Pedi Practice - From Class
Marfan syndrome is a congenital defect sometimes associated with CHD. Affected persons have valvular problems, increased dilatation of the Aorta, are tall and lean in stature with a "wingspan" that exceeds their height. Abe Lincoln was thought to have Marfan syndrome T/F
1 true
A nurse is evaluating the background of four teenagers. Which statements by the teens should the nurse recognize as psychosocial factors contributing to the risk of pregnancy for these teens? Select all that apply. "I just want someone to love me." "I want a prescription for oral contraceptives." "I have a hard time feeling good about myself." "I'd leave my boyfriend, but I'm afraid of what he might do."
1,3,4
The nurse explains to the parents of a 5 year old with a VSD that a cardiac cath has been scheduled to: Identify the specific location of the defect Determine the degree of cardiomegaly present Confirm the presence of a pansystolic murmur Establish the presence of ventricular hypertrophy
1. A cardiac catheterization will identify the exact location of the VSD as well as assess pulmonary pressures.
A health care provider is preparing to examine the throat of a child diagnosed with acute epiglottis. A priority nursing responsibility would be to? 1.) have a tracheotomy set at the bedside 2.) immobilize the child's head 3.) restrain the child's arms 4.) have oxygen available
1. have a tracheotomy set at the bedside
Gillian-Barre Syndrome is an uncommon disorder that is appearing in the news more often lately. Which of the following statements are true about gillian barre syndrome in children? 1. Is usually fatal in children 2. the syndrome can be autoimmune 3. involves paralysis starting from the neck to the feet 4. may be a result of previous vital or bacterial infection 5. can become life threatening if it reaches the diaphragm
2, 4, 5 2. the syndrome can be autoimmune 4. may be a result of previous vital or bacterial infection 5. can become life threatening if it reaches the diaphragm
ECHO can be used to detect the pressure in the chambers of the heart and it's surrounding vessels. T/F
2. False Cardiac Catheterization is used for pressure readings inside the heart.
A neoplasm can best be described as: A tumor lacking structural differentiation The production of cancer Genes found in the chromosome of tumor cells Any abnormal growth of new tissues that may be benign or cancerous.
4
Which sign or symptom observed in a sleeping 2-year-old child immediately after a tonsillectomy necessitates reporting and follow-up care? pulse of 110 beats/min. a blood pressure of 96/64 mm Hg. nausea. frequent swallowing
4. Frequent swallowing
which of the following statements is false The prognosis of acute lymphoblastic leukemia is based on the white cell count at diagnosis As the bone marrow expands, joint and bone may occur An early development in ALL is a faint, pink rash that extends over the torso Genetic factors and chromosome abnormalities may play a role in its development
An early development in ALL is a faint, pink rash that extends over the torso
The school nurse taught elementary school teachers about occurrences of violence towards children. The nurse knows that further teaching is necessary if a teacher makes which of the following statements? Children with special needs are less vulnerable to physical abuse than other children. Physically abused children may appear overly submissive and eager to please their teacher. Children who are physically abused by their parents are more likely to abuse siblings. Poor hygiene and inappropriate clothing are possible signs of child abuse.
Answer 1
The interval when a client manifests signs and symptoms specific to a type of infection is the: 1. Illness Stage 2. Convalescence 3. Prodromal Stage 4. Incubation Period
Answer 1. Illness stage
Which nursing intervention best helps decrease anxiety for the parents of a child scheduled for cardiac surgery? Tell the parents not to worry, because the physician performs this procedure all the time. Obtain an order for anti-anxiety medication for the parents, if requested. Teach the parents and the child about the surgery 1 month before the procedure. Explain the steps that will occur before and after surgery. The parents need something tangible to focus on.
Answer 4
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 20,000/ul. Based on the laboratory results, which intervention will the nurse document in the plan of care? Monitor closely for signs of infection 2. Monitor the temperature every 4hours 3. Initiate protective isolation precautions 4. Use soft small toothbrush for mouth care
Correct Ans 4 If a child is severely thrombocytopenic and has a platelet count less than 20,000/ul, bleeding precautions need to be initated because of increased risk of bleeding or hemorrhage. Options 1,2,3 are related to the prevention of infection rather than bleeding
An infant diagnosed with hypertrophic pyloric stenosis is admitted with history of vomiting for several days. Which nursing diagnosis would be the priority? Deficient fluid volume related to prolonged vomiting Ineffective airway clearance related to impaired swallowing Imbalanced nutrition: less than body requirements related to prolonged vomiting Anxiety related to loss of body control
Deficient fluid volume related to prolonged vomiting
A typical, developmentally appropriate behavior of a toddler includes Egocentrism Pre operational thought principles of conservation solitary play
Egocentrism
The nurse understands that 'failure to thrive' in a child with cardiac disease is related to poor feeding due to Medications abnormal swallowing Fatigue due to increased work of breathing developmental delays
Fatigue due to increased work of breathing
A nursing student enters the room of a 6 year old child and immediately suspects the child has a cardiac disease by the following signs and symptoms The child has ptosis The child is gasping for air The child is connected to oxygen The child has soft, rounded, moon like fingernails
The child has soft, rounded, moon like fingernails
A 5 month old infant being assessed was born at 12 weeks gestation. The nurse doing the well-child check up should compare the baby to what norms? The development of a 10 week old The development of a 3 month old The development of a 5 month old The development of a 20 week old
The development of a 3 month old
Before the nurse enters the exam room, she reads in the chart that the child has torticollis. Knowing this, she assumes the child has an acquired condition that requires surgery a genetic condition that can be corrected with surgery a painless condition that can be corrected by BT and botox a congenital syndrome that increased neck hip and foot involvement
a painless condition that can be corrected by BT and botox
the nursing professor understands that her class has grasped major concepts of neurology when the class agrees with the following statements EXCEPT febrile seizures are the most common seizures in childhood anti convulsive medications are given to children for all seizures newborn seizures are often associated with hypoxic ischemia, infection, metabolic disorders seizures occur in about 1/10 chidlren
anticonvulsants are NOT given to children for all seizures- depends on the reason
A nurse is caring for a school aged child who possible has Reye syndrome. which of the following is a risk factor for developing Reye syndrome? recent history of aspirin recent history of bacterial diarrhea recent history of bacterial otitis media recent history of use of corticosteroids
asprin
A moher arrives at the ER with her 5 year old child and states that the child fell off a bunk bed. A head injury is suspected and the nurse checks the childs airway status and assesses the child for signs of increased intracranial pressure. Which of the following is a late sign of increased ICP in this child nausea bradycardia high pitched cry dilated scalp veins
bradycardia
The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the childs record and expects to note which symptoms of this disorder are documented? watery diarrhea ribbon line stools bright red blood and mucus in the stools profuse projective vomiting
bright red blood and mucus in the stools
A nurse is reviewing the medical record of an infant with hydronephrosis. Which of the following would the nurse expect to find in the hosiery and physical examination? Select all that apply Oliguria hypotension failure to thrive intermitted hematuria abdominal mass on palpation
failure to thrive, intermitted hematuria, abdominal mass on palpation
Congenital myelomeningocele is commonly associated with which of the following conditions? Hydrocephalus Microencephaly Cranial suture overlap Absence of cranial vault
2. Microencephaly
sickle cell anemia is a disease found only in people of african decent t/f
false
The usual treatment for iron-deficiency anemia includes: Vitamin B12 injection. Non-enteric-coated ferrous sulfate Enteric-coated or sustained-release ferrous sulfate. Whole blood transfusion.
B
a 9 year old comes to the clinic for a sick visit and expressed a concern that is developmentally approbate for their age. Which of the following statements would the nurse recognize as developmentally appropriate for the school ged child. the child is worried that he is sick and will need surgery the child is worried that he is going to grow up disfigured the child is fearful of loud noises the child is fearful of pain
the child is worried that he is sick and will need surgery
The nurse is caring for an 11 year old with otalgia and fever. when viewing the child's medical record, which of the following would the nurse identify as a risk factor for acute otitis media? the child was breastfed, not bottle fed the child lives in a family with smokers the childs first ear infection was 3 months ago the child has disoriented external ear structures
the child lives in a family with smokers
which of the following best describes erikson's psychosocial development task for the school age child? the child is developing his or her own personal identity the child understands and response to discipline the child is learning to do things on its own the child wants to successfully complete new skills to achieve increased sense of self worth
the child wants to successfully complete new skills to achieve increased sense of self worth
The most appropriate instructions a nurse should supply a client with regards to preventing antibiotic-resistant bacterial infection is: Wash hands after toileting and before meals Avoid crowds and contact with others who are ill Take the prescribed antibiotics at the time for which they are prescribed and for the duration directed Request antibiotics for colds or flu that doesn't not come to an end in 2-3 days
Answer 3
a clinic nurse reviews the record of an infant and notes that the NP has documented a diagnosis of suspected Kirschprung's disease. The nurse reviews the assessment findings documented in the record, knowing which symptoms most likely led the mother to seek health care for the infant? diarrhea projectile vomiting foul smelling ribbon like stools regurgitation of feedings
foul smelling ribbon like stools
While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse what the difference is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a malignant tumor in that benign tumors Do not cause damage to adjacent tissue. Do not spread to other tissues and organs. Are simply an overgrowth of normal cells. Frequently recur in the same site.
2
Which of the following behaviors by the nurse would be nontherapeutic when working with adolescent clients? Accept and support all behaviors exhibited by clients without question. Acknowledge feelings of anger precipitated by a client's behaviors. Provide honest feedback to the adolescent. Set limits on unacceptable client behaviors.
1
A child is admitted to the pediatric unit with idiopathic thrombocytopenic pupura. Which finding do you expect? oliguria petechiae dark colored urine external hemorrhage
petechiae
The infant measured 20 inches at birth. If the fans is following the normal pattern of growth which of the following ranges would be an expected height for this child at the age of 12 months? 27-29 32-34 36-38 40-42
27-29
A child is getting diagnostic work up for nephrotic syndrome. Which of the following lab results would the nurse not expect to see? increased WBC count hypercholesterolemia hypoalbuminemia proteinuria
increased white blood cell count
A 3 year old wants to do everyitng independently, including putting on shoes. Every day, no matter how hard he tries, he puts the shoes on the wrong feet until finally he is successful. According to Erikson, what developmental task is the child trying to master? autonomy vs shame initiative vs guilt trust vs mistrust industry vs inferiority
initiative vs guilt
The nurse is assessing a child. which of the following is not a clinical manifestation of legs-calve-perthes disease? mild hip pain and stiffness painless limp with walking intense pain requiring opiates limited ROM
intense pain requiring opiates
The most effective way to break the chain of infection is by: Practicing good hand hygiene. Wearing gloves. Placing clients in isolation. Providing private rooms for clients
Answer 1 Good hand hygiene is the most effective way to break the chain of infection. Wearing gloves can help in decreasing disease transmission, but clean hands are required for it to be truly effective. Placing clients in isolation is costly and often unnecessary, and clients can be psychologically harmed by isolation. Even providing private rooms for clients will not be effective if health care workers do not follow good hand hygiene practices.
The most common type of solid tumor in children is: Brain tumor Wilms tumor (kidney) Lymphoma Bone tumor
Answer 1 brain tumor
Nurses should evaluate family response to teen pregnancy. Which of the following psychosocial factors should be included in the nursing assessment of the family because of their potential influence on family response to teen pregnancy? Select all that apply. Educational and career level Cultural and religious beliefs Nutritional status Birth setting
Answers 1 & 2 Nutritional status is not psychosocial, same with birth setting
When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to: Discourage the use of stool softeners Assess temperature readings every six hours Avoid invasive procedures Encourage the use of a hard, brittle toothbrush
Avoid invasive procedures
The nurse is conducting a physical examination of a 7 year old girl prior to a cardiac catheterization. The nurse knows to pay particular attention to assessing the child's pedal pulses. How can the nurse best facilitate their assessment after the procedure? Mark the childs pedal pulses with an inedible marker, then document Mark the location of the childs peripheral pulses with an inedible marker Document the location and quality of the childs pedal pulses Assess the location and quality of the childs peripheral pulses
Document the location and quality of the childs pedal pulses
A child is admitted to the pediatric unit with idiopathic thrombocytopenic purpura. Which finding do you expect? Dark-colored urine Petechiae External hemorrhage Temperature more than 101°F (38.3° C)
Petechia Most common symptoms: easy bruising, petechiae, bleeding from mucous membranes. Dark colored urine many indicate concentrated urine. Hemorrhage is a rate physical finding, fever isn't always precent
A nurse is providing instruction to a mother of an infant diagnosed with gastroesophageal reflux disease. To assist in reducing the episodes of emesis, the nurse tells the mother to: Provide less frequent feedings Thicken the feedings by adding rice cereal to the formula Burp the infant less frequently during the feedings to prevent reflux thin the feedings by adding water to the formula so that it will go down easily
Thicken the feedings by adding rice cereal to the formula
Which question would be most helpful in obtaining a nursing history from the mother of an infant with suspected intussusception? Is your child eating normally? How often has your child been vomiting? What do your child's stools look like? When did your child last urinate?
What do your childs stools look like
The nursing student is taking care of a patient with Wilms tumor. He is reviewing what he is about to teach the patient's family prior to discharge. Which statement would his clinical nurse facility want to correct? Keep him away from crowds He must be clean and his teeth brushed When you suspect he has an infection, a rectal temperature is the most accurate method of getting an accurate reading Do not allow him to have a live vaccine, such as chickenpox vaccine or MMR
When you suspect he has an infection, a rectal temperature is the most accurate method of getting an accurate reading
A nurse is teaching a group of parents about fractures. Which of the following should be included in teaching? children need a longer time to heal from a fracture than an adult epiphyseal plate injuries may result in altered bone growth a green stick fracture is a complete break in the bone bones are unable to bend, so they break
epiphyseal plate injuries may result in altered bone growth
Parents of a 3 year old son ask the nurse for suggestions on how to deal with their nightmares. Which of the following suggestions would be LEAST ineffective? try to reassure him that it was a dream and not real talk to him that night about the details of the dreams keep a radio on with smoothing music to calm the child if they awaken from their dream and are frightened search the room to show him that there aren't any monsters
keep a radio on with smoothing music to calm the child if they awaken from their dream and are frightened
A nurse is evaluating a childs diet with the mother of a child with iron deficiency anemia. Which statement would the nurse most likely want to correct? my child doesn't drink sodas but rather drinks a;most half a gallon of milk a day for strong bones my son loves tofu i had diabetes in pregnancy but the midwife was aware of it and gave me some medicine i needed to take every day someone told me if my child gets fat, they may be anemic
my child doesn't drink sodas but rather drinks a;most half a gallon of milk a day for strong bones
When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be LEAST likely to note Parallel play cooperative play fantasy play dramatic play
parallel play
Craniosynostosis is premature closure of cranial sutures a condition that is only diagnosed at birth a common problem seen in infants whose mothers do not take folic acid an symmetrical share of the head used by "back to sleep"
premature closure of the cranial sutures
A nurse is assessing an infant who has been committing and experiencing diarrhea. Which of the following would indicate to the nurse that the infant is experiencing severe dehydration? Select all.. Sunken fontanels pink moist oral mucosa cool mottled extremities slightly increased urine output
sinken fontanels cool mottled extremeties
a toddlers parents want to begin toilet training him. as a rule, the best instructions you could give them is toilet training is a 12 month process the best time to bowel train is followed by a meal all children should be toilet trained by age 2 years bladder training is achieved before bowel training
the best time to bowel train is followed by a meal
A toddler's parents want to begin toilet training him. as a rule the best instruction you could give them is all children should be toilet trained by age 2 years toilet training is a 12 month process the best time to bowel train is following a meal children can remain dry during the night before they can do so during the day
the best time to bowel train is following a meal
The nurse is aware that a common physiologic adaptation of children with Tetralogy of Fallot is: Clubbing of fingers Slow, irregular respirations Subcutaneous hemorrhages Decreased red blood cell count
1. Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips.
A child with a known seizure disorder is hospitalized for an unrelated procedure. Upon walking the child back from the restroom, the nurse notices tonic-clonic movements. Which action should the nurse take first? Note the time Ease the child to the floor Clear the area of objects and pad the head Roll the child to side-lying position to protect the airway
1. Note the time
When palpating the brachial, radial, and femoral pulses of a neonate, the nurse notes a difference in pulse amplitude between the femoral and radial pulses bilaterally. This difference suggests: patent ductus arteriosus coarctation of the aorta diminished cardiac output left to right shunting in the heart.
2 A difference in pulse amplitude between the upper and lower extremities or between the femoral and radial pulses suggests a coarctation of the aorta (narrowing of the aorta below the left subclavian artery). A patent ductus arteriousus is associated with a bounding pulse due to left-to-right shunting of blood in the heart. A weak or thinner pulse indicates diminished cardiac output.
When talking with the parents of a Down Syndrome child, which of the following goals would be most appropriate for the child and family? Teaching the child one new thing every day Encouraging self-care skills in the child Establishing more lenient behavior standards Achieving age-appropriate social skills
2. Encouraging self-care skills in the child
The nurse is planning a community program to decrease adolescent pregnancy. According to research, successful community teen pregnancy prevention programs use which approaches? Focus on negative aspects of teen sexual behavior, pregnancy, and parenting. Have a board of directors made up of community dignitaries. Programs are short term due to limited teen attention span. Address societal issues of poverty and education.
3
Which respiratory illness is most commonly seen in children? asthma group epiglottitis mononucleosis
asthma
What time of treatment would be given for bronchiolitis Oxygen therapy Pulmonary toiling Antibiotics corticosteroids
pulmonary toiling
Nurse Betina is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature? Eustachian tubes Nasopharynx Tympanic membrane External ear canal
1. Eustachian tubes
A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse knows that teaching about management of the skin reaction has been effective when the patient says "I can use ice packs to relieve itching in the treatment area." "I can buy a steroid cream to use on the itching area." "I will expose the treatment area to a sun lamp daily." "I will scrub the area with warm water to remove the scales."
2
Which of the following is the best indicator of brain function in a child with a moderate brain injury? Pupil response Vital signs Level of consciousness Gross motor strength
3. Level of consciousness
When administering digoxin (Lanoxin) to an infant, the medication should be withheld and the physician notified if the: 1.) pulse rate is below 60 beats/min 2.) infant is dyspneic 3.) pulse rate is below 100 beats/min 4.) respiratory rate is above 40 breaths/min
3. Pulse rate is below 100 beats / minute
What congenital heart defect causes cyanosis in children? Atrial Septal Defect (ASD) Coarctation of the Aorta Ventricular Septal Defect (VSD) Transposition of the Great Vessels
4 With transposition of the great vessels, the pulmonary artery is attached to the left ventricle and the aorta is attached to the right ventricle. The child is cyanotic because blood reaches the tissues from the right ventricle before being oxygenated by the lungs. In atrial septal defect and ventricular septal defect, blood is shunted from the left side of the heart to the right side through patent openings. Because the blood travels from left to right, it's oxygenated and doesn't produce cyanosis. Coarctation of the aorta is a narrowing of the aorta that decreases the circulation of oxygenated blood to the body. With this condition, the child won't be cyanotic unless cardiac output drops.
In infectious diseases such as hepatitis B and C, a reservoir for pathogens is: The blood. The urinary tract. The respiratory tract. The reproductive tract
Answer 1 The blood is a reservoir for pathogens in hepatitis B and C. Neither organism can survive in the urinary, reproductive, or respiratory tract.
The nurse is assessing a four month-old infant. The nurse would anticipate finding that the infant would be able to Hold a rattle. Bang two blocks. Drink from a cup. Wave "bye-bye"
Answer 1. The age at which a baby will develop the skill of grasping a toy with help is 4 to 6 months.
A mother asks the nurse how to handle her 5-year-old child, who recently started wetting the pants after being completely toilet trained. The child just started attending nursery school 2 days a week. Which principle should guide the nurse's response? The child forgets previously learned skills The child experiences growth while regressing, regrouping, and then progressing The parents may refer less mature behaviors The child returns to a level of behavior that increases the sense of security.
Answer D. The stress of starting nursery school may trigger a return to a level of successful behavior from earlier stages of development. A child's skills remain intact, although increased stress may prevent the child from using these skills. Growth occurs when the child does not regress. Parents rarely desire less mature behaviors.
A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patient's self-esteem, the nurse plans to suggest that the patient limit social contacts until re-growth of the hair occurs. encourage the patient to purchase a wig or hat and wear it once hair loss begins. have the patient wash the hair gently with a mild shampoo to minimize hair loss. inform the patient that hair loss will not be permanent and that the hair will grow back.
B Rationale: The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patient's self-esteem.
The nurse is assessing a 6 y/o diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? Fever and infections Nausea and vomiting Excessive energy and high platelet count Cervical lymph node enlargement and positive acid-fast bacillus
Correct: 1. 1. Fever and infection are hallmark symptoms of leukemia. They occur because the bone marrow is unable to produce WBCs of the number and maturity needed to fight infection (CORRECT). 2. Nausea and vomiting are symptoms related to the treatment of cancer but not to the diagnosis of leukemia (omit #2). 3. The clients are frequently fatigued and have low platelet counts. The platelet count is low as a result of the inability of the bone marrow to produce the needed cells (omit #3). 4. Cervical lymph node enlargement is associated with Hodgkin's lymphoma, and positive acid-fast bacillus is diagnostic for tuberculosis (omit #4)."
The nurse is examining a 3 year old boy with acute otitis media who has a mild earache and temperature of 38.5C. Which of the following actions will be taken? Administer antivirals Administer antibiotics Obtain a culture of the middle ear fluid Instruct the parent to watch for worsening symptoms
Instruct the parent to watch for worsening symptoms
The nurse has provided nutritional teaching on foods high in folate to a client with folate deficiency related to malabsorption syndromes and poor nutrition. Which of the following foods, if chosen by the client, indicates that the client understands the teaching Bread and fish Potatoes and carrots Liver and dark green leafy vegetables Whole milk and eggs
Liver & dark green leafy veggies
Which of the following shows an example of Erik Erikson's developmental task for the infant? The infant plays the game of peek-a-boo The infant smiles as people walk past the crib The infant begins talking The infant cries when they have a wet diaper
The infant cries when they have a wet diaper
An infant is admitted to the hospital with a diagnosis of respiratory syncytial virus (RSV). The type of transmission based isolation precautions the nurse would set up would be? Standard precautions Contact precautions Droplet precautions airborne infection isolation precautions
droplet precautions
a mother brings her 11 month old child to the emergency room giving the nurse practitioner the following history. This morning my daughter suddenly started coughing, wheezing and has this horrible new sound when she breaths The nurse practitioner identifies the breathing sound as stridor. The Np develops a list of possible explanations. At the top of the list is croup asthma foreign body aspiration pneumonia
foreign body aspiration
Which is a priority nursing diagnosis in a child admitted to the hospital with acute asthma risk for infection imbalanced nutrition disturbed body image ineffective breathing pattern
ineffective breathing pattern
The nurse prepares for a Denver Screening test with a 3 year-old child in the clinic. The mother asks the nurse to explain the purpose of the test. The BEST response is to tell her that the test Measures potential intelligence. Assesses a child's development. Evaluates psychological responses. Diagnoses specific problems
Answer 2. The Denver Developmental Test II is a screening test to assess children from birth through 6 years in personal/social, fine motor adaptive, language and gross motor development. A child experiences the fun of play during the test.
An infant with Tetralogy of Fallot becomes cyanotic and dyspneic after a crying episode. To relieve the cyanosis and dyspnea, the nurse should place the infant in the: Orthopedic position Knee-chest position Lateral Sims' position Semi-Fowler's position
2 Flexing the hips and knees decreases venous return to the heart from the legs; when venous return to the heart is decreased, the cardiac workload is decreased.
Symptoms of an earache in and infant include external drainage, pain, and decrease in temp tugging at the ear and rolling head from side to side crying and pointing to affected ear redness of the cheeks and cyanosis of the ear
2. Tugging at the ear and rolling head from side to side
The mother of a child with a congenital cardiac defect asks the nurse why her child squats after exertion. The nurse should reply that this position: Reduces muscle aches Increases cardiac efficiency Enhances the pull of gravity Decreases blood volume in the extremities
2. When the child squats, blood pools in the lower extremities because of flexion of the hips and knees; less blood returns to the hear, enabling the heart to beat more effectively.
A 4 year old is undergoing allogenic bone marrow transplantation. This type of bone marrow transplantation means: The donor has an identical twin. Our 4 year old will receive his own bone marrow. The donor is not a perfect match. Cells are collected peripherally and returned to the body.
3
A adolescent is undergoing a needle biopsy for a lump in her right breast. The purpose of a biopsy is to: Remove & treat the patient's malignancy ASAP. Identify tumor markers that can be used to detect cancer or monitor response to therapy. Surgically remove living tissue from an organ or other part of the body for microscopic examination. Manipulate the immune system to resort, augment, or modulate its function.
3
Mandy, age 12, is 7 months pregnant. When teaching parenting skills to an adolescent, the nurse knows that which teaching strategy is least effective? Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model Initiating a teenage parent support group with first - and - second-time mother Using audiovisual aids that show discussions of feelings and skills Providing age-appropriate reading materials
4.
Which nursing action should be a priority when the parents first meet their infant with an open spinal defect? Have the parents feed the infant Encourage discussion of fears and concerns Provide written information reinforcing health care provider education Emphasize the infant's normal and positive features
4. Emphasize the infant's normal and positive features
Which is a priority nursing diagnosis in a child admitted with acute asthma? 1.) risk for infection 2.) imbalanced nutrition 3.) ineffective breathing pattern 4.) disturbed body image
Answer 3 ineffective breathing patterns
A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first?Heart rate, respiratory rate, and blood pressure Recent exposure to communicable diseases Number of immunizations received Height and weight
Answer A. The most important data to obtain on a child's arrival in the emergency department are vital sign measurements. The nurse should gather the other data later.
A client on the medical surgical floor is ordered a unit of packed red blood cells. While receiving the unit the client develops chills and a temperature of 102.4 degrees (F). The nurse: Notify the doctor and the blood bank Slows down the infusion recognizing this as a mild reaction while still monitoring the client Adds a leukocyte filter to the blood transfusion Stops the transfusion and removes the IV catheter
The correct answer is (d). Chills and fever are signs of an acute reaction. The blood transfusion should be stopped immediately. -
What notable sign may indicate increased intercranial pressure in an infant? Overflowing voiding Bulging fontanel when crying High-pitched cry Minimal lower extremity movement
2 Bulging fontanel when crying
Which of the following interventions by the nurse would not be appropriate when addressing scapegoating behaviors on a mental health unit? Ask the group to focus on their behaviors and feelings prior to the scapegoating Rescue the client who is being scapegoated from the group. Set limits on the behaviors. Anticipate the behavior and try to circumvent the process.
3.
When developing a plan of care for a male adolescent, the nurse considers the child's psychosocial needs. During adolescence, psychosocial development focuses on: Becoming industrious Establishing an identity Achieving intimacy Developing initiative
3. Erickson's trust vs. mistrust
An infant is admitted with a diagnosis of respiratory syncytial virus (RSV) infection . The type of transmission-based isolation precaution the nurse would set up would be: 1.) standard precautions 2.) droplet precautions 3.) contact precautions 4.) airborne infection isolation precautions
Answer 2 droplet precautions
In planning care for the adolescent with behavioral problems, which of the following would not be incorporated into the treatment planning process? The client's strengths and weaknesses The client's goals for retirement The client's developmental stage The underlying meaning of the behavior or problem
Answer 2.
When performing a physical examination on an infant, the nurse in charge notes abnormally low-set ears. This findings is associated with: Otogenous tetanus Tracheoesophageal fistula Congenital heart defects Renal anomalies
Answer D. Normally the top of the ear aligns with an imaginary line drawn across the inner and outer canthus of the eye. Ears set below this line are associated with renal anomalies or mental retardation. Low-set ears do not accompany otogenous tetanus, tracheoesophageal fistula, or congenital heart defects.
Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely? At 1 to 2 years of age At I week to 1 year of age, peaking at 2 to 4 months At 6 months to 1 year of age, peaking at 10 months At 6 to 8 weeks of age
Answer B. SIDS can occur any time between 1 week and 1 year of age. The incidence peaks at 2 to 4 months of age.
When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to stop the infusion if swelling is observed at the site. infuse the medication over a short period. administer the chemotherapy through small-bore catheter. hold the medication unless a central venous line is available.
Answer 1 Rationale: Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication should generally be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapy drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred
A female child, age 6, is brought to the health clinic for a routine checkup. To assess the child's vision, the nurse should ask: "Do you have any problems seeing different colors?" "Do you have trouble seeing at night?" "Do you have problems with glare?" "How are you doing in school?"
Answer 4 A child's poor progress in school may indicate a visual disturbance. The other options are more appropriate questions to ask when assessing vision in a geriatric patient.
During a well-baby visit, Jenny asks the nurse when she should start giving her infant solid foods. The nurse should instruct her to introduce which solid food first? Applesauce Egg whites Rice cereal Yogurt
Answer C. Rice cereal is the first solid food an infant should receive because it is easy to digest and is associated with few allergies. Next, the infant can receive pureed fruits, such as bananas, applesauce, and pears, followed by pureed vegetables, egg yolks, cheese, yogurt, and finally, meat. Egg whites should not be given until age 9 months because they may trigger a food allergy.
Parents of a newborn are confused when their child is diagnosed with a genetic disorder because neither of them has a defect. Testing is done and it is determined that both parents are carriers of the disorder even though they are asymptomatic. Understanding the principles of the Mendelian Pattern of Inheritance what condition is the likely reason for this genetic disorder? Recessive versus dominant condition Autosomal dominant conditions X-linked recessive condition Autosomal recessive condition
Answer 4 Autosomal recessive: A genetic condition that appears only in individuals who have received two copies of an autosomal gene, one copy from each parent. The gene is on an autosome, a nonsex chromosome. The parents are carriers who have only one copy of the gene and do not exhibit the trait because the gene is recessive to its normal counterpart gene. Wrong answers? Autosomal dominant Only one mutated copy of the gene will be necessary for a person to be affected by an autosomal dominant disorder. Each affected person usually has one affected parent. The chance a child will inherit the mutated gene is 50%. Autosomal dominant conditions sometimes have reduced penetrance, which means although only one mutated copy is needed, not all individuals who inherit that mutation go on to develop the disease. Examples of this type of disorder are Huntington's disease, neurofibromatosis type 1, neurofibromatosis type 2, Marfan syndrome, hereditary nonpolyposis colorectal cancer, and hereditary multiple exostoses, Tuberous sclerosis, Von Willebrand disease, acute intermittent porphyria which is a highly penetrant autosomal dominant disorder. Birth defects are also called congenital anomalies. Autosomal recessive Two copies of the gene must be mutated for a person to be affected by an autosomal recessive disorder. An affected person usually has unaffected parents who each carry a single copy of the mutated gene (and are referred to as carriers). Two unaffected people whom each carry one copy of the mutated gene have a 25% chance with each pregnancy of having a child affected by the disorder. Examples of this type of disorder are, cystic fibrosis, sickle-cell disease, Tay-Sachs disease, X-linked inheritance means that the gene causing the trait or the disorder is located on the X chromosome. Females have two X chromosomes, while males have one X and one Y chromosome. Common diseases are Red-Green Color blindness, Hemophilia A, Hemophilia B (Christmas Disease-Queen Victoria's descendants), Duchenne Muscular Dystrophy (It is characterized by rapid progression of muscle degeneration, eventually leading to loss of skeletal muscle control, respiratory failure, and death.) Becker's muscular dystrophy, a milder form of Duchenne, which causes slowly progressive muscle weakness of the legs and pelvis.
While teaching a 10 year-old child about their impending heart surgery, the nurse should Provide a verbal explanation just prior to the surgery. Provide the child with a booklet to read about the surgery. Introduce the child to another child who had heart surgery three days ago. Explain the surgery using a model of the heart
Answer 4. According to Piaget, the school age child is in the concrete operations stage of cognitive development. Using something concrete, like a model will help the child understand the explanation of the heart surgery.
The nurse is observing children playing in the hospital playroom. She would expect to see 4 year-old children playing Competitive board games with older children. With their own toys along side with other children. Alone with hand held computer games. Cooperatively with other preschoolers
Answer 4. Cooperative play is typical of the preschool period.
Nurse Raven should expect a 3-year-old child to be able to perform which action? Ride a tricycle Tie the shoelaces Roller-skates Jump rope
Answer A. At age 3, gross motor development and refinement in eye-hand coordination enable a child to ride a tricycle. The fine motor skills required to tie shoelaces and the gross motor skills requires for roller-skating and jumping rope develop around age 5.
While examining a 2-year-old child, the nurse in charge sees that the anterior fontanel is open. The nurse should: Notify the doctor Look for other signs of abuse Recognize this as a normal finding Ask about a family history of Tay-Sachs disease
Answer A. Because the anterior fontanel normally closes between ages 12 and 18 months, the nurse should notify the doctor promptly of this finding. An open fontanel does not indicate abuse and is not associated with Tay-Sachs disease.
A nursing student is questioning her instructor as to the relevance of gene knowledge for herself as a beginning practitioner. Which of the following statements by the nursing instructor depicts the significance of genetic advances on health care delivery? "It is nice for the nurse to have knowledge of genes, and the consequences of gene alterations." "Knowledge of how gene alterations are inherited is important for nursing interventions and teaching." "Knowledge of the function and inheritance of genes are explicit in health promotion." "It is advanced genetic nursing only that involves initiating a referral to genetic specialists."
Answer 4
The nurse is planning care for an 18 month-old child. Which of the following should be included the in the child's care? Hold and cuddle the child often. Encourage the child to feed himself finger food. Allow the child to walk independently on the nursing unit. Engage the child in games with other children
Answer 2. According to Erikson, the toddler is in the stage of autonomy versus shame and doubt. The nurse should encourage increasingly independent activities of daily living.
The nurse is assessing a six-month-old child. Which developmental skills are normal and should be expected? Speaks in short sentences. Sits alone. Can feed self with a spoon. Pulling up to a standing position.
Answer 2. The child develops language skills between the ages of one and three. A six-month-old child is learning to sit alone. The child begins to use a spoon at 12-15 months of age. The baby pulls himself to a standing position about ten months of age.
A 3 year old child is admitted with a fever of unknown origin. The mother reports that the child has been vomiting bright red blood at home and is unable to keep any fluids down. After the mother leaves the child eats supper without experiencing any nausea or vomiting. The following day the mother returns and soon reports the child has vomited and shows the nurse an emesis basin full of bright red blood. Which of the following actions would be best for the nurse take? Call the police to arrest the mother. Administer a PRN antiemetic as prescribed. Report the observations to the healthcare provider. Review the child's past medical records.
Answer 3
The nurse is reinforcing teaching concerning the use of a cromolyn sodium inhaler for a 10-year-old with asthma. Which would be an accurate concept to emphasize? 1.) you should use the inhaled whenever you feel some difficulty in breathing 2.) you should use the inhaler between meals 3.) you should use the inhaler regularly every day even if you are symptom free 4.) you can discontinue using the inhaler when you are feeling stronger
Answer 3 you should use the inhaler regularly every day even if you are symptom free
The nurse is caring for the mother of a newborn. The nurse recognizes that the mother needs more teaching regarding cord care because she: Keeps the cord exposed to the air Washer her hands before sponge bathing Washes the cord and surrounding area well with water at each diaper change Checks it daily for bleeding and drainage
Answer 3. Exposure to air helps dry the cord. Good hand washing is the prime mechanism for preventing infection. Washing the surrounding area is fine but wetting the cord keeps it moist and predisposes it to infection. It is important to check for complications of bleeding and drainage that might occur.
Becky, age 5, with intelligence quotient of 65 is admitted to the hospital for evaluation. When planning care, the nurse should keep in mind that this child is: Within the lower range of normal intelligence Mildly retarded but educable Moderately retarded but trainable Completely dependent on others for care
Answer B. According to the American Association on Mental Deficiency, a person with an intelligence quotient (IQ) between 50 and 70 is classified as mildly mentally retarded but educable. One with an IQ between 35 and 50 is classified as moderately retarded but trainable. One with an IQ below 36 is severely and profoundly impaired, requiring custodial care.
The nurse is aware that the most common assessment finding in a child with ulcerative colitis is: Intense abdominal cramps Profuse diarrhea Anal fissures Abdominal distention
Answer B. Ulcerative colitis causes profuse diarrhea, intense abdominal cramps, anal fissures, and abdominal distentions are more common in Crohn's disease.
Andrea with suspected rheumatic fever is admitted to the pediatric unit. When obtaining the child's history, the nurse considers which information to be most important? A fever that started 3 days ago Lack of interest in food A recent episode of pharyngitis Vomiting for 2 days
Answer C. A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Although the child may have a history of fever or vomiting or lack interest in food, these findings are not specific to rheumatic fever.
When caring for a 3 year old with Tetralogy of Fallot, he nurse expects to see fatigue and poor activity tolerance. This is caused by: poor muscle tone inadequate oxygenation of tissues. restricted blood flow leaving the heart inadequate intake of food.
2 he child's fatigue results from left to right shunting that occurs with tetralogy of Fallot. This shunting causes poorly oxygenated blood to circulate through the body. Poor muscle tone and inadequate food intake can result from this condition, but these are effects, not causes. Restricted blood flow leaving the heart is associated with aortic stenosis.
The nurse is evaluating a new mother feeding her newborn. Which observation indicates the mother understands proper feeding methods for her newborn? Holding the bottle so the nipple is always filled with formula. Allowing her seven - pound baby to sleep after taking 1 ½ ounces from the bottle. Burping the baby every ten minutes during the feeding. Warming the formula bottle in the microwave for 15 seconds and giving it directly to the baby
Answer 1. Holding the bottle so the nipple is always filled with formula prevents the baby from sucking air. Sucking air can cause gastric distention and intestinal gas pains. A seven-pound baby should be getting 50 calories per pound: 350 calories per day. Standardized formulas have 20 calories per ounce. This seven-pound baby needs 17.5 ounces per day. 17.5 ounces per day divided by 6-8 feedings equals 2-3 ounces per feeding. A normal newborn without feeding problems could be burped halfway through the feeding and again at the end. If burping needs to be at intervals, it should be done by ounces or half ounces, not minutes. Microwaving is not recommended as a method of warming due to the uneven heating of the formula. If used, the formula should be shaken after warming and the temperature then checked with a drop on the wrist. The recommended method of warming is to place the bottle in a pan of hot water to warm, and then check the temperature on the wrist before feeding.
If an infectious disease can be transmitted directly from one person to another, it is: A susceptible host. A communicable disease. A portal of entry to a host. A portal of exit from the reservoir
Answer 2 If an infectious disease is transmitted directly from one person to another, it is a communicable disease. Portals of entry and exit are the mechanisms of disease transmission. A susceptible host is a person who can acquire an infection.
While giving nursing care to a hospitalized adolescent, the nurse should be aware that the MAJOR threat felt by the hospitalized adolescent is Pain management. Restricted physical activity. Altered body image. Separation from family
Answer 3. The hospitalized adolescent may see each of these as a threat, but the major threat that they feel when hospitalized is the fear of altered body image, because of the emphasis on physical appearance.
While teaching a 10 year-old child about their impending heart surgery, the nurse should Provide a verbal explanation just prior to the surgery. Provide the child with a booklet to read about the surgery. Introduce the child to another child who had heart surgery three days ago. Explain the surgery using a model of the heart
Answer 4. According to Piaget, the school age child is in the concrete operations stage of cognitive development. Using something concrete, like a model will help the child understand the explanation of the heart surgery.
When developing a plan care for a hospitalized child, nurse Mica knows that children in which age group are most likely to view illness as a punishment for misdeeds? Infancy Preschool age School age Adolescence
Answer B. Preschool-age children are most likely to view illness as a punishment for misdeeds. Separation anxiety, although seen in all age group, is most common in older infants. Fear of death is typical of older school-age children and adolescents. Adolescents also fear mutilation
Nurse Liza is administering a medication via the intraosseous route to a child. Intraosseous drug administration is typically used when a child is: Under age 3 Over age 3 Critically ill and under age 3 Critically ill and over age 3
Answer C. In an emergency, intraosseous drug administration is typically used when a child is critically ill and under age 3.
Nurse Taylor suspects that a child, age 4, is being neglected physically. To best assess the child's nutritional status, the nurse should ask the parents which question? "Has your child always been so thin?" "Is your child a picky eater?" "What did your child eat for breakfast?" "Do you think your child eats enough?"
Answer C. The nurse should obtain objective information about the child's nutritional intake, such as by asking about what the child ate for a specific meal. The other options ask for subjective replies that would be open to interpretation.
When evaluating a severely depressed adolescent, the nurse knows that one indicator of a high risk for suicide is: Depression Excessive sleepiness A history of cocaine use A preoccupation with death
Answer D. An adolescent who demonstrates a preoccupation with death (such as by talking about death frequently) should be considered at high risk for suicide. Although depression, excessive sleepiness, and a history of cocaine use may occur in suicidal adolescents, they also occur in adolescents who are not suicidal.
When administering an I.M. injection to an infant, the nurse in charge should use which site? Deltoid Dorsogluteal Ventrogluteal Vastus lateralis
Answer D. The recommended injection site for an infant is the vastus lateralis (outer thigh between the hip and above the knee or rectus femoris muscles (rectus femoris is situated in the middle of the front of the thigh. )The deltoid is inappropriate. The dorsogluteal and ventrogluteal sites can be used only in toddlers who have been walking for about 1 year.
