring infection. Strict hand washing and standard precautions are insufficient for this client because they don't require the use of a mask.
Which intervention provides the most accurate information about an infant's hydration status? 1. Monitoring the infant's vital signs 2. Accurately measuring intake and output 3. Monitoring serum electrolyte levels 4. Weighing the infant daily
4. Weighing the infant daily Weighing an infant daily provides the most accurate information about the infant's hydration status. Vital signs, intake and output, and electrolyte levels provide helpful information about an infant's hydration status, but they aren't as accurate as weighing daily.
A nurse is caring for a four month old infant who has meningitis. Which of the following findings is associated with this diagnosis? A. depressed anterior fontanel B. constipation C. presence of the rooting reflex D. high pitched cry
D. high pitched cry
A 16-year-old client sustains a severe head injury in a motor vehicle accident. He's admitted to the neurologic unit and subsequently develops neurogenic diabetes insipidus. The physician prescribes vasopressin (Pitressin), 5 units subcutaneously (S.C.) twice per day. When vasopressin is given S.C., it begins to act within: 1. 5 minutes. 2. 1 hour. 3. 2 hours. 4. 4 hours.
2. 1 hour. When vasopressin is given S.C., it begins to act within 1 hour. Its duration of action is 2 to 8 hours.
A 4-year-old boy is scheduled for a nephrectomy to remove a Wilms' tumor. Which intervention shouldn't be included in the nursing care plan? 1. Provide preoperative teaching to the child and his parents. 2. Palpate his abdomen to monitor tumor growth. 3. Assess vital signs and report hypertension. 4. Monitor urine for hematuria.
2. Palpate his abdomen to monitor tumor growth. The abdomen of a child with Wilms' tumor should never be palpated because it may increase the risk of metastasis. All children and their parents require preoperative teaching when surgery is planned. The child with Wilms' tumor may be hypertensive as a result of excessive renin production and may have hematuria.
A 4-year-old girl has a urinary tract infection (UTI). When teaching the parents how to help her avoid recurrent UTIs, the nurse should emphasize which preventive measure? 1. Wiping her perineum from back to front after she uses the toilet 2. Administering prophylactic antibiotics 3. Giving her a warm bath for 15 minutes daily 4. Making sure she avoids bubble baths
4. Making sure she avoids bubble baths The child should avoid bubble baths because oils in the bubble bath preparation may irritate the urethra, contributing to UTIs. Girls and women should wipe the perineum from front to back, not back to front, to avoid contaminating the urinary tract with fecal bacteria. Although antibiotics are used to treat UTIs, they aren't given prophylactically. No evidence suggests that warm baths help prevent UTIs.
A 14-year-old child with type 1 diabetes checks his blood glucose level at 9:00 p.m. before going to bed. It has been 4 hours since his dinner and his regular insulin dose. His blood glucose level is 60 mg/dl, and he states that he feels a little shaky. Which of the following should the nurse suggest? 1. A snack of an 8-oz glass of milk and graham crackers with peanut butter before going to sleep 2. Going to sleep to decrease the metabolic demands on the body 3. Taking a dose of glucagon 4. Doing nothing because the glucose level is unreliable because the child measured it himself
1. A snack of an 8-oz glass of milk and graham crackers with peanut butter before going to sleep Milk is a readily absorbed form of carbohydrate and will elevate blood glucose level rapidly, thus alleviating hypoglycemia. Crackers and peanut butter contain complex carbohydrates and will maintain blood glucose level. Decreased activity and sleep aren't effective for hypoglycemia. Glucagon should be reserved for more severe signs of hypoglycemia, such as disorientation and unconsciousness. To avoid rapid deterioration, steps should always be taken whenever hypoglycemia is suspected, regardless of who's performing the procedure.
When teaching parents about fifth disease (erythema infectiosum) and its transmission, the nurse should provide which information? 1. Fifth disease is transmitted by respiratory secretions. 2. Fifth disease has an unknown transmission mode. 3. Fifth disease is transmitted by respiratory secretions, stool, and urine. 4. Fifth disease is transmitted by stool.
1. Fifth disease is transmitted by respiratory secretions. Fifth disease is transmitted by respiratory secretions. The transmission mode for roseola is unknown. Rubella is transmitted by respiratory secretions, stool, and urine. Intestinal parasitic conditions, such as giardiasis and pinworm infection, are transmitted by stool.
When assessing a child with juvenile hypothyroidism, the nurse expects which finding? 1. Goiter 2. Recent weight loss 3. Insomnia 4. Tachycardia
1. Goiter Juvenile hypothyroidism results in goiter, weight gain, sleepiness, and a slow heart rate. It doesn't cause weight loss, insomnia, or tachycardia.
The nurse is evaluating a child with acute poststreptococcal glomerulonephritis (APSGN) for signs of improvement. Which finding typically is the earliest sign of improvement? 1. Increased urine output 2. Increased appetite 3. Increased energy level 4. Decreased diarrhea
1. Increased urine output Increased urine output, a sign of improving kidney function, typically is the first sign that a child with APSGN is improving. Increased appetite, an increased energy level, and decreased diarrhea aren't specific to APSGN.
A 3-month-old with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the highest priority? 1. Instituting droplet precautions 2. Administering acetaminophen (Tylenol) 3. Obtaining history information from the parents 4. Orienting the parents to the pediatric unit
1. Instituting droplet precautions Instituting droplet precautions is a priority for a newly admitted infant with meningococcal meningitis. Acetaminophen may be prescribed but administering it doesn't take priority over instituting droplet precautions. Obtaining history information and orienting the parents to the unit don't take priority.
A preschool child is admitted to the pediatric unit with acute nephritis. Which electrolyte replacement agent is used as an adjunct to treatment for this condition? 1. Magnesium sulfate 2. Calcium glubionate 3. Potassium chloride 4. Sodium lactate
1. Magnesium sulfate Magnesium sulfate is an electrolyte that is used as an adjunct to treat acute nephritis. It also is used to treat seizures and severe toxemia. Calcium glubionate, potassium chloride, and sodium lactate aren't therapeutic in acute nephritis and, in fact, may worsen the condition.
A neonate born 18 hours ago with myelomeningocele over the lumbosacral region is scheduled for corrective surgery. Preoperatively, what is the most important nursing goal? 1. Preventing infection 2. Ensuring adequate hydration 3. Providing adequate nutrition 4. Preventing contracture deformity
1. Preventing infection Preventing infection is the nurse's primary preoperative goal for a neonate with myelomeningocele. Although the other options are relevant for this neonate, they're secondary to preventing infection.
A 4-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. The nurse should suspect that the child's I.V. fluid intake is excessive if assessment reveals: 1. worsening dyspnea. 2. gastric distention. 3. nausea and vomiting. 4. a temperature of 102° F (38.9° C).
1. worsening dyspnea. Dyspnea and other signs of respiratory distress signify fluid volume overload, which can occur quickly in a child as fluid shifts rapidly between the intracellular and extracellular compartments. Gastric distention suggests excessive oral fluid intake or infection. Nausea and vomiting or an elevated temperature may indicate a fluid volume deficit.
A toddler is admitted to the facility with nephrotic syndrome. The nurse carefully monitors the toddler's fluid intake and output and checks urine specimens regularly with a reagent strip (Labstix). Which finding should the nurse report? 1. Proteinuria 2. Glycosuria 3. Ketonuria 4. Polyuria
1. Proteinuria In nephrotic syndrome, the glomerular membrane of the kidneys becomes permeable to proteins. This results in massive proteinuria, which the nurse can detect with a reagent strip. Nephrotic syndrome typically doesn't cause glycosuria or ketonuria. Because the syndrome causes fluids to shift from plasma to interstitial spaces, it's more likely to decrease urine output than to cause polyuria (excessive urine output).
The nurse is interviewing the mother of a 7-year-old child. Which symptom reported by the mother would most lead the nurse to suspect that the child has type 1 diabetes? 1. Recent bed-wetting 2. Poor appetite 3. Weight gain 4. Boundless energy
1. Recent bed-wetting Polyuria is a hallmark of type 1 diabetes mellitus. Parents often notice this symptom as bed-wetting in a child previously toilet-trained. Polyphagia is also a hallmark of type 1 diabetes mellitus. A parent is likely to report that a child eats excessively but seems to be losing weight. The child with type 1 diabetes mellitus may also complain of fatigue.
A 10-year-old child diagnosed with acute glomerulonephritis is admitted to the pediatric unit. The nurse should ensure that which of the following is a part of the child's care? 1. Taking vital signs every 4 hours and obtaining daily weight 2. Obtaining a blood sample for electrolyte analysis every morning 3. Checking every urine specimen for protein and specific gravity 4. Ensuring that the child has accurate intake and output and eats a high-protein diet
1. Taking vital signs every 4 hours and obtaining daily weight Because major complications — such as hypertensive encephalopathy, acute renal failure, and cardiac decompensation — can occur, monitoring vital signs (including blood pressure) is an important measure for a child with acute glomerulonephritis. Obtaining daily weight and monitoring intake and output also provide evidence of the child's fluid balance status. Sodium and water restrictions may be ordered depending on the severity of the edema and the extent of impaired renal function. Typically, protein intake remains normal for the child's age and is only increased if the child is losing large amounts of protein in the urine. Checking urine specimens for protein and specific gravity and daily monitoring of serum electrolyte levels may be done, but their frequency is determined by the child's status. These are less important nursing measures in this situation.
An adolescent with well-controlled type 1 diabetes has assumed complete management of the disease and wants to participate in gymnastics after school. To ensure safe participation, the nurse should instruct the child to adjust the therapeutic regimen by: 1. eating a snack before each gymnastics practice. 2. measuring the urine glucose level before each gymnastics practice. 3. measuring the blood glucose level after each gymnastics practice. 4. increasing the morning dosage of intermediate-acting insulin.
1. eating a snack before each gymnastics practice. Because exercise decreases the blood glucose level, the nurse should instruct the child to eat a snack before engaging in physical activity to prevent a hypoglycemic episode. Option 2 is incorrect because the urine glucose level doesn't reflect the current blood glucose level. To prevent hypoglycemia, the blood glucose level should be measured before the activity, making option 3 incorrect. Option 4 may lead to hypoglycemia during gymnastics practice; to avoid this condition, the child may need to decrease, not increase, the morning dosage of intermediate-acting insulin.
A school-age child experiences symptoms of excessive polyphagia, polyuria, and weight loss. The physician diagnoses type I diabetes mellitus and admits the child to the facility for insulin regulation. The physician prescribes an insulin regimen of insulin (Humulin R) and isophane insulin (Humulin N) administered subcutaneously. How soon after administration can the nurse expect the regular insulin to begin to act? 1. ½ to 1 hour 2. 1 to 2 hours 3. 4 to 8 hours 4. 8 to 10 hours
1. ½ to 1 hour Regular insulin, a rapid-acting insulin, begins to act in ½ to 1 hour, reaches peak concentration levels in 2 to 10 hours, and has a duration of action of 5 to 15 hours.
After being hospitalized for status asthmaticus, a child, age 5, is discharged with prednisone (Deltasone) and other oral medications. Two weeks later, when the child comes to the clinic for a checkup, the nurse instructs the mother to gradually decrease the dosage of prednisone, which will be discontinued. The mother asks why prednisone must be discontinued. How should the nurse respond? 1. "Steroids increase the appetite, leading to obesity with prolonged use." 2. "Long-term steroid therapy may interfere with a child's growth." 3. "The child may develop a hypersensitivity to steroids with continued use." 4. "Prolonged steroid use may cause depression."
2. "Long-term steroid therapy may interfere with a child's growth." Steroids suppress release of adrenocorticotropic hormone from the pituitary gland, stopping production of endogenous hormones by the adrenal cortex. Because prolonged adrenal suppression may cause growth retardation in a child, the duration and dosage of steroid therapy must be kept to a minimum. Steroids also may cause central nervous system effects, such as euphoria, insomnia, and mood swings. Although they increase the appetite, this isn't the reason for limiting their use in children. Steroids are present in the body, so hypersensitivity isn't a problem. They're likely to cause euphoria, not depression.
A 15-year-old girl with a urinary tract infection is admitted to the facility. She tells the nurse she hopes that she's pregnant. Which of the following would be the best response by the nurse? 1. "Does your mother know about this?" 2. "Tell me what pregnancy would mean to you." 3. "Congratulations. Does the baby's father know?" 4. "I hope you aren't pregnant; you're too young."
2. "Tell me what pregnancy would mean to you." When talking with adolescents, it's best to get their viewpoints and thoughts first. Doing so promotes therapeutic communication. Asking whether the mother knows or about the baby's father focuses the attention away from the adolescent. Making a statement about her being too young to be pregnant is a value judgment and inappropriate.
An adolescent with type 1 diabetes mellitus is experiencing a growth spurt. Which treatment approach would be most effective for this client? 1. Administering insulin once a day 2. Administering multiple doses of insulin 3. Limiting dietary fat intake 4. Substituting an oral antidiabetic agent for insulin
2. Administering multiple doses of insulin During an adolescent growth spurt, a regimen of multiple insulin doses achieves better control of the blood glucose level because it more closely simulates endogenous insulin release. A single daily dose of insulin wouldn't control this client's blood glucose level as effectively. Limiting dietary fat intake wouldn't help the body use glucose at the cellular level. A child with type 1 diabetes mellitus doesn't produce insulin and therefore can't receive an oral antidiabetic agent instead of insulin.
When teaching the parent of a school-age child about signs and symptoms of fever that require immediate notification of the physician, which description should the nurse include? 1. Burning or pain with urination 2. Complaints of a stiff neck 3. Fever disappearing for longer than 24 hours, then returning 4. History of febrile seizures
2. Complaints of a stiff neck A child with a fever and a stiff neck should be evaluated immediately for meningitis. All other symptoms should be addressed by the physician but can wait until office hours.
A school-age child begins to have a seizure while walking to the bathroom. What should the nurse do first? 1. Call the physician caring for the child. 2. Ease the child to the floor and turn him on his side. 3. Administer diazepam (Valium) through the I.V. tubing. 4. Notify the parents so they can be with their child.
2. Ease the child to the floor and turn him on his side. Because the child is standing, he should be eased to the floor and turned to the side to prevent aspiration. Notifying the physician wouldn't be the first action the nurse would take because the child's safety is of primary importance. Diazepam would be administered only if it had been ordered. Notifying the parents, although important, isn't the priority. They can be informed after the seizure is over.
A nurse is caring for a 3-year-old child with viral meningitis. Which signs and symptoms would the nurse expect to find during the initial assessment? 1. Bulging anterior fontanel 2. Fever 3. Nuchal rigidity 4. Petechiae 5. Irritability 6. Photophobia 7. Hypothermia
2. Fever 3. Nuchal rigidity 5. Irritability 6. Photophobia Common signs and symptoms of viral meningitis include fever, nuchal rigidity, irritability, and photophobia. A bulging anterior fontanel is a sign of hydrocephalus, which isn't likely to occur in a toddler because the anterior fontanel typically closes by age 24 months. A petechial, purpuric rash may be seen with bacterial meningitis. Hypothermia is a common sign of bacterial meningitis in an infant younger than age 3 months.
When caring for an adolescent who's at risk for injury related to intracranial pathology, which action would maintain stable intracranial pressure (ICP)? 1. Turn the client's head from side to side frequently. 2. Keep the head in midline position while raising the head of the bed 15 to 30 degrees. 3. Hyperextend the client's head with a blanket roll. 4. Suction frequently to maintain a clear airway.
2. Keep the head in midline position while raising the head of the bed 15 to 30 degrees. Elevating the head of the bed while keeping the client's head in midline position will facilitate venous drainage and avoid jugular compression. Turning the head, hyperextending the neck, and suctioning will increase ICP.
The nurse is developing a care plan for a 10-year-old child who has recently been diagnosed with type 1 diabetes mellitus. Which of the following would be inappropriate to include in a teaching plan focusing on proper hygiene? 1. Encourage regular dental care. 2. Teach blood glucose monitoring. 3. Teach care of cuts and scratches. 4. Teach proper foot care.
2. Teach blood glucose monitoring. Teaching blood glucose monitoring and the use of equipment is necessary in diabetic teaching within the care plan that focuses on demonstrating testing blood glucose levels. Encouraging regular dental care is important for the child's general health. Teaching proper care of cuts and scratches will minimize the risk of infection. Teaching proper foot care is necessary and becomes a priority when the child becomes an adult.
A preschool-age child is admitted to the facility with nephrotic syndrome. Nursing assessment reveals a blood pressure of 100/60 mm Hg, lethargy, generalized edema, and dark, frothy urine. After prednisone (Deltasone) therapy is initiated, which nursing action takes highest priority? 1. Monitoring the child for hypertension 2. Turning and repositioning the child frequently 3. Providing a high-sodium diet 4. Discussing the adverse effects of steroids with the parents
2. Turning and repositioning the child frequently The child with nephrotic syndrome is at risk for skin breakdown from generalized edema. Because this syndrome typically impairs independent movement, the nurse must turn and reposition the child frequently to help prevent skin breakdown. Frequent turning also helps prevent respiratory infections, which may arise during the edematous phase of nephrotic syndrome. The syndrome typically causes hypotension, not hypertension, from significant loss of intravascular protein and a subsequent drop in oncotic pressure. Dietary sodium should be restricted because it worsens edema. Although the nurse should discuss the adverse effects of steroids with the parents, this isn't a priority at this time.
A child is diagnosed with nephrotic syndrome. When planning the child's care, the nurse understands that the primary goal of treatment is to: 1. manage urinary changes by monitoring fluid intake and output and observing for hematuria. 2. reduce the excretion of urinary protein. 3. help prevent cardiac or renal failure by carefully monitoring fluid and electrolyte balance. 4. decrease edema and hypertension through bed rest and fluid restriction.
2. reduce the excretion of urinary protein. The primary goal of treatment for a child with nephrotic syndrome is to reduce excretion of urinary protein and maintain a protein-free urine. Nephrotic syndrome isn't associated with hematuria, cardiac failure, or hypertension. Fluid restriction isn't warranted.
When developing a care plan for a toddler with a seizure disorder, which of the following would be inappropriate? 1. Padded side rails 2. Oxygen mask and bag system at bedside 3. Arm restraints while asleep 4. Cardiorespiratory monitoring
3. Arm restraints while asleep Restraints should never be used on a child with a seizure disorder because they could harm him if a seizure occurs. Padded side rails will prevent the child from injuring himself during a seizure. The bag and mask system should be present in case the child needs oxygen during a seizure. Cardiopulmonary monitoring should be readily available for checking vital signs during a seizure.
To treat a child's atopic dermatitis, a physician prescribes a topical application of hydrocortisone cream twice daily. After medication instruction by the nurse, which statement by the parent indicates effective teaching? 1. "I will spread a thick coat of hydrocortisone cream on the affected area and will wash this area once a week." 2. "I will gently scrape the skin before applying the cream to promote absorption." 3. "I will avoid using soap and water on the affected area and will apply an emollient cream on this area frequently." 4. "I will apply a moisturizing cream sparingly and will wash the affected area frequently."
3. "I will avoid using soap and water on the affected area and will apply an emollient cream on this area frequently." The parent should avoid washing the affected area with soap and water because this removes moisture from the horny layer of the skin. Applied in a thin layer, emollient cream holds moisture in the skin, provides a barrier to environmental irritants, and helps prevent infection. Topical steroid creams such as hydrocortisone should be applied sparingly as a light film; the affected area should be cleaned gently with water before the cream is applied. Scraping or abrading the skin may increase the risk of infection and alter drug absorption. Excessive application of steroidal creams may result in systemic absorption and Cushing's syndrome. Frequent washing dries the skin, making it more susceptible to cracking and further breakdown.
Which statement by the mother of a toddler with nephrotic syndrome indicates that the nurse's discharge teaching was effective? 1. "I know that I'll need to keep my child as quiet as possible." 2. "I just went out and bought all I'll need for the special diet." 3. "I've been checking the urine for protein so I'll be able to do it at home." 4. "I'm sure that my child will be back to normal soon."
3. "I've been checking the urine for protein so I'll be able to do it at home." Protein in urine is an indication of the progression of nephrotic syndrome, so parents are taught to test the child's urine. The child doesn't need to be kept quiet and usually isn't on a specific diet. How the child feels will dictate the child's activity level. Most children return to normal soon but may relapse.
A child, age 15 months, is admitted to the health care facility. During the initial nursing assessment, which statement by the mother most strongly suggests that the child has a Wilms' tumor? 1. "My child has grown 3" in the past 6 months." 2. "My child seems to be napping for longer periods." 3. "My child's abdomen seems bigger, and his diapers are much tighter." 4. "My child's appetite has increased so much lately."
3. "My child's abdomen seems bigger, and his diapers are much tighter." The most common presenting sign of a Wilms' tumor is abdominal swelling or an abdominal mass. A rapid increase in length (height) isn't associated with this type of tumor. Although lethargy may accompany a Wilms' tumor, abdominal swelling is a more specific sign. Children with a Wilms' tumor usually have a decreased appetite.
A 15-month-old child is being discharged after treatment for severe otitis media and bacterial meningitis. Which statement by the parents indicates effective discharge teaching? 1. "We should have gone to the physician sooner. Next time, we will." 2. "We'll take our child to the physician's office every week until everything is okay." 3. "We'll go to the physician if our child pulls on the ears or won't lie down." 4. "We're just so glad this is all behind us."
3. "We'll go to the physician if our child pulls on the ears or won't lie down." The parents indicate full understanding of discharge teaching by repeating the specific, common signs of otitis media in toddlers, such as pulling on the ears and refusing to lie down, and by verbalizing the need for immediate follow-up care if these signs arise. Option 1 implies a sense of guilt. Option 2 addresses only weekly follow-up care. Option 4 is unrealistic because the child's condition may recur.
When assessing an 18-month-old child, the nurse determines that the child's height and weight fall below the 5th percentile on the growth chart. In all previous visits, the child's height and weight fell between the 30th and 40th percentiles. The child's mother expresses concern about the slowed growth rate. How should the nurse respond? 1. "What do you feed your child?" 2. "Don't worry. Your child is bound to have a growth spurt soon." 3. "Your child's height and weight must be checked again in 1 month." 4. "How much weight did you gain when you were pregnant with this child?"
3. "Your child's height and weight must be checked again in 1 month." Although the growth rate usually slows between ages 1 and 3, it normally doesn't drop as dramatically as this child's. Therefore, the nurse should advise the mother to have the child's growth rate monitored frequently, such as every month. Option 1 implies that the mother is at fault for the child's slow growth. Option 2 doesn't address the mother's concern about the child. Option 4 is inappropriate because maternal weight gain during pregnancy wouldn't affect a child's growth rate at 18 months.
The nurse is preparing to administer short-acting insulin to a child with type 1 diabetes mellitus. When should the nurse measure the child's blood glucose level? 1. Immediately before administering insulin 2. 15 minutes after administering insulin 3. 1 hour after administering insulin 4. 4 hours after administering insulin
3. 1 hour after administering insulin Short-acting insulins peak in 30 minutes to 2 hours after administration. The nurse should check the child's blood glucose level during this period, such as 1 hour after administration.
An infant undergoes surgery to remove a myelomeningocele. To detect increased intracranial pressure (ICP) as early as possible, the nurse should stay alert for which postoperative finding? 1. Decreased urine output 2. Increased heart rate 3. Bulging fontanels 4. Sunken eyeballs
3. Bulging fontanels Because an infant's fontanels remain open, the skull may expand in response to increased ICP. Therefore, bulging fontanels are a cardinal sign of increased ICP in an infant. Decreased urine output and sunken eyeballs indicate dehydration, not increased ICP. With increased ICP, the heart rate decreases.
When assessing a preschooler who has sustained a head trauma, the nurse notes that the child appears to be obtunded. Which of the following denotes the child's level of consciousness? 1. No motor or verbal response to noxious (painful) stimuli 2. Remains in a deep sleep; responsive only to vigorous and repeated stimulation 3. Can be aroused with stimulation 4. Limited spontaneous movement; sluggish speech
3. Can be aroused with stimulation The child is obtunded if he can be aroused with stimulation. If the child shows no motor or verbal response to noxious stimuli, he's comatose. If the child remains in a deep sleep and is responsive only to vigorous and repeated stimulation, he's stuporous. If the child has limited spontaneous movement and sluggish speech, he's lethargic.
A toddler with hemophilia is hospitalized with multiple injuries after falling off a sliding board. X-rays reveal no bone fractures. When caring for the child, what is the nurse's highest priority? 1. Administering platelets as prescribed 2. Taking measures to prevent infection 3. Frequently assessing the child's level of consciousness (LOC) 4. Discussing a safe play environment with the parents
3. Frequently assessing the child's level of consciousness (LOC) In hemophilia, one of the factors required for blood clotting is absent, significantly increasing the risk of hemorrhage after injury. The nurse must assess the child frequently for signs and symptoms of intracranial bleeding, such as an altered LOC, slurred speech, vomiting, and headache. To manage hemophilia, the absent blood clotting factor is replaced via I.V. infusion of factor, cryoprecipitate, or fresh frozen plasma; this may be done prophylactically or after a traumatic injury. Platelet transfusions aren't necessary. Hemophiliacs aren't at increased risk for infection. Discussing a safe play environment with the parents is important but isn't the highest priority.
Craniocerebral injury in a child differs substantially from craniocerebral trauma in an adult. Which of the following identifies a negative difference between children and adults that could produce a life-threatening complication for a child? 1. Cerebral tissues in children are softer, thinner, and more flexible. 2. A child's skull can expand more than an adult's can. 3. Greater portions of a child's blood volume flows to the head. 4. Hematomas in children can include subdural, epidural, and intracerebral.
3. Greater portions of a child's blood volume flows to the head. If hemorrhage is associated with a head injury and it goes undetected, a child may experience hypovolemic shock because a large portion of a child's blood volume goes to the head. In children, cerebral tissues are softer, thinner, and more flexible — conditions that permit diffusion of the impact. Because a child's skull can expand more than an adult's can, a greater amount of posttraumatic edema can occur without evidence of neurologic deficits. Subdural, epidural, and intracerebral hematomas are the different types of head injury that can occur in children and adults.
An 8-year-old child is suspected of having meningitis. Signs of meningitis include which of the following? 1. Cullen's sign 2. Koplik's spots 3. Kernig's sign 4. Chvostek's sign
3. Kernig's sign In Kernig's sign, the client is in the supine position with knees flexed; a leg is then flexed at the hip so that the thigh is brought to a position perpendicular to the trunk. An attempt is then made to extend the knee. If meningeal irritation is present, the knee can't be extended and attempts to extend the knee result in pain. Other common symptoms include stiff neck, headache, and fever. Cullen's sign is the bluish discoloration of the periumbilical skin due to intraperitoneal hemorrhage. Koplik's spots are reddened areas with grayish blue centers that are found on the buccal mucosa of a client with measles. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. A calcium deficit is suggested if the facial muscles twitch.
A toddler is having a tonic-clonic seizure. What should the nurse do first? 1. Restrain the child. 2. Place a tongue blade in the child's mouth. 3. Remove objects from the child's surroundings. 4. Check the child's breathing.
3. Remove objects from the child's surroundings. During a seizure, the nurse's first priority is to protect the child from injury. To prevent injury caused by uncontrolled movements, the nurse must remove objects from the child's surroundings and pad objects that can't be removed. Restraining the child or placing an object in the child's mouth during a seizure may cause injury. Once the seizure stops, the nurse should check for breathing and, if indicated, initiate rescue breathing.
The physician prescribes corticosteroids for a child with nephrotic syndrome. What is the primary purpose of administering corticosteroids to this child? 1. To increase blood pressure 2. To reduce inflammation 3. To decrease proteinuria 4. To prevent infection
3. To decrease proteinuria The primary purpose of administering corticosteroids to a child with nephrotic syndrome is to decrease proteinuria. Corticosteroids have no effect on blood pressure. Although they help reduce inflammation, this isn't the reason for their use in clients with nephrotic syndrome. Corticosteroids may predispose a client to infection.
The nurse is teaching parents how to reduce the spread of impetigo. The nurse should encourage parents to: 1. teach children to cover mouths and noses when they sneeze. 2. have their children immunized against impetigo. 3. teach children the importance of proper hand washing. 4. isolate the child with impetigo from other members of the family.
3. teach children the importance of proper hand washing. The spread of childhood infections, including impetigo, can be reduced when children are taught proper hand-washing technique. Because impetigo is spread through direct contact, covering the mouth and nose when sneezing won't prevent its spread. Currently, there is no vaccine to prevent a child from contracting impetigo. Isolating the child with impetigo is unnecessary.
The nurse is developing a teaching plan for a child with acute poststreptococcal glomerulonephritis. What is the most important point to address in this plan? 1. Infection control 2. Nutritional planning 3. Prevention of streptococcal pharyngitis 4. Blood pressure monitoring
4. Blood pressure monitoring Because poststreptococcal glomerulonephritis may cause severe, life-threatening hypertension, the nurse must teach the parents how to monitor the child's blood pressure. Infection control, nutritional planning, and prevention of streptococcal pharyngitis are important but are secondary to blood pressure monitoring.
he nurse is assessing an infant for signs of increased intracranial pressure (ICP). What is the earliest sign of increased ICP in an infant? 1. Vomiting 2. Papilledema 3. Headache 4. Increased head circumference
4. Increased head circumference Increased head circumference is the first sign of increased ICP in an infant. Vomiting occurs later. Papilledema is a late sign of increased ICP and may not be evident. Because the infant can't speak, the nurse would have trouble determining whether the infant has a headache.
A child, age 15 months, is recovering from surgery to remove a Wilms' tumor. Which finding best indicates that the child is free from pain? 1. Decreased appetite 2. Increased heart rate 3. Decreased urine output 4. Increased interest in play
4. Increased interest in play A behavioral change is one of the most valuable clues to pain. A child who's pain-free likes to play; in contrast, a child in pain is less likely to play or to consume food or fluids. An increased heart rate indicates increased pain. Decreased urine output may signify dehydration.
After a series of tests, a 6-year-old client weighing 50 lb (22.7 kg) is diagnosed with complex partial seizures. The physician prescribes phenytoin (Dilantin), 125 mg by mouth twice per day. After the nurse administers phenytoin, where is the drug metabolized? 1. Pancreas 2. Kidneys 3. Stomach 4. Liver
4. Liver Phenytoin is metabolized in the liver. The pancreas isn't involved in the pharmacokinetic activity of phenytoin. The stomach absorbs orally administered phenytoin, which is excreted by the kidneys in the urine.
The nurse teaches a mother how to provide adequate nutrition for her toddler, who has cerebral palsy. Which observation indicates that teaching has been effective? 1. The toddler stays neat while eating. 2. The toddler finishes the meal within a specified period of time. 3. The child lies down to rest after eating. 4. The child eats finger foods by himself.
4. The child eats finger foods by himself. The child with cerebral palsy should be encouraged to be as independent as possible. Finger foods allow the toddler to feed himself. Because spasticity affects coordinated chewing and swallowing as well as the ability to bring food to the mouth, it's difficult for the child with cerebral palsy to eat neatly. Independence in eating should take precedence over neatness. The child with cerebral palsy may require more time to bring food to the mouth; thus, chewing and swallowing shouldn't be rushed to finish a meal by a specified time. The child with cerebral palsy may vomit after eating owing to a hyperactive gag reflex. Therefore, the child should remain in an upright position after eating to prevent aspiration and choking.
Which assessment finding would lead the nurse to suspect dehydration in a preterm neonate? 1. Bulging fontanels 2. Excessive weight gain 3. Urine specific gravity below 1.012 4. Urine output below 1 ml/hour
4. Urine output below 1 ml/hour Urine output below 1 ml/hour is a sign of dehydration. Other signs of dehydration include depressed fontanels, excessive weight loss, decreased skin turgor, dry mucous membranes, and urine specific gravity above 1.012.
The school nurse is examining a student at an elementary school. Which findings would lead the nurse to suspect impetigo? 1. Small, red lesions on the trunk and in the skin folds 2. A discrete pink-red maculopapular rash that starts on the head and progresses down the body 3. Red spots with a blue base found on the buccal membranes 4. Vesicular lesions that ooze, forming crusts on the face and extremities
4. Vesicular lesions that ooze, forming crusts on the face and extremities Impetigo starts as papulovesicular lesions surrounded by redness. The lesions become purulent and begin to ooze, forming crusts. Impetigo occurs most often on the face and extremities. Small red lesions on the trunk and in the skin folds are characteristic of scarlet fever. A discrete pink-red maculopapular rash that starts on the face and progresses down to the trunk and extremities is characteristic of rubella (German measles). Red spots with a blue base found on the buccal membranes, known as Koplik's spots, are characteristic of measles (rubeola).
A child is diagnosed with Wilms' tumor. During assessment, the nurse expects to detect: 1. gross hematuria. 2. dysuria. 3. nausea and vomiting. 4. an abdominal mass.
4. an abdominal mass. The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria isn't associated with Wilms' tumor. Nausea and vomiting are rare in children with Wilms' tumor.
The nurse is assessing an 8-month-old child for signs of neurologic deficit and increased intracranial pressure (ICP). These signs would include: 1. a depressed fontanel. 2. slurred speech. 3. tachycardia. 4. an altered level of consciousness.
4. an altered level of consciousness. One sign of neurologic deficit in an 8-month-old child includes a decreased or altered level of consciousness. The fontanel would bulge if he had increased ICP. The child isn't able to speak at this age, but a change in cry may be noted. Bradycardia — not tachycardia — is a sign of increased ICP.
After a head injury, a child experiences enuresis, polydipsia, and weight loss. Based on these findings, the nurse should monitor closely for signs and symptoms of: 1. hypercalcemia. 2. hyperglycemia. 3. hyponatremia. 4. hypokalemia.
4. hypokalemia. Enuresis, polydipsia, and weight loss suggest diabetes insipidus, a disorder that may result from a head injury that damages the neurohypophyseal structures. Diabetes insipidus places the child at risk for fluid volume depletion and hypokalemia. It doesn't cause hypercalcemia, hyperglycemia, or hyponatremia.
A nurse is teaching a parent about demethasone (Decadron) to treat head injury. Which of the following should be included in the teaching? A. it decreases cerebral edema B. it promotes the control of seizures C. it promotes improved pain management D. it is used to treat an infection
A. it decreases cerebral edema
A nurse is caring for a child who was admitted to the emergency department after a motor vehicle crash. The child is unresponsive, has spontaneous respirations of 22/min, and has a laceration on the forehead that is bleeding. Which of the following is the primary nursing action at this time? A. keep the neck stabilized B. insert a nasogastic tube C. obtain vital signs D. establish IV access
A. keep the neck stabilized
A nurse is caring for a child who has absence seizures. Which of the following findings can the nurse expect? (select all that apply) A. loss of consciousness B. appearance of day dreaming C. dropping held objects D. falling to the floor E. having a piercing cry
A. loss of consciousness B. appearance of day dreaming C. dropping held objects
A nurse is reviewing cerebrospinal fluid analysis for a client who has suspected meningitis. Which of the following results indicate viral meningitis? (select all that apply) A. negative gram stain B. normal glucose content C. cloudy color D. decreased WBC count E. normal protein content
A. negative gram stain B. normal glucose content E. normal protein content
A nurse is reviewing treatment options with the parent of a child who has worsening seizures. Which of the following should be included in the discussion? (select all that apply A. vagal nerve stimulator B. additional antiepileptic medications C. corpus callosotomy D. focal resection E. radiation therapy
A. vagal nerve stimulator B. additional antiepileptic medications C. corpus callosotomy D. focal resection
A nurse is caring for a child who has increased intracranial pressure. Which of the following are appropriate actions by the nurse? (select all that apply) A. suction the endotracheal tube every 2 hr B. maintain a quiet environment C. use two pillows to elevate the head D. administer stool softener E. maintain body alignment
B. maintain a quiet environment D. administer stool softener E. maintain body alignment
