Pediatrics Final Exam

SIADH nursing management

- accurate I/O - observe signs of fluid overload - seizure precautions - Administer ADH antagonizing medications

What are the essential features of intellectual disability?

- significant deficits in intellectual functioning - significant deficits or impairments in adaptive functioning - Onset before age 18 (during developmental years)

Pertussis vaccination should begin at which age?

2 months

Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process? A. Normal hemoglobin is replaced by abnormal hemoglobin. B. There is a lack of cellular hemoglobin being produced C. There is a deficiency in the production of WBC. D. The size and depth of the hemoglobin are affected.

A

2. The nurse has received report on four children. Which child should the nurse assess first? a. A school-age child in a coma with stable vital signs b. A preschool child with a head injury and decreasing level of consciousness c. An adolescent admitted after a motor vehicle accident is oriented to person and place d. A toddler in a persistent vegetative state with a low-grade fever

A preschool child with a head injury and decreasing LOC *Assessment of LOC remains the earliest indicator of improvement or deterioration in neurologic status

The mother of an infant who has had a series of hospitalizations related to bronchiolitis asks the healthcare provider why her infant seems to be prone to respiratory infections. Which of these provide the most accurate information about the respiratory systems of infants and young children? Select all that apply A. Respiratory airways of infants and young children are more narrow so they are easily obstructed. B. The metabolic rate and oxygen consumption of infants and young children are faster than older children. C. Please choose from one of the following options.Infants and young children have more rigid chest walls which increases the work of breathing. D. Decreased surfactant in infants and young children makes it harder for them to keep their airways open

A, B

While giving discharge instructions to the father of a child that was diagnosed with Asthma the nurse reviews all the following to prevent exacerbation ? Select all that apply A. get yearly flushot B. Keep rescue inhalers available at all times C. Remove molds and dust mites from the home. D. avoid flu shot if symptomatic

A, B, C

The nurse is caring for a child with neurofibromatosis. What local manifestations does the nurse expect to assess in this child? (Select all that apply.) a. Pigmented nevi b. Axillary freckling c. Café-au-lait spots d. Slowly growing cutaneous neurofibromas e. Wheals that spread irregularly and fade within a few hours

A, B, C, D

A patient is diagnosed with Sickle cell anemia the nurse reconizes that the best way to avoid a crisis is to educate the parents on prevention .What would the nurse include in her teaching? Select all that apply A. Stay hydrated B. Increase oxygen demand with exercise C. Encourage immunizations D. Hypothermia

A, C

Which dietary recommendations should a nurse make to an adolescent patient to manage constipation related to opioid analgesic administration? (Select all that apply.) a. Bran cereal b. Decrease fluid intake c. Prune juice d. Cheese e. Vegetables

A, C, E

Where do the lesions of atopic dermatitis (eczema) most commonly occur in the infant? (Select all that apply.) a. Cheeks b. Buttocks c. Extensor surfaces of arms and legs d. Back e. Trunk f. Scalp

A, C, E, F

The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations should be expected? (Select all that apply.) a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash

A, C, F *Vomiting, failure to gain weight, and persistent diaper rash

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? Select all that apply A. Swimming B. Soccer C. Basketball D. golf

A, D

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.) a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

A, D, E Apples, Carrot sticks, Strawberries *Avoid foods high in potassium and sodium

An infant 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, E, F * Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. I/O should be measured carefully. Abdominal distention could be a sign of peritonitis or a post op ileum.

A child who has just had definitive repair of a high rectal malformation is to be discharged. Which should the nurse address in the discharge preparation of this family? (Select all that apply.) a. Perineal and wound care b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as child returns home d. Reporting any changes in stooling patterns to practitioner e. Use of diet modification to prevent constipation

A,D,E *wound care instructions is necessary in a child who is being d/c after sx. Notify practitioner if any signs of an anal stricture. Constipation is avoided, since a firm stool will place strain on the suture line.

The nurse is discussing with a child and family the various sites used for insulin injections. Which site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

Abdomen

The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor? a. Abdominal swelling b. Weight gain c. Hypotension d. Increased urinary output

Abdominal swelling

Question 21: The RN is administering a dose of liquid oral abx. 30 mins later, the child vomits the dose. What should the RN do? A) Contact the physician immediately B) Offer a snack and administer another dose. C) Immediately administer another dose. D) Administer the next dose as ordered in 12 hours.

Administer the next dose as ordered in 12 hours

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. What does therapeutic management include? a. Administration of vitamin D b. Administration of cortisone c. Administration of stool softeners d. Administration of calcium carbonate

Administration of cortisone cortisone is administered to suppress the abnormally high secretions of adrenocorticotrophic hormone (ACTH). This inhibits the secretion of adrenocorticosteroid, which stems the progressive virilization.

Which is 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 20 years. d. Oral agents are often effective for treatment.

Age at onset is usually younger than 20 years. The immune-mediated type I DM typically has its onset in children or young adults.

when the nurse interview an adolescent, which of the following is especially important? A) focus the discussion on the peer group B) allow an opportunity to express feelings C) Use the same type of language as the adolescent D) Emphasize that confidentiality will always be maintained

Allow an opportunity to express feelings

Which explains the importance of detecting strabismus in young children?

Amblyopia, a type of blindness, may result

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered? A) at bedtime B) After meals C) Before meals D) on arising in the morning

At bedtime Injections are best given at bedtime to more closely approximate the physiologic response of GH.

The RN is ready to begin a physical exam on a 8M old infant. The child is sitting contentedly on the mother's lap chewing on a toy. What should the RN do?

Auscultate the heart and lungs

What is beneficial in reducing the risk of Reye syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin to treat fever associated with influenza

Avoidance of aspirin to treat fever associated with influenza

A mom cries out that her daughter is will not wake up and has stopped breathing. The nurse goes in the room the 7 month old HR is 80 the nurse has hit the button for help.What does she do next? A. Administer oxygen via face mask 4liters B. Administer 100% oxygen via bag valve mask C. administer oxygen via nasal canula 2liters D. give a albuterol treatment

B

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? A. Hepatomegaly, intrahepatic cholestasis B. Painful swelling of hands and feet; painful joints C. Cardiomegaly, systolic murmurs D. Circulatory collapse

B

The nurse is providing care to the family of a preschool-age child who is diagnosed with sickle cell disease. Which statement made by the sibling would initiate a teaching session is needed? Select all that apply A. "I like it when my brother is not sick ." B. "I am afraid that I caused my brother to get sick again because I was mad at him." C. "I never get to go over to my friends' houses because we are always taking my brother to the doctor." D. When I lied to my parents, I was punished for a week and my brother never gets punished."

B, C, D

Which is true concerning hepatitis B (select all) A)Hep B cannot exist in carrier state B) Hep B can be prevented by HBV vaccine C) Hep B can be transferred to an infant of a breastfeeding mother D) Onset of Hep B is insidious E) Principal mode of transmission for hep B is fecal-oral route F) Immunity to hep B occurs after one attack

B, C, D, F

Which therapeutic management treatment is implemented for children with Hirschsprung disease? A.Daily enemas B.Surgical removal of affected section of bowel C. Permanent colostomy D. Low-fiber diet

B, D

A child with sickle cell anemia (SCA) is admitted in a vasoocclusive crisis (VOC). Which of the following interventions should the nurse expect to see ordered? Select all that apply. a. Cold compresses to painful joints b. IV fluids started, and oral fluids encouraged c. Meperidine ordered every 4 hours for pain d. High-calorie, high-protein diet e. Antibiotics ordered for any existing infection

B, D, E

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased intracranial pressure (ICP) in an infant? (Select all that apply.) a. Tachycardia b. Alteration in pupil size and reactivity c. Increased motor response d. Extension or flexion posturing e. Cheyne-Stokes respirations

B, D, E Late signs of ICP in an infant or child include bradycardia, alteration in pupil size and reactivity, decreased motor response, extension or flexion posturing and cheyne-stokes respirations

The nurse is talking to a parent of an infant with severe atopic dermatitis (eczema). Which response(s) should the nurse reinforce with the parent? (Select all that apply.) a. "You can use warm wet compresses to relieve discomfort." b. "You will need to keep your infant's skin well hydrated by using a mild soap in the bath." c. "You should bathe your baby in a bubble bath two times a day." d. "You will need to prevent your baby from scratching the area by using a mild antihistamine." e. "You can try a fabric softener in the laundry to avoid rough cloth." f. "You should apply an emollient to the skin immediately after a bath."

B, D, F

The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

Begin 0.9% saline solution intravenously as prescribed. All DKA patients experience dehydration because of the osmotic diuresis, accompanied by depletion of electrolytes, sodium, potassium, chloride, phosphate, and magnesium.

How to manage GH deficiency

Biosynthetic growth hormone injections - hormone replacements including: thyroid extract, cortisone, testosterone or estrogens and progesterone - Response varies based on age, length of tx, frequency of doses, dosage, weight, and GH receptor amount - FAMILY SUPPORT NEEDS!! if truly GH deficiency, child will be affected by self body image and the tx is $$$

The major determinant of neonatal death in technologically developed countries is: a) birth weight b) short gestation c) long gestation d) HIV infection

Birth weight

A 6 year old with Leukemia has been admitted to the hospital. He is experiencing a lot of pain. The child asks the nurse if the pain will ever go away. The nurse should make which BEST response? A. "The pain will go away if you want it to '' B. 'Try not to think about it the more you think the worse it is'' C. ''I know it must hurt tell me when it does and I will try to make it hurt a little less'' D. ''Every time it hurts , press the call bell and I will give you something to make it go all away''

C

The nurse is correctly educating a patient on the use of his inhalers when she tells the patient to A. hold his/her breath for 60 seconds after inhaling the medication. B. only take his long acting steroid inhaler when he has symptoms. C. take his bronchodilating (albuterol) inhaler first. D. wait 2 seconds between puffs.

C

The nurse is facilitating a conference between the teachers and parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity disorder (ADHD). What does the nurse stress? a. Academic subjects should be taught in the afternoon. b. Low-interest activities in the classroom should be minimized. c. Visual references should accompany verbal instruction. d. The child's environment should be visually stimulating.

C

What is a characteristic of children with depression? a. Increased range of affective response b. Tendency to prefer play instead of schoolwork c. Change in appetite resulting in weight loss or gain d. Preoccupation with need to perform well in school

C

Which approach would be best to use to ensure a positive response from a toddler? A. Stand by the toddler, addressing him or her by name B. Call the toddler's name while picking him or her up C. Assume an eye-level position and talk quietly D. Call the toddler's name and say, "I'm your nurse"

C

Which is descriptive of bulimia during adolescence? A. Feelings of elation after the binge-purge cycle B. Profound lack of awareness that the eating pattern is abnormal C. Weight that can be normal, slightly above normal D. Strong sense of control over eating behavior

C

Which are clinical manifestations of increased intracranial pressure (ICP) in infants? (Select all that apply.) a. Low-pitched cry b. Sunken fontanel c. Diplopia and blurred vision d. Irritability e. Distended scalp veins f. Increased blood pressure

C,D, E *Diplopia and blurred vision, irritability, and distended scalp veins are signs of ICP in infants

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 which knowledge? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. Parents are better able to manage the disease.

Children are better able to manage the diabetes

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. What should follow this rapid-releasing sugar? a. Fat b. Fruit juice c. Several glasses of water d. Complex carbohydrate and protein

Complex carbohydrate and protein

After teaching the parents of a preschooler who has undergone tonsillectomy and adenoidectomy about appropriate foods to give the child after discharge. Which of the following if stated by the parents as appropriate foods, indicates successful teaching A) meatloaf and uncooked carrots B) pork and noodle casserole C) cream of chicken soup and orange sherbet D) hot dog and potato chips

Cream of chicken soup and orange sherbet liquids and soft foods are best tolerated by the child while the throat is sore

A 2 year old is hospitalized with suspected intussusception. Which finding is associated with intussusception? A) "currant jelly" stools B) projectile vomiting C) "ribbonlike" stools D) Palpable mass over the flank

Currant jelly stools * stools that contain blood and mucus

A child with autism spectrum disorder (ASD) is admitted to the hospital with pneumonia. The nurse should plan which priority intervention when caring for the child? A. Take the child frequently to the playroom to play with other children. B. Maintain frequent touch and eye contact with the child. C. Place child in a room with a roommate of the same age. D. Maintain a structured routine and keep stimulation to a minimum

D

Examination of the abdomen is performed correctly by the nurse in the following order: a. Inspection, palpation, percussion, and auscultation b. Inspection, percussion, auscultation, and palpation c. Palpation, percussion, auscultation, and inspection d. Inspection, auscultation, percussion, and palpation

D

The nurse is presenting an educational program to a group of parents about differences between anorexia nervosa (AN) and bulimia nervosa (BN) at a community outreach program. What statement by a parent would indicate a need for additional teaching? a. "A child with AN will turn away from food to cope, but a child with BN turns to food to cope." b. "A child with AN maintains rigid control and is introverted, but a child with BN is an extrovert and frequently loses control." c. "A child with AN denies the illness, but a child with BN recognizes the illness." d. "A child with AN is usually sexually active and seeks intimacy, but a child with BN avoids intimacy and is usually not sexually active."

D

What is characteristic of children with posttraumatic stress disorder (PTSD)? a. Denial as a defense mechanism is unusual. b. Traumatic effects cannot remain indefinitely. c. Previous coping strategies and defense mechanisms are not useful. d. Children often play out the situation over and over again.

D

Which drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting β2 agonists

D

Which is probably the most important criterion on which to base the decision to report suspected child abuse? A. Inappropriate parental concern for the degree of injury B. Inappropriate response of child C. Absence of parents for questioning about child's injuries D. Incompatibility between the history and injury observed

D

The nurse is caring for a 6-year-old girl who had surgery 12 hours ago. The child tells the nurse that she does not have pain, but a few minutes later she tells her parents that she does. Which should the nurse consider when interpreting this? a. Truthful reporting of pain should occur by this age. b. Inconsistency in pain reporting suggests that pain is not present. c. Children use pain experiences to manipulate their parents. d. Children may be experiencing pain even though they deny it to the nurse.

D * children may deny pain to the nurse because they fear receiving an injectable analgesic or because they believe they deserve to suffer as a punishment for a misdeed. They may refuse to admit pain to a stranger but readily tell a parent. Pain is whatever the experiencing person says it is, whenever the person says it exists

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage the child to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

D, E, F

Using knowledge of a child development, which of the following is the BEST approach when preparing a toddler for a procedure? A) avoid asking the child to make choices B) demonstrate the procedure on a doll C) Plan for teaching session to last about 20 minutes D) Show necessary equipment without allowing child to handle it.

Demonstrate the procedure on a doll

A nasal spray of desmopressin acetate (DDAVP) is used to treat which disorder? A) hypopituitarism B) Diabetes insipidus C) Acute adrenocortical insufficiency D) Syndrome of inappropriate antidiuretic hormone

Diabetes insipidius The drug of choice for the tx of diabetes insipidus is DDAVP, which is a synthetic analogue of vasopressin

Which muscle is contraindicated for the administration of immunizations in infants and young children?

Dorsogluteal * The deltoid is recommended for 12 months and older. * The ventrogluteal thigh site is safe for infants

The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

Dry skin Dry skin, mental decline and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common with juvenile hypothyroidism

The nurse demonstrates understanding of family-centered care by? A. expecting the child to perform self-care in activities of daily living B. assuming total care for the child C. limiting visitation to three time periods per day D. encouraging family visitation

Encouraging family visitation

Which is an important nursing consideration when caring for an infant with failure to thrive? a. Establish a structured routine and follow it consistently. b. Maintain a nondistracting environment by not speaking to child during feeding. c. Place child in an infant seat during feedings to prevent overstimulation. d. Limit sensory stimulation and play activities to alleviate fatigue.

Establish a structure routine and follow it consistently

Which is the priority nursing intervention for an unconscious child after a fall? A) Establish adequate airway B) Perform neurologica assessment C) Monitor intracranial pressure D) Determine whether a neck injury is present

Establish adequate airway

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. Which should the nurse explain about exercise in type 1 diabetes? a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.

Extra snacks are needed before exercise exercise lowers blood glucose, which can be compensated for by extra snacks.

The nurse is completing a pain assessment on a 4-year-old child. Which of the depicted pain scale tools should the nurse use with a child this age? a. FACES b. Numeric pain scales c. Word graphic scales d. Visual analogue scales

FACES *the pain scale appropriate for a 4 year old child is the FACES pain scale.

A 2-year-old child has been returned to the nursing unit after an inguinal hernia repair. Which pain assessment tool should the nurse use to assess this child for the presence of pain? a. FACES pain rating tool b. Numeric scale c. Oucher scale d. FLACC tool

FLACC tool *FLACC (face, legs, activity, cry, consolability) tool should be used with a 2 year old child.

FLACC Scale [2 months to 7 years] 0 = NO PAIN 10 = WORST PAIN

Face: 0 = no particular expression or smile 1 = occasional grimace, frown, withdrawn, disinterest 2 = freq to constant frown, clenched jaw, quivering chin Legs: 0 = normal position or relaxed 1 = uneasy, restless, tense 2 = Kicking or legs drawn up Activity: 0 = lying quietly, normal position, moves easily 1 = squirming, shifting back/forth, tense 2 = Arched, rigid, or jerking Cry: 0 = No cry (awake or asleep) 1 = moans or whimpers, occasional complaint 2 = crying steadily, screams, or sobs, freq complaint Consolability: 0 = content, relaxed 1 = reassured by occasional touch, hug, talking 2 = Difficult to console or comfort

True or False: Soy based formulas can be given to infants with congenital hypothyroidism

False

When nonpharmacologic methods of pain relief are used, the child should not be given analgesics. False True

False

When assessing a child with possible intussusception, which of the following would be LEAST likely to provide valuable information? A) stool inspection B) pain pattern C) Family history D) abdominal palpation

Family history intussusception is not believed to have a familial tendency.

Which condition in a child should alert a nurse for increased fluid requirements? A) Fever B) Mechanical ventilation C) CHF D) ICP

Fever *leads to insensible fluid loss in young children because of increased body surface area relative to fluid volume.

The RN teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which of the following interventions would be most appropriate? A) fitting the diaper under the straps B) leaving the harness off while the infant sleeps C) Check for skin redness under straps every other day D) Putting powder on the skin under the straps every day

Fitting the diaper under the straps. knee socks are also worn to prevent the straps and foot and leg pieces from rubbing directly on the skin. The infant should wear the harness continuously. Inspect skin several times a day, not every other day, for signs of irritation or redness.

Because children younger than 5 years are egocentric, the nurse should do which of the following when communicating with them? a. Focus communication on the child. b. Use easy analogies when possible. c. Explain experiences of others to the child. d. Assure child that communication is private.

Focus communication on the child

Which is considered a cardinal sign of DM? A) nausea B) seizures C) impaired vision D) frequent urination

Frequent urination Hallmarks of DM are glycosuria, polyuria, and polydipsia.

The child is vomiting/crying nonstop due to laying flat causing heartburn in chest. Over inflated stomach causing spitting up

GERD

What is the most common cause of hyperthyroidism?

Graves' Disease

Which physical sign is indicating respiratory failure in a child with RSV? Tachypnea Rales Wheezing Grunting

Grunting

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which 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.

He is old enough to give most of his own injections

A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show: a. bacteriuria, hematuria. b. hematuria, proteinuria. c. bacteriuria, increased specific gravity. d. proteinuria, decreased specific gravity.

Hematuria, proteinuria

What is the most common complication with Meckel's diverticulitis?

Hemorrhage

Which vaccine is now recommended for the immunization of all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines

Hepatitis B

The accumulation of stool with distention. Failure of internal anal sphincter to relax. Enterocolitis may occur

Hirschsprung Disease

A newborn's failure to pass meconium within the first 24 hours after birth may indicate which of the following? A) hirschsprung disease B) Celiac disease C) intussusception D) abdominal wall defect

Hirschsprung disease a congenital anomaly resulting in mechanism obstruction due to inadequate motility in an intestinal segment.

Lethargy, confusion, thirst, N/V, abdominal pain, signs of dehydration, rapid respirations, fruity breath all manifest: A) Hypoglycemia B) Hyperglycemia

Hyperglycemia

What condition may cause exophthalmos (protruding eyeballs) in children? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism

Hyperthyroidism

Projectile vomiting, hypochlordomic, hyponatremia is common with the GI disease

Hypertrophic Pyloric Stenosis

What is the best description of pyloric stenosis? a. Dilation of the pylorus b. Hypertrophy of the pyloric muscle c. Hypotonicity of the pyloric muscle d. Reduction of tone in the pyloric muscle

Hypertrophy of the pyloric muscle *occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel.

The nurse is teaching the parents of a child who is receiving methimazole (Tapazole) 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."

If my child develops a sore throat and fever, I shoud contact the physician. Children being tx with Tapazole must be carefully monitored for the s/e of the medications. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These s/sx should be immediately reported.

The nurse is assessing a 6-year-old girl who is visually impaired and very anxious. Appropriate actions by the nurse include all of the following except: Initiate IV access as soon as possible Use her name and announce your presence Allow her to hold her teddy bear Explain use of the call light system

Initate IV access as soon as possible

The nurse is examining a 4-year-old boy with parental concern for possible otitis media. The child has no ear pain and a temperature of 38.5 C. Which of the following actions will be taken? Obtain a culture of the middle ear fluid Instruct the parents to watch for worsening of symptoms Administer Antibiotics Administer Antivirals

Instruct the parents to watch for worsening of symptoms

The nurse is caring for a 4-year-old with bacterial conjunctivitis. Parent education will include all of the following except: Intermittent warm compresses to the eyes for comfort Good handwashing to prevent spread of infection No school or daycare until 24 hours of eye drops have been completed Instructions on use of steroid based eye drops to reduce inflammation

Instructions on use of steroid based eye drops to reduce inflammation

A nurse is conducting an in-service on childhood gastrointestinal disorders. Which statement is most descriptive of Meckel diverticulum? a. It is more common in females than in males. b. It is acquired during childhood. c. Intestinal bleeding may be mild or profuse. d. Medical interventions are usually sufficient to treat the problem.

Intestinal bleeding may be mild or profuse *Bloody stools are often presenting sign of Meckel diverticulum. It is associated with mild to profuse intestinal bleeding. It is twice as common in males. It is the most common congenital malformation of the GI tract.

What is invagination of one segment of bowel within another called? a. Atresia b. Stenosis c. Herniation d. Intussusception

Intussusception *occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it.

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.

Ketouria is suspected. urine testing is still performed to detect evidence of coterie. Urine testing for glucose is no longer indicated because of poor correlation between blood glucose levels and glycosuria.

Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease)? a. Seizures b. Enlargement of all lymph glands c. Pancreatitis or cholecystitis d. Lethargy and somnolence

Lethargy and somnolence parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. Enlargement of the salivary and cervical lymph glands occurs.

What is the treatment for precocious puberty?

Leuprolide acetate (Lupron, Depot) which slows pre-puberty changes, back off therapy when getting to normal puberty age. Slows prepubertal growth to normal rates.

The nurse is caring for a school-aged child after a submersion injury causing the loss of circulatory and respiratory function for 4 minutes. What assessments or goals would be indicated while caring for this child on life support? (SELECT ALL THAT APPLY.) A. Listen to breath sounds frequently B. Monitor the child for hyperthermia during the first 12 hours after rescue C. Watch for a capillary refill taking no more than 2 seconds D. Check for tachycardia and respiratory alkalosis E. Maintain the body temperature between 36.5 F. Position the head in the midline with the head of the bed at 45 degrees

Listen to breath sounds frequently Watch for a capillary refill taking no more than 2 seconds Check for tachycardia and respiratory alkalosis Maintain the body temperature between 36.5

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a sudden infant death syndrome incident? (Select all that apply.) a. Breastfeeding b. Low Apgar scores c. Male sex d. Birth weight in the 50th or higher percentile e. Recent viral illness

Low apgar scores male sex Recent viral illness

A child will start treatment for precocious puberty. The RN recognizes that this will involve the injection of which synthetic medication? A) thyrotropin B) Gonadotropins C) Somatotrophic hormone D) Luteinizing hormone-releasing hormone

Luteinizing hormone-releasing hormone. Precocious puberty of central origin is treated with monthly sub-Q injections of luteinizing hormone-releasing hormone.

Most common cause of thyroid disease in children and adolescents that's also known as Hashimoto disease?

Lymphocytic Thyroiditis

A nurse is preparing to feed a 12-month-old infant with failure to thrive. Which intervention should the nurse implement? a. Provide stimulation during feeding. b. Avoid being persistent during feeding time. c. Limit feeding time to 10 minutes. d. Maintain a face-to-face posture with the infant during feeding.

Maintain a face-to-face posture with the infant during feeding

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)? a. Explain how SIDS could have been predicted and prevented. b. Interview parents in depth concerning the circumstances surrounding the child's death. c. Discourage parents from making a last visit with the infant. d. Make a follow-up home visit to parents as soon as possible after the child's death.

Make a follow-up home visit to parents as soon as possible after the child's death

Which drug should the RN administer to a preschool child who has ICP resulting from cerebral edema? A) Mannitol (Osmitrol) B) Epinephrine hydrochloride (Adrenalin) C) Atropine sulfate (Atropine) D) Sodium bicarbonate

Mannitol *For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction

Which one of the following patient outcomes is individualized for Sara? a) Sara will receive her immunizations on time b) Sara will demonstrate adherence to the nurse's recommendations c) Marisa Gutierrez will verbalize the need to keep small objects away from Sara to avoid aspiration d) Sara's brothers will verbalize the need to stop playing with small objects

Marisa Gutierrez will verbalize the need to keep small objects away from Sara to avoid aspiration

The most common congential malformation of the GI Tract

Meckel Diverticulum

A previously healthy 5 y/o presents to the ED with her parents with a temperature of 100.8F and a 2-day history decreased appetite and persistent vague abdominal pain with tenderness in the mid-abdomen and right lower quadrant. Her parents report that she has had no appetite and felt nauseous but hasn't vomited. Lab results show 16,000 cells/ml for WBCs. 18 hours into her admission she passes copious amounts of bloody stool. A) Appendicitis B) Colonic arteriovenous malformation C) Gastric stress ulcer D) Colonic diverticulitis E) Meckel's diverticulitis

Meckel's diverticulitis

What are the results of excessive vomiting in an infant with pyloric stenosis? a. Hyperchloremia b. Hypernatremia c. Metabolic acidosis d. Metabolic alkalosis

Metabolic alkalosis *due to loss of hydrogen ions.

When caring for the child with Reye syndrome, what is the priority nursing intervention? a. Monitor intake and output b. Prevent skin breakdown c. Observe for petechiae d. Do range-of-motion exercises

Monitor I/O * adequate and frequent monitoring of I/O is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema.

What is an appropriate nursing intervention when caring for an unconscious child? a. Change the child's position infrequently to minimize the chance of increased ICP b. Avoid using narcotics or sedatives to provide comfort and pain relief c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema d. Give tepid sponge baths to reduce fever because antipyretics are contraindicated

Monitor fluid intake and output carefully to avoid fluid overload and cereral edema * often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What is the priority nursing intervention? a. Forcing fluids b. Monitoring pulse oximetry c. Instituting seizure precautions d. Encouraging a high-protein diet

Monitoring pulse oximetry

o help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions

Need to be perfect and similar to peers

A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis? a. Nonproductive cough, wheezing b. Fever, general malaise c. Productive cough, rales d. Stridor, substernal retractions

Nonproductive cough, wheezing

Which describes marasmus? a. Deficiency of protein with an adequate supply of calories b. Not confined to geographic areas where food supplies are inadequate c. Syndrome that results solely from vitamin deficiencies d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites)

Not confined to geographic areas where food supplies are inadequate A syndrome of emotional and physical deprivation

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which nursing action is the most appropriate? a. Notify practitioner b. Measure abdominal girth c. Auscultate for bowel sounds d. Take vital signs, including blood pressure

Notify practitioner

which of the following should the RN do first after noting that a child with Hirschsprung disease has a fever and watery explosive diarrhea? A) notify the physician immediately B) Administer antidiarrheal meds C) Monitor child Q30 min D) Nothing, this is a characteristic of Hirschsprung disease

Notify the physician immediately fever and explosive diarrhea indicate enterocolitis, a life-threatening situation.

The nurse is taking care of a child who is alert but showing signs of increased intracranial pressure. Which test is contraindicated in this case? A) Oculovestibular response B) Doll's head maneuver C) Funduscopic examination for papilledema D) Assessment of pyramidal tract lesions

Oculovestibular response *(caloric test) involves the instillation of ice water into the ear of a comatose child. It is painful and is never performed on a child who is awake or one who has a ruptured tympanic membrane

The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

Oliguria and hypertension

What medication would be prescribed with an infant who has congenital hypothyroidism?

Oral levothroxine (Synthroid)

Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face b. Buttocks c. Oral mucosa d. Palms and soles

Oral mucosa

When assessing a newborn for developmental dysplasia of the hip, the RN would expect to assess which of the following? A) Symmetrical gluteal folds B) Trendelemburg sign C) Ortolani's sign D) Characteristic limp

Ortolani's sign an abnormal clicking sound when the hips are abducted. Produced when the femoral head enters the acetabulum.

Which observation made of the exposed abdomen is most indicative of pyloric stenosis? a. Abdominal rigidity b. Substernal retraction c. Palpable olive-like mass d. Marked distention of lower abdomen

Palpable olive-like mass *easily palpated when the stomach is empty, the infant is quiet, and the abdominal muscles are relaxed.

when examining a child with hypopituitarism, what should a RN look at in relation to the child's height/weight?

Parents

Older infants respond to simple games. What old game is an excellent means of initiating communication with infants while maintaining a "safe", non-threatening distance?

Peek-a-boo

The parents of a 3 month old are instructed to have all family members and caregivers to have there tdap and dtap booster vaccines to prevent the potentially fatal illness? A. Rubella B. Mumps C. Measles D. Pertussis

Pertussis

The nurse is conducting a staff in-service on newborn defects of the genitourinary system. Which describes the narrowing of the preputial opening of the foreskin? a. Chordee b. Phimosis c. Epispadias d. Hypospadias

Phimosis

The most prominent feature of childhood and adolescents?

Physical growth

A Child diagnosed with tetraology of fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and respiratory rate increases to 44 bpm. Which of the following actions would the nurse do first? A) obtain an order for sedation for the child B) assess for an irregular heart rate and rhythm C) explain to the child that it will only hurt for a short time D) place the child in knee-to-chest position

Place the child in knee-to-chest position The child is experiencing a "tet spell" or hypoxic episode. Flexing the legs reduces venous flow of blood from lower extremities and reduces the volume of blood being shunted through the inter ventricular septum

This is the universal language of children. What is the most important form of communication and can be an effective technique in relating to children?

Play

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the RN expect? A) weight gain B) Bradycardia C) Poor skin turgor D) Brisk capillary refill

Poor skin turgor

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

Poor wound healing

The nurse is conducting a staff in-service on childhood endocrine disorders. Diabetes insidious is a disorder of: A) anterior pituitary B) posterior pituitary C) adrenal cortex D) adrenal medulla

Posterior pituitary the principal disorder of posterior pituitary hypofunction is diabetes insidious.

A hospitalized preschooler with meningitis who is d/c becomes angry when the d/c is delayed. Which of the following play activities would be most appropriate at this time? A) reading the child a story B) painting with water colors C) pounding on a pegboard D) Stacking a tower of blocks

Pounding on a pegboard

Sexual development before age 9 in boys; before age 7 years in caucasian girls, or before 6 years in African American girls. Occurs most frequently in females. Commonly presents with adipose tissue/breast development in 7-9 y/o, menses, hair development

Precocious Puberty

When developing the teaching plan for the parents of a 12 month old infant with hypospadias and chord repair, which of the following would the RN expect to include as most important? A) assisting the child to become familiar with his dressing so he will leave them alone B) encouraging the child to ambulate as soon as possible by using a favorite push toy C) forcing fluids to at least 250 ml/day by offering his favorite juices D) Preventing the child from disrupting the catheter by using soft restraints

Preventing the child from disrupting the catheter by using soft restraints * the most important consideration for a successful outcome of this surgery is maintenance of the catheters or stents

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of this medication? a. Prevent reflux b. Prevent hematemesis c. Reduce gastric acid production d. Increase gastric acid production

Reduce gastric acid production

A nurse is receiving report on a newborn admitted yesterday after a gastroschisis repair. In the report, the nurse is told the newborn has a physician's prescription for an NG tube to low intermittent suction. The reporting nurse confirms that the NG tube is to low intermittent suction and draining light green stomach contents. Upon initial assessment, the nurse notes that the newborn has pulled the NG tube out. Which is the priority action the nurse should take? a. Replace the NG tube and continue the low intermittent suction. b. Leave the NG tube out and notify the physician at the end of the shift. c. Leave the NG tube out and monitor for bowel sounds. d. Replace the NG tube, but leave to gravity drainage instead of low wall suction.

Replace the NG tube and continue the low intermittent suction

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? a. Treatment is most successful if it is started during adolescence. b. Treatment is considered successful if children attain full stature by adulthood. c. Replacement therapy requires daily subcutaneous injections. d. Replacement therapy will be required throughout the child's lifetime.

Replacement therapy requires daily subcutaneous injections

Which should be the major consideration when selecting toys for a child who is cognitively impaired? Ability to provide exercise Age appropriateness Ability to teach useful skills Safety

Safety

Parents of a toddler with hypopituitarism ask the nurse, "What can we expect with this condition?" The nurse should respond with which statement? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal

Skeletal proportions are normal for age

Congenital Hypothyroidism symptoms:

Slow growth poor circulation mottled, dry skin brittle hair constipation mental decline sleepliness dull expression puffy eyes large tongue tendency to cold

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

Slowed growth

A 4-year-old boy is having issues with constipation. Which of the following food selections would be most appropriate for his lunch. A) Fried eggs, bacon and iced tea B) A cheeseburger on a bun, French fries, and milk C) Spaghetti with marinara sauce, carrot sticks, and apple juice D) A grilled cheese sandwich, potato chips, and a milkshake Dietary choices for children with constipation should include fruits & vegetables. Reduce cheese and dairy because it can increase constipation.

Spagetti with marinara sauce, carrot sticks, and apple juice **Dietary choices for children with constipation should include fruits & vegetables. Reduce cheese and dairy because it can increase constipation.

A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing, and circulation. What is the next nursing action? a. Place on side b. Take blood pressure c. Stabilize neck and spine d. Check scalp and back for bleeding

Stabilize neck and spine

The nurse has initiated a blood transfusion on a 10 year old child. The child begins to exhibit signs of a transfusion reaction.What would the nurse do first? A. Maintain a patent IV line with normal saline. B. Take the vital signs C. Notify the practitioner. D. Stop the transfusion.

Stop the transfusion

A major risk for injury among adolescents is: A) Disease B) Abduction by strangers C) Substance Abuse D) Bicycle injuries

Substance abuse

Which of the following accounts for the most deaths in infants <1 year of age? a) pneumonia/influenza b) congenital heart defects c) HIV infection d) Sudden infant death syndrome

Sudden Infant death syndrome

Which therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel

Surgical removal of affected section of bowel *remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter

Which of the following should the RN expect to note as a frequent complication for a child with congenital heart disease? A) susceptibility to respiratory infection B) bleeding tendencies C) Frequent vomiting and diarrhea D) Seizure disorder

Susceptibility to respiratory infection

What would a heel stick test show if congenital hypothyroidism?

T4 decreased, TSH increased

What advise would the nurse give a mother with a child that has a barky cough? Take the child outside to the cool air Go to the ER Give the child some adult cough medicine give them some hot tea

Take the child outside to the cool air

The nurse is planning how to prepare a 4y/o child for some diagnostic procedures. Guidelines for preparing this preschooler should include which of the following? A) Plan for a short teaching session of about 30 min B) Tell the child that procedures are never a form of punishment C) Keep equipment out of the child's view D) Use correct scientific and medical terminology in explanations

Tell the child that procedures are never a form of punishment

Who among the following pediatric clients should be assessed first by the RN? A) the child with 2 episodes of soft stools during the shift B) the child who had cough for the past three days, with clear nasal discharge and is irritable C) The child with 2 episodes of inconsolable crying while the knees are drawn over the abdomen and plays between the episodes D) The child with skin rashes on his face and trunk

The child with 2 episodes of inconsolable crying while the knees are drawn over the abdomen and plays between the episodes. Indictates appendicitis

What is the single most important factor to consider when communicating with children? A. Presence or absence of the child's parent B. The child's developmental level C. The child's physical condition D. The child's nonverbal behaviors

The child's developmental level

Which of the following should the nurse consider when having consent forms signed for surgery and procedures on children? A) only a parent or legal guardian can give consent B) The person giving consent must be at least 18 y/o C) The risks and benefits of a procedure are part of the consent process D) A mental age of 7 years or older is required for a consent to be considered "informed"

The risks and benefits of a procedure are part of the consent process

The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn? a. Absence of a urethral opening is noted. b. Penis appears shorter than usual for age. c. The urethral opening is along the dorsal surface of the penis. d. The urethral opening is along the ventral surface of the penis.

The urethral opening is along the ventral surface of the penis

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

There is heightened airway reactivity

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. Which should the nurse suggest to minimize reflux? a. Place in Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.

Thick formula with rice cereal *small, freq feedings of formula combined with 1 tsp to 1 tbsp of rice cereal per oz of formula have been recommended

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

Thyroid

Which type of DM is characterized by destruction of pancreatic beta cells?

Type I DM

Which clinical manifestation would be seen in a child with chronic renal failure? a. Hypotension b. Massive hematuria c. Hypokalemia d. Unpleasant "uremic" breath odor

Unpleasant "uremic" breath odor

The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient's a. weight has increased. b. urinary output is increased. c. peripheral edema is decreased. d. urine specific gravity is increased.

Urinary output is increased. demeclocycline blocks the actions of the ADH on the renal tubules and increases urine output.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a. blood pressure will stabilize. b. the child will have more energy. c. urine will be free of protein. d. urinary output will increase.

Urinary output will increase

Which of the following would the RN perform to help alleviate a child's joint pain associated with rheumatic fever? A) maintaining the joints in an extended position B) applying gentle traction to the child's affected joints C) supporting proper alignment with rolled pillows D) Using a bed cradle to avoid the weight of bed linens on the joints

Using a bed cradle to avoid the weight of bed linens on the joints

The nurse is administering a intramuscular injection (IM) to a 1 year old .What site should the nurse use? ventrogluteal Deltoid Vastus lateralis Dorsal gluteal

Vastus lateralis

Persistent repeated UTIs, flank pain, and enuresis are clinical manifestations of what GU disease?

Vesicoureteral Reflux

A nurse is admitting an infant with asthma. What usually triggers asthma in infants? a. Medications b. A viral infection c. Exposure to cold air d. Allergy to dust or dust mites

Viral infections *cause inflammation that causes increased airway reactivity in asthma.

An infant has been diagnosed with cow's milk allergy. What are the clinical manifestations the nurse expects to assess? (Select all that apply.) a. Pink mucous membranes b. Vomiting c. Rhinitis d. Abdominal pain e. Moist skin

Vomiting Rhinitis Abdominal pain

An infant experienced an apparent life-threatening event (ALTE) and is being placed on home apnea monitoring. Parents have understood the instructions for use of a home apnea monitor when they state? a. "We can adjust the monitor to eliminate false alarms." b. "We should sleep in the same bed as our monitored infant." c. "We will check the monitor several times a day to be sure the alarm is working." d. "We will place the monitor in the crib with our infant."

We will check the monitor several times a day to be sure the alarm is working

A RN caring for an infant that has recently been dx with a congenital heart defect. Which of the following clinical signs would most likely be present? A) slow pulse rate B) weight gain C) Decreased systolic pressure D) irregular WBC lab values

Weight gain

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect? Select all that apply weight loss Tachycardia Poor skin turgor Brisk capillary refill

Weight loss Tachycardia poor skin turgor

FACES pain scale * Most widely used * age 3-4 y/o

consists of six cartoon faces ranging from smiling face for "no pain" to tearful face for "worst pain"

Pheochromocytoma

increased production of catecholamines - Palpations - headache - Episodic sweating (diaphoresis)

The nurse must assess 10-month-old Chad. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which of the following initial actions by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. b. Ask father to place Chad on the examination table. c. Talk softly to Chad while taking him from his father. d. Undress Chad while he is still sitting on his father's lap.

initiate a game of peek-a-boo

SIADH in children

low serum sodium (125 or less) high urine specific gravity decreased serum osmolality increased urine osmolality Fluid retention slightly elevated plasma vol weight gain seizures may develop with hyponatremia. Treatment depends on strict fluid restriction to maintain serum sodium. Frequent and precise measurements of recording I/O along with daily weights

The nurse is caring for a preschool child with suspected diabetes insipidus. Which clinical manifestation should the nurse expect to observe? A) oliguria B) Glycosuria C) N/V D) polyuria and polydipsia

polyuria and polydipsia Excessive urination accompanied by thirst is the primary clinical manifestations of diabetes

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful? a. Recommend that the child keep a diary. b. Provide supplies for the child to draw a picture. c. Suggest that the parent read fairy tales to the child. d. Ask the parent if the child is always uncommunicative.

provide supplies for the child to draw a picture

The nurse is caring for an 8-year-old child with type 1 diabetes. The nurse should teach the child to monitor for which manifestation of hypoglycemia? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizziness

shaky feeling and dizziness

Parents of two school-age children with asthma ask the nurse, "What sports can our children participate in?" The nurse should recommend which sport? a. Soccer b. Running c. Swimming d. Basketball

swimming

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a. Abdominal rigidity and pain on palpation b. Rounded abdomen and hypoactive bowel sounds c. Visible peristalsis and weight loss d. Distention of lower abdomen and constipation

visible peristalsis and weight loss * move from left to right across the epigastrium and weight loss are observed in pyloric stenosis.

The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? A. Puppet play in the child's room B. A walk down to the hospital lobby C. Participation in dance activities in the playroom D. Game of "hide and seek" in the children's outdoor play area

A

The nurse's approach when introducing hospital equipment to a preschooler who seems afraid should be based on which one of the following principles? a. The child may think the equipment is alive. b. Explaining the equipment will only increase the child's fear. c. One brief explanation will be enough to reduce the child's fear. d. The child is too young to understand what the equipment does.

A

Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.) a. Allow parents to say goodbye to their infant. b. Once parents leave the hospital, no further follow-up is required. c. Arrange for someone to take the parents home from the hospital. d. Avoid requesting an autopsy of the deceased infant. e. Conduct a debriefing session with the parents before they leave the hospital.

A, C, E

Which of the following is a true statement about pertussis? A. Adults caring for children should receive a booster vaccine for pertussis. B. Children with pertussis develop a cough that sounds like a seal barking. C. Pertussis has been almost completely eradicated in the United states D. Pertussis may lead to permanent lung problems

A,D

The nurse is taking a sexual history on an adolescent girl. Which of the following is the best way to determine whether she is sexually active? a. Ask her, "Are you sexually active?" b. Ask her, "Are you having sex with anyone?" c. Ask her, "Are you having sex with a boyfriend?" d. Ask both the girl and her parent if she is sexually active.

Ask her, "are you having sex with anyone"

A nurse recognizes which physiologic responses as a manifestation of pain in a neonate? (Select all that apply.) a. Decreased respirations b. Diaphoresis c. Decreased SaO2 d. Decreased blood pressure e. Increased heart rate

B, C, E

What are indictators of development?

Bone age & Dentition

A 12-year-old male has short stature and appears depressed . What should the nurse be the most concerned about? A. Child's self-esteem B. Proper administration of thyroid hormone C. Proper administration of human growth hormones D. Helping child understand that he has not completed growing

Child's self-esteem

Shakiness, diaphoresis, anxiety, nervousness, chills, headache, confusion, labile, difficulty focusing, hunger, dizziness, pallor, palpations all manifest: A) Hypoglycemia B) Hyperglycemia

Hypoglycemia

Nonpharmacologic strategies for pain management: a. may reduce pain perception. b. make pharmacologic strategies unnecessary. c. usually take too long to implement. d. trick children into believing they do not have pain.

May reduce pain perception *Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics.

What are appropriate interventions to facilitate socialization of the cognitively impaired child? A. Provide peer experiences B. Provide age-appropriate toys and play activities C. Avoid exposure to strangers who may not understand cognitive development. D. Emphasize mastery of physical skills because they are delayed more often than verbal skills

Provide peer experiences

Which is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

Severe dehydration

An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess growth hormone (GH) after closure of the epiphyseal plates. c. There is an excess of growth hormone (GH) before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.

There is excess growth hormone (GH) after closure of the epiphyseal plates. Excess GH after closure of the epiphyseal plates results in acromegaly.

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried. d. A more comfortable environment is produced.

They are safer

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which of the following pediatric disorders? (Select all that apply.) a. SIDS b. Torticollis c. Failure to thrive d. Apnea of infancy e. Plagiocephaly

Torticollis Plagiocephaly

Which type of DM arises when the body fails to use insulin properly combined with insulin insufficiency

Type II DM

After a child reaches the age of 1 year, the leading cause of death is from: a) HIV b) congenital anomolies c) unintentional injuries d) heart disease

Unintentional injuries

Marisa Gutierrez arrives with her infant, Sara, in the well-baby clinic. Sara, who is 15 mos old, is the youngest of 3 children. Her mother has brought her to the clinic for well-child care. Sara's 2 bros, who are 7 and 8, have come as well. As the nurse interviews the mother, Sara explores the exam room. She reaches for her older brother' coins and put one in her mouth. After organizing the data into similar categories, the nurse correctly makes which one of the following decisions? a) no dysfunctional health problems are evident b) high risk for dysfunctional health problems exists c) actual dysfunctional health problems are evident d) potential complications are evident

actual dysfunctional health problems are evident

Two basic concepts in philosophy of family-centered nursing care are: a) enabling and empowerment b) empowerment and bias c) enabling and curing d) empowerment and self-control

enabling and empowerment

When assessing a 12 year old child with Wilm's tumor, the RN should keep in mind that it is most important to avoid which of the following? A) measuring the child's chest circumference B) Palpating the child's abdomen C) Placing the child in upright position D) measuring the child's occipitofrontal circumference

palpating the child's abdomen

Another term for "the new morbidity" is a) pediatric social illness b) pediatric noncompliance c) learning disorder d) autism spectrum distorder

pediatric social illness

The nurse has just finished administering the DTaP vaccine to a 2-month-old and is educating the parent about immunization. Which of the following statements is accurate?

"Bring her back for the second dose when she is 4 months old."

During the evaluation phase, which one of the following responses by Sara's mother would indicate that the expected outcomes have been met? a) "I will have to go through all the boys' things when we get home to be sure there aren't any other small objects that could hurt Sara." b) "I had forgotten how curious babies are. It has been many years since the boys were babies, and they didn't have an older child's toys around." c) "I will have to start to discipline Sara now so that she knows not to play with the older children's belongings." d) "I am afraid she cannot receive her immunizations. She had a fever after her last one."

"I had forgotten how curious babies are. It has been many years since the boys were babies, and they didn't have an older child's toys around."

A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made? a. "I will record the average of the readings." b. "I should be sitting comfortably when I perform the readings." c. "I will record the readings at the same time every day." d. "I will repeat the routine two times."

"I will record the readings at the same time every day"

The nurse is discussing measles, mumps, and rubella vaccination with a mother who is concerned about using the combined vaccine for her 12-month-old. Which statements by the nurse will be most helpful to the mother in accepting the vaccine?

"The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." The mother may not understand that combining the vaccines creates no safety or effectiveness problems and reduces the number of injections her child must endure. The other statements are true and offer some reassurance as to safety and efficacy but are not as helpful to the parent in understanding how she can protect her child from unnecessary discomfort. pg 262

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse that they will be back to visit at 6 PM. When the child asks the nurse when his parents are coming, the nurse's best response is? A. "They will be here soon." B. "Let me show you on the clock when 6 PM is." C. "They will come after dinner." D. "I will tell you every time I see you how much longer it will be."

"They will come after dinner"

A mother tells the nurse that she is newly pregnant and asks about her 15-month-old's need for the chicken pox immunization because her two older children did "fine" when they had the disease. What is the nurse's best response?

"When your child avoids chicken pox, it protects other children from being exposed to the disease. Some cannot be immunized because of their health conditions."

Late signs of increasing ICP:

- Bradycardia - Decreased LOC - Decreased motor response to commands (does not answer, knuckle sternum "sternal rub") - Decreased sensory response to painful stimuli - Alterations in pupil size and reactivity - Papilledema - Flexion or extension posutring - Cheyne-Stokes respirations

Early signs of Cognitive impairment:

- Dysmorphic syndrome (i.e. Downs, fragile X) - Irritability or nonresponsiveness to environment - major organ system dysfunction (i.e. feeding, breathing difficulties) - Gross motor delay - Fine motor delay - Language difficulities or delay - Behavior difficulties

Clinical manifestations of Increased ICP in children:

- HEADACHE!! - vomiting: w or w/o nausea - motor weakness - Discoordiation - Seizures - Diplopia and blurred vision - Irritability, restlessness - Behavioral changes - Sleep alterations - Somnolence - Personality change

Growth Hormone Deficiency

- inhibits somatic growth in all cells of the body - Primary site of dysfunction is the hypothalamus - Dx based on the absence of or subnormal reserves of pituitary GH - Hand-wrist xray to examine for centers of ossification - Look at parent and child growth trajectories -Bone age to determine if GH deficiency is present

Clinical manifestations of Increased ICP in infants:

- irritability - High pitched cry - Fontanels are tense/bulging - Cranial sutures separated - Eyes: setting sun sign - Scalp veins distended - Macewen sign - Increased occipitiofrontal circumference

Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than _____ mg/dl. a. 100 b. 120 c. 180 d. 200

200 DKA is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 200 mg/dl.

An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? 14 16 18 21

21 ** birth weight triples by end of first year of life.

A 15 year-old patient is treated for an asthma attack following exposure to tobacco smoke at a friend's home. The BEST advice the nurse can give is A. "avoidance of known triggers is the best way to prevent attacks." B. "it will be a good practice to take your preventive medications after going to your friend's house the next time." C. "your friend's parents need to be advised that they cannot smoke in their home when you come to visit." D. "take a extra dose of your long acting inhaler before you go over to your friends house"

A

A school nurse is conducting a class with adolescents on suicide. Which true statement about suicide should the nurse include in the teaching session? A. Gay and lesbian adolescents are at a particularly high risk for suicide B. A sense of hopelessness and despair are a normal part of adolescence C. Problem-solving skills are of limited value to the suicidal adolescent. D. Previous suicide attempts are not an indication of risk for completed suicides

A