OBPEDI Exam 6
What most accurately describes bowel function in children born with a myelomeningocele? -Incontinence cannot be prevented. -Enemas and laxatives are contraindicated. -Some degree of fecal continence can usually be achieved. -Colostomy is usually required by the time the child reaches adolescence.
-Some degree of fecal continence can usually be achieved. Correct
Nephrotic syndrome
The glomerular membrane, normally impermeable to albumin and other proteins, becomes permeable to proteins, especially albumin, that leak through the membrane and are lost in urine
Clinical manifestation of diabetes mellitus type I 3Ps
(polydipsia, polyphagia, polyuria)
Treatment for acne Isotretinoin (Accutane)
) o Contraindications and monitoring iPLEDGE, avoid pregnancy, make sure your patient is taking birth control (they typically recommend two methods of BC) monthly pregnancy testing is required for refills
The nurse is admitting a young child to the hospital with suspected diagnosis of bacterial meningitis. The PRIORITY of nursing care is to a. initiate isolation precautions as soon as the diagnosis is confirmed. b. initiate isolation precautions as soon as the causative agent is identified. c. administer antibiotic therapy as soon as it is ordered. d. administer sedatives/analgesics on a preventive schedule to manage pain.
. administer antibiotic therapy as soon as it is ordered. Correct
The nurse is preparing to treat a patient with systemic mycoses. The nurse understands that the usual portal of entry for blastomycosis is the a. GI tract b. lungs. c. mucosal membranes. d. integumentary system
b. lungs.
A nurse is planning care for a school-age child diagnosed with type 1 diabetes. Which insulin preparations are either rapid or short acting? (Select all that apply.) a. Novolin N b. Lantus c. NovoLog d. Novolin R
c. NovoLog d. Novolin R
The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would be observable? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polydipsia
d. Polydipsia
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing
d. Poor wound healing
What are the manifestations of hypoglycemia? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizziness
d. Shaky feeling and dizziness
The clinic nurse is reviewing hemoglobin A1c levels on several children with type 1 diabetes. Hemoglobin A1c levels of less than _____% are a goal for children with type 1 diabetes. Record your answer as a whole number.
7
A1C goals
7%
The nurse is assessing an 8-year-old boy suspected of having Rocky Mountain spotted fever. Which of the following signs and symptoms would the nurse expect to find?
A. Maculopapular rash that begins on the wrists and ankles and spreads centripetally RATIONALE•Rocky Mountain spotted fever starts with a fever, usually within a few days of a tick bite. Along with a headache and myalgia, a maculopapular rash develops 2-6 days after the onset of a fever. The rash first appears in the wrists and ankles, then spreads centripetally to the trunk.•Rocky mountain spotted fever is the most common rickettsial disease seen in the United states and is transmitted by ticks. It can be a life-threatening illness if undiagnosed or untreated.•Stiff neck and a positive Kernig's sign is indicative of meningitis.•Spasms of the jaw and arching of the back are signs of tetanus.•A circular outward expanding rash is a classic sign of early Lyme disease.
4.What should the nurse recommend to prevent urinary tract infections in young girls? a. Wearing cotton underpants b. Limiting bathing as much as possible c. Increasing fluids; decreasing salt intake d. Cleansing the perineum with water after voiding
A: Wearing cotton underpants
Priority interventions in infants with fractures
Abuse
The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. The best reply is: a. blood pressure changes are a common side effect of antibiotic therapy b. blood pressure changes are a sign that the condition has become chronic c. Acute hypertension must be anticipated and identified d. Hypotension or low blood pressure leading to sudden shock can develop at any time.
Acute hypertension must be anticipated and identified
Immediately after delivery, the nurse notices signs of possible UTI in the neonate. What is the likely bacterial route of the infection?
Blood
Laboratory findings of type I diabetic ketoacidosis
DKA is a state of relative insulin insufficiency and may include the presence of hyperglycemia (blood glucose level ≥ 200 mg/dL), ketonemia (strongly positive), acidosis (pH < 7.30 and bicarbonate < 15 mmol/L), glycosuria, and ketonuria
One of the clinical manifestations of chronic renal failure is uremic frost. What best describes the term?
Deposits of urea crystals on the skin
What are the clinical manifestations of cystitis in an infant?
Fever Poor feeding Vomiting Failure to gain weight excessive thirst frequent urination straining or screaming during urination foul smelling urine pallor persistent diaper rash dehydration enlarged kidneys or bladder
While assessing the penis of a child who has had surgery for repair of hypospadias, the nurse observes the appearance of the penis. The nurse should report which aspect to the surgeon?
Dusky blue at the tip may indicate problem with circulation and the surgeon should be notified
For a child with a diagnosis of UTI and dehydration, what would you expect to see on UA results?
Elevated WBC count (>2) Specific gravity 1.030 or greater
A mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about casts in the urine. Casts in the urine indicates:
Glomerular injury
Pathophysiology of glomerulonephritis:
Glomerulonephritis has a decreased filtration of plasma. The resulting decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. Hypertension with AGN cannot completely be caused by edema, Excess Renin may be produced
What is the adrenal cortex responsible for secreting?
Glucocorticoids (cortisol), Mineralocorticoids (aldosterone), Sex hormones (androgens, estrogens, progestrins)
A child is admitted with acute glomerulonephritis. The nurse expect the urinalysis during this acute phase to show:
Hematuria and proteinuria
GCS scoring-TBI- What actions do you take when a patients GCS has declined?
If you have a patient with a head injury who has had GCS of 12 and 13 all shift and suddenly its 4- what are you going to do? NOTIFY PCP
Peritoneal dialysis- what finding would alert that the child has peritonitis?
Observe for changes in the color of the dialysate draining from the child. The spent solution should be clear. If the color is cloudy, notify the practitioner immediately.
What medication is used for CRF with elevated potassium levels?
Kayexalate (sodium polystyrene sulfonate)
First line treatment for JA (Juvenile Arthritis)
NSAIDS
Know the rapid and short acting insulins
Novolog and Novolin R
Peritoneal dialysis- what finding would alert that the child has peritonitis?
Observe for changes in the color of the dialysate draining from the child. The spent solution should be clear. If the color is cloudy, notify the practitioner immediately
Receiving dialysis for edema, what is an expected finding?
Pallor, this can occur owing to hemodilution as interstitial fluid moves to the vascular space. They will have audible pulmonary crackles secondary to pulmonary congestion and edema, elevation of BP due to excessive fluid, and dialysate outflow would decrease as the body attempts to conserve fluid
Glomerulonephritis is characterized by:
Proteinuria Hematuria
An objective of care for the child with nephrosis is what desired outcome?
Reduced excretion of urinary protein
The most appropriate nursing diagnosis for the child with acute glomerulonephritis is:
Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration
What factors predispose a child to urinary tract infections?
Shorter urethras in females The shorter urethra in females provides a ready pathway for invasions of organisms.
Propylthiouracil- patient teaching on side effects
Sore throat and fever- see PCP leukopenia
The nurse is assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding?
Tea colored urine (could indicate hematuria)
Expected findings in CSF sample
The patient generally has an elevated white blood cell count, often predominantly polymorphonuclear leukocytes. The glucose level is reduced, generally in proportion to the duration and severity of the infection. The relationship between the CSF glucose and serum glucose levels is important in evaluating the glucose content of CSF; therefore a serum glucose sample is drawn approximately a half-hour before the lumbar puncture. Protein concentration is usually increased. o Nursing management for a child with meningitis
Emergency treatment Basilar skull fracture
Trauma assessmentC-spine Do not use NG tube Rapid correction of hypoxia and hypotension
The nurse is explaining that the destruction of pancreatic beta-cells is the cause of which disorder? Type 1 diabetes Type 2 diabetes Impaired glucose tolerance Gestational diabetes
Type 1 diabetes Correct
When a child diagnosed with chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as what? a. Uremia b. Oliguria c. Proteinuria d. Pyelonephritis
Uremia
The nurse understands that hypospadias refers to what urinary anomaly? a. Absence of a urethral opening b. Penis shorter than usual for age c. Urethral opening along dorsal surface of penis d. Urethral opening along ventral surface of penis
Urethral opening along ventral surface of penis
What is the next step in diagnosis of urinary tract infections when urine dipstick shows nitrites and urinalysis shows hematuria and white blood cells?
Urine culture
What major complication is noted in a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen
Water and Sodium Retention
Clinical manifestations of nephrotic syndrome
Weight gain Puffiness of face (facial edema): • Especially around the eyes Abdominal swelling (ascites) Pleural effusion Labial or scrotal swelling Edema of intestinal mucosal, possibly causing: • Diarrhea • Anorexia • Poor intestinal absorption Ankle or leg swelling Irritability Easily fatigued Lethargic Blood pressure normal or slightly decreased Susceptibility to infection Urine alterations: • Decreased volume • Frothy
What teaching can be included for prevention of UTI?
Wiping front to back Avoid soaking in bubble baths Limit caffeine
A toddler, who fell out of a second-story window, had brief loss of consciousness and vomited 4 times. Since admission, the child has been alert and oriented. The mother asks why a computed tomography (CT) scan is required when the child ―seems fine.‖ The nurse should base the response on the need to monitor for what possible complication? a. A brain injury b. Coma c. Seizures d. Skull fracture
a. A brain injury
The nurse is conducting discharge teaching with parents of a preschool child with a myelomeningocele, repaired at birth, who is being discharged from the hospital after a urinary tract infection (UTI). Which should the nurse include in the discharge instructions related to management of the child's genitourinary function? (Select all that apply.) a. Continue to perform the clean intermittent catheterizations (CIC) at home. b. Administer the oxybutynin chloride as prescribed. c. Reduce fluid intake in the afternoon and evening hours. d. Monitor for signs of a recurrent UTI. e. Administer furosemide as prescribed
a. Continue to perform the clean intermittent catheterizations (CIC) at home. b. Administer the oxybutynin chloride as prescribed. d. Monitor for signs of a recurrent UTI.
The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? (Select all that apply.) a. Do not reuse needles. b. Inject insulin when it is cold. c. Flex or tense the muscle during injection. d. Rotate sites. e. Do not move the direction of the needle-syringe during insertion or withdrawal.
a. Do not reuse needles. Correct d. Rotate sites. Correct e. Do not move the direction of the needle-syringe during insertion or withdrawal.
A nurse should expect which cerebrospinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis? (Select all that apply.) a. Elevated white blood cell (WBC) count b. Decreased protein c. Decreased glucose d. Cloudy in color e. Increase in red blood cells (RBCs)
a. Elevated white blood cell (WBC) count c. Decreased glucose d. Cloudy in color
The nurse has administered a medication to a child. Which reaction is considered a common adverse medication reaction among children? a. Fixed eruption b. Maculopapular rash c. Sandpaper rash d. Anaphylaxis
a. Fixed eruption
Which problem is most often associated with myelomeningocele? a. Hydrocephalus b. Craniosynostosis c. Biliary atresia d. Esophageal atresia
a. Hydrocephalus
Spastic cerebral palsy is characterized by what presentation? a. Hypertonicity and poor control of posture, balance, and coordinated motion b. Athetosis and dystonic movements c. Wide-based gait and poor performance of rapid, repetitive movements d. Tremors and lack of active movement
a. Hypertonicity and poor control of posture, balance, and coordinated motion
Which drug would be used to treat a child who has increased intracranial pressure (ICP) resulting from cerebral edema? a. Mannitol b. Epinephrine hydrochloride c. Atropine sulfate d. Sodium bicarbonate
a. Mannitol
A 14 year old is in the intensive care unit after a spinal cord injury 2 days ago. Which nursing care interventions are needed for this child? (Select all that apply.) a. Monitoring and maintaining systemic blood pressure b. Administering corticosteroids c. Minimizing environmental stimuli d. Discussing long-term care issues with the family e. Monitoring for respiratory complications
a. Monitoring and maintaining systemic blood pressure b. Administering corticosteroids e. Monitoring for respiratory complications
What is the most common problem for children born with a myelomeningocele? a. Neurogenic bladder b. Intellectual impairment c. Respiratory compromise d. Cranioschisis
a. Neurogenic bladder
What is an appropriate intervention while the child with nephrotic syndrome is confined to bed? a. Restraining child as necessary b. discouraging parents from holding child c. doing passive range of motion exercises once a day d. adjusting activities to childs tolerance level
adjusting activities to childs tolerance level
An infant diagnosed with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care? (Select all that apply.) a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention
a. Observe closely for signs of infection. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention
Which condition can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection
a. Osteoporosis
A 3-year-old child is status postshunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? (Select all that apply.) a. Personality change b. Bulging anterior fontanel c. Vomiting d. Dizziness e. Fever
a. Personality change Correct c. Vomiting Correct e. Fever Correct
The nurse is caring for an infant with developmental dysplasia of the hips (DDH). Which clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani sign b. Unequal gluteal folds c. Negative Babinski's sign d. Trendelenburg's sign e. Telescoping of the affected limb f. Lordosis
a. Positive Ortolani sign b. Unequal gluteal folds
Which measure is important in managing hypercalcemia in a child who is immobilized? a. Promoting adequate hydration b. Changing position frequently c. Encouraging a diet high in calcium d. Providing a diet high in protein and calories
a. Promoting adequate hydration Correct
The nurse is evaluating a child who has been outside in the woods at camp. The child has multiple, small annular lesions without an indurated center, on the arm. The nurse suspects Lyme disease. Which stage of Lyme disease does the nurse believe that this child is exhibiting? a. Second stage b. First stage c. Third stage
a. Second stage
What effect does immobilization have on the cardiovascular system? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes
a. Venous stasis
The nurse is planning care for a school-age child with bacterial meningitis. The plan should include a. keeping environmental stimuli at a minimum. b. avoiding giving pain medications that could dull sensorium. c. measuring head circumference to assess developing complications. d. having child move head side to side at least every 2 hours.
a. keeping environmental stimuli at a minimum. Correct
A 15 year old is admitted to the intensive care unit (ICU) with a spinal cord injury. The MOST appropriate nursing interventions for this adolescent are (Select all that apply.) a. monitoring neurologic status. b. administering corticosteroids. c. monitoring for respiratory complications. d. discussing long-term care issues with the family. e. monitoring and maintaining hemodynamic status.
a. monitoring neurologic status. Correct b. administering corticosteroids. Correct c. monitoring for respiratory complications. Correct e. monitoring and maintaining hemodynamic status. Correct
Hydrocephalus and Ventriculoperitoneal shunt o Postoperative care- clinical findings that warrants immediate interventions
abdominal distention
Hypospadias- complications
appearance after surgery is often normal, what would alert you that something is wrong, blue/dusky in color
an 8 year old boy is found to have a mild concussion and is to be discharged home. The parent is instructed to check their child for responsiveness every 2 hours and to wake hi for this assessment after he goes to sleep. They call the nurse and say they are afraid to allow him to go to sleep. How would the nurse respond? a. you can bring him to the hospital before bedtime, if you prefer b. if your son becomes difficult to awaken bring him to the hospital. c. theres no need to worry because you son is past the critical period. d. awakening your son throughout the night is no longer necessary
b. if your son becomes difficult to awaken bring him to the hospital.
a child is admitted to the pediatric intensive care unit with acute bacterial meningitis. Which intervention would the nurse include in the plan of care? a. offering clear liquids when the child is awake b. checking the child level of consciousness hourly c. assessing the childs BP every 4 hours d. administering the prescribed oral antibiotic medication
b checking LOC is part of the total neurological check, it can reveal increasing ICP as result of cerebral inflammation.
How much folic acid is recommended for women of childbearing age? a. 0.1 mg b. 0.4 mg c. 1.5 mg d. 2 mg
b. 0.4 mg
The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor for? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones
b. Decreased metabolic rate
The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.
b. He is old enough to give most of his own injections.
Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones b. Low arterial pH c. Elevated serum carbon dioxide d. Elevated serum phosphorus
b. Low arterial pH
Which finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy? a. Tremulous movements at rest and with activity b. Positive Babinski reflex c. Writhing, uncontrolled, involuntary movements d. Clumsy, uncoordinated movements
b. Positive Babinski reflex
Which child is most likely to develop a bacterial infection of the skin? a. The child with a previous bacterial skin infection b. The child with leukemia c. The child who is recovering from pneumonia d. The child who has a sibling with diabetes
b. The child with leukemia
The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him a. prone and tube feed. b. prone, turn head to side, and nipple feed. c. supine in infant carrier and nipple feed. d. supine, with defect supported with rolled blankets, and nipple feed.
b. prone, turn head to side, and nipple feed.
What marks on a baby's skin may indicate an underlying problem that requires notification of a physician? a. Mongolian spots on the back b. Telangiectatic nevi on the nose or nape of the neck c. Petechiae scattered over the infant's body d. Erythema toxicum anywhere on the body
c. Petechiae scattered over the infant's body
A 6-year-old child with acute renal failure is being transferred out of the intensive care unit. Considering their diagnoses, which child would be the MOST appropriate roommate for this child? a. 6-year-old child with pneumonia b. 4-year-old child with gastroenteritis c. 5-year-old child who has a fractured femur d. 7-year-old child who had surgery for a ruptured appendix
c. 5-year-old child who has a fractured femur
Diabetes insipidus is a disorder of which organ? a. Anterior pituitary b. Posterior pituitary c. Adrenal cortex d. Adrenal medulla
c. Adrenal cortex
What is the characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 18 years. d. Oral agents are often effective for treatment
c. Age at onset is usually younger than 18 years.
A child has come into the emergency department after a confirmed bite from a brown recluse. Which action can the nurse take to alleviate pain? a. Elevate the affected area. b. Place an ace wrap on the bite. c. Apply a cool compress. d. Administer Benadryl
c. Apply a cool compress.
A nurse is caring for an infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? (Select all that apply.) a. Lordosis b. Positive Babinski sign c. Asymmetric thigh and gluteal folds d. Positive Ortolani and Barlow tests e. Shortening of limb on affected side
c. Asymmetric thigh and gluteal folds Correct d. Positive Ortolani and Barlow tests Correct e. Shortening of limb on affected side Correct
The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? (Select all that apply.) a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone
c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on what information? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children need to learn to manage their diabetes. d. The parents are better able to manage the disease.
c. Children need to learn to manage their diabetes.
A current recommendation to prevent neural tube defects is the administration of what supplement? a. Vitamin A throughout pregnancy b. Multivitamin preparations as soon as pregnancy is suspected c. Folic acid for all women of childbearing age
c. Folic acid for all women of childbearing age
The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hips (DDH). What information should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove the harness several times a day to prevent contractures. c. Hip stabilization usually occurs within 12 weeks. d. Place a diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.
c. Hip stabilization usually occurs within 12 weeks.
The nurse is caring for a school-age child with hyperthyroidism (Graves' disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply.) a. Constipation b. Hypotension c. Hyperthermia d. Tachycardia e. Vomiting
c. Hyperthermia d. Tachycardia e. Vomiting
The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome? (Select all that apply.) a. Palpable distal pulse b. Capillary refill to extremity of <3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity
c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity
When caring for a child with probable appendicitis, the nurse should be alert to recognize what sign of perforation? a. Bradycardia b. Anorexia c. Sudden relief from pain d. Decreased abdominal distention
c. Sudden relief from pain
An advantage of continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents that require dialysis is that a. hospitalization is only required several nights per week. b. dietary restrictions are no longer necessary. c. adolescents can carry out procedures themselves. d. insertion of catheter does not require surgical placemen
c. adolescents can carry out procedures themselves.
Clinical manifestations of increased intracranial pressure (ICP) in infants are (Select all that apply.) a. low-pitched cry. b. sunken fontanel. c. drowsiness. d. irritability. e. distended scalp veins. f. increased blood pressure.
c. drowsiness. d. irritability. e. distended scalp veins.
A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, baseball, and swim. The nurse's response should be based on knowledge that a. exercise is contraindicated. b. soccer and baseball are too strenuous, but swimming is acceptable. c. exercise is not restricted unless indicated by other health conditions. d. the level of activity depends on the type of insulin required.
c. exercise is not restricted unless indicated by other health conditions. Correct
The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves' disease). Which statement made by the parent indicates a correct understanding of the teaching? a. ―I would expect my child to gain weight while taking this medication.‖ b. ―I would expect my child to experience episodes of ear pain while taking this medication.‖ c. ―If my child develops a sore throat and fever, I should contact the physician immediately.‖ d. ―If my child develops the stomach flu, my child will need to be hospitalized.‖
c. ―If my child develops a sore throat and fever, I should contact the physician immediately.‖
The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching? a. ―These injections will help with the hypertension.‖ b. ―We're glad the injections only need to be given once a month.‖ c. ―The red blood cell count should begin to improve with these injections.‖ d. ―Urine output should begin to improve with these injections.
c. ―The red blood cell count should begin to improve with these injections.
which nursing care would the nurse provide for an infant the first 24 hours after surgical placement of a ventriculoperitoneal shunt for hydrcephaus? a. medicating the infant for pain b. placing the infant in high fowlers c. positioning the infant on the side that has the shunt d. monitoring the infant for increasing ICP
d shunt may become obstructed leading to accululation of CSF and increased ICP
The nurse is performing a Glasgow Coma Scale (GCS) on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record? a. 8 b. 11 c. 13 d. 15
d. 15
Which is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? a. Increased metabolism b. Increased venous return c. Increased cardiac output d. Decreased exercise tolerance
d. Decreased exercise tolerance Correct
The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which instructions should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.
d. Elevate casted arm when resting and when sitting up.
Which symptom is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination
d. Frequent urination
The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What is the most essential part of the nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness
d. Level of consciousness
Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? a. Aspirin b. Corticosteroids c. Cytotoxic drugs such as methotrexate d. Nonsteroidal antiinflammatory drugs (NSAIDs)
d. Nonsteroidal antiinflammatory drugs (NSAIDs)
What is an advantage of peritoneal dialysis? a. Treatments are done in hospitals. b. Protein loss is less extensive. c. Dietary limitations are not necessary. d. Parents and older children can perform treatments.
d. Parents and older children can perform treatments.
Which nursing intervention is appropriate to assess for neurovascular competency in a child suspected of experiencing compartment syndrome? a. The degree of motion and ability to position the extremity. b. The length, diameter, and shape of the extremity. c. The amount of swelling noted in the extremity and pain intensity. d. The skin color, temperature, movement, sensation, and capillary refill of the extremity
d. The skin color, temperature, movement, sensation, and capillary refill of the extremity
Which statement best describes a myelomeningocele? a. Fissure in the spinal column that leaves the meninges and the spinal cord exposed. b. Herniation of the brain and meninges through a defect in the skull. c. Hernial protrusion of a sac-like cyst of meninges with spinal fluid but no neural elements. d. Visible defect with an external sac-like protrusion containing meninges, spinal fluid, and nerves.
d. Visible defect with an external sac-like protrusion containing meninges, spinal fluid, and nerves.
The nurse is caring for an immobilized preschool child. During this period of immobilization, the nurse's BEST action is to a. encourage wearing pajamas. b. let the child have few behavioral limitations. c. keep child away from other immobilized children if possible. d. take child for a "walk" by wagon outside the room.
d. take child for a "walk" by wagon outside the room. Correct
What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition? a. ―One of the parents carries a defective gene that causes myelomeningocele.‖ b. ―A deficiency in folic acid in the father is the most likely cause.‖ c. ―Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele.‖ d. ―There may be a variety of different causes.‖
d. ―There may be a variety of different causes.‖
Define uremic frost
deposits of urea on the skin
Grave's Disease (hyperthyroidism)
excess secretion of TH, Thyrotoxicosis (thyroid "crisis" or thyroid "storm") may occur from sudden release of TH. Although thyrotoxicosis is unusual in children, it can be life threatening.
Signs of neurosurgical emergency
fixed and dilated pupil
Which laboratory finding in conjunction with the presenting symptoms, indications nephrosis? a. Hypoalbuminemia b. low specific gravity c. decrease hemoglobin d. decreased hematocrit
hypoalbuminemia
Organ involvement in diabetes insipidus and the clinical manifestations of diabetes insipidus
hypofunction of the posterior pituitary gland
DDH (developmental dysplasia of hip) Treatment with Pavlik harness
is it worn continuously? When can you expect hip stabilization? 6-12 weeks
The diet of a child with chronic renal failure is usually characterized as a. high in protein. b. low in vitamin D. c low in phosphorus. d. supplemented with vitamins A, E, and K.
low in phosphorus
Clinical Manifestations of thyroid storm
m severe irritability, vomiting, diarrhea, hyperthermia, HTN, severe tachycardia
Lab findings in nephrotic syndrome
massive proteinuria hypoalbuminemia hyperlipidemia edema
An important nursing intervention when caring for a child with myelomeningocele in the postoperative stage is to -place child on his or her side to decrease pressure on the spinal cord. -apply a heat lamp to facilitate drying and toughening of the sac. -keep skin clean and dry to prevent irritation from diarrheal stools. -measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.
measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus. Correct
Care of limb after cast applied
monitoring for s/sx of compartment syndrome
Oculovestibular testing - when is it appropriate and how is the test performed
never perform this on a child that is awake or has tympanic membrane rupture, why? What is this test and what can happen if your patient is await
Nursing assessments for a child post head injury
observation of LOC, pupillary reaction, vital signs, temp
Signs of DIC
petechia
The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. The MOST appropriate nursing assessment in this case is a. reactivity of pupils. b. doll's head maneuver. c. oculovestibular response. d. funduscopic examination to identify papilledema.
reactivity of pupils.
Major goals of the therapeutic management of juvenile idiopathic arthritis are to -prevent joint discomfort and regain proper alignment. -prevent loss of joint function and achieve cure. -prevent physical deformity and preserve joint function. -prevent skin breakdown and relieve symptoms.
prevent physical deformity and preserve joint function. Correct
External defects of the genitourinary tract such as hypospadias are usually repaired as early as possible to a. prevent urinary complications. b. prevent separation anxiety. c. promote acceptance of hospitalization. d. promote development of normal body image.
promote development of normal body image.
Clinical manifestations (early and late) of increased ICP in both children and infants
s bradycardia, decreased motor response to command, decreased sensory response to sensory, alterations in pupil size and reactivity, extension or flexion posturing, Cheyne-stokes respirations, papilledema, decreased LOC, coma
Clinical manifestations that would alert you to a child having hydrocephalus
s head enlargement, irritable, poorly feeding, changes in LOC, shrill, high-pitch cry, lower extremity spasticity
The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. In the discussion the nurse should include that a. parental protection is essential until the child reaches adulthood. b. cognitive impairment is to be expected with hydrocephalus. c. shunt malfunction or infection requires immediate treatment. d. most usual childhood activities must be restricted.
shunt malfunction or infection requires immediate treatment. Correct
Treatment of hypoglycemia
the simpler the carbohydrate, the more rapidly it will be absorbed (8 oz of milk equals 15 g of carbohydrate). The rapidly releasing sugar is followed by a complex carbohydrate (such as a slice of bread or a cracker) and by a protein (such as peanut butter or milk)
What clinical manifestations would be seen in a child with chronic renal failure?
unpleasant uremic breath odor
A nurse is caring for an infant with a suspected urinary tract infection. Based on the nurses knowledge of UTIs, which clinical manifestations would be observed? a. vomiting b. jaundice c. swelling of the face d. persistent diaper rash e. failure to gain weight
vomiting persistent diaper rash failure to gain weight
Acute renal failure and complications
water intoxication and hyponatremia (hyperkalemia, HTN, anemia,
In a non potty trained child with nephrotic syndrome, the best way to detect fluid retention is to: a. weigh daily b. test the urine for hematuria c. measure the abdominal girth weekly d. count the number of wet diapers
weigh daily
