Peds EAQ Exam #2 Review

Through which body part does approximately two-thirds of insensible water losses occur? a. Skin b. Lungs c. Bowels d. Kidney

ANS: A Rationale Approximately two-thirds of insensible water losses occur through the skin. The other remaining one-third is lost through the respiratory tract. Urinary and fecal losses are not considered insensible water losses.

What physiologic alteration is characterized by destruction of pancreatic beta cells that produce insulin? a. Type 1 diabetes b. Type 2 diabetes c. Gestational diabetes d. Impaired glucose tolerance

ANS: A Rationale Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta cells.

Which symptoms reflect dehydration in infants and children? Select all that apply. a. weight loss b. weight gain c. sunken eyes d. puffy fontanels e. prolonged capillary refill

ANS: A, C, E Rationale Clinical signs of dehydration in infants and children include weight loss, sunken eyes, and prolonged capillary refill. Weight gain and puffy fontanels are symptoms of fluid excess.

Nursing care of the child myelosuppression from leukemia or chemotherapeutic agent must include which intervention? a. Restriction of oral fluids b. Institution of strict isolation c. Use of good hand washing technique d. Administration of immunizations appropriate of age

ANS: C Rationale Good hand washing technique is the most effective means of preventing disease transmission in children with myelosuppression. There is no indication for reduction of fluids in children with myelosuppression. Strict isolation is not necessary in children with myelosuppression. The child should not receive any live vaccines, because the immune system is not capable of responding appropriately to them.

What is the most common form of childhood cancer? a. Sarcoma b. Epistaxis c. Leukemia d. Retinoblastoma

ANS: C Rationale Leukemia is the most common form of childhood cancer. Epistaxis is not cancer; it is the medical term for a nosebleed. Sarcoma is not the most common form of childhood cancer; nor is retinoblastoma.

When does rapid-acting insulin peak? a. 2 hours after injection b. 5 hours after injection c. 15 to 30 minutes after injection d. 30 to 90 minutes after injection

ANS: C Rationale Rapid-acting insulin peak 30 to 90 minutes after injection, not 2 hours, 5 hours, or 15 to 30 minutes after injection.

What does the nurse teach a parent about careful food preparation to prevent food poisoning? Select all that apply. a. "Do not freeze the ground meat." b. "Always thaw food on the counter." c. "Cook meat until the pink color disappears." d. "Wash hands and utensils with hot, soapy water." e. "Cook the meat to an internal temperature of 71 C"

ANS: C, D, E Rationale Food poisoning occurs when there is overgrowth of harmful bacteria in food. The meat should always be cooked until gray inside. Presence of pink indicates that the meat is undercooked. Hands and utensils must be washed with hot, soapy water to prevent the spread of bacteria. Meat must be cooked to an internal temperature of 71 C. Ground meat should be quickly frozen to prevent spoilage and bacterial growth. Food should never be thawed on the counter because this encourages microbial growth.

Which ethnic group has the highest incidence of sickle cell disease? a. Whites b. Hispanics c. American Indians d. African Americans

ANS: D Rationale African Americans have the highest incidence of sickle cell disease; Hispanics have the second-highest incidence of sickle cell disease. American Indians and whites have lower incidence of sickle cell disease than do African Americans and Hispanics.

Which nursing explanation is appropriate for the parent of a child receiving an iron preparation whose stools are a tarry black color? a. A symptom of iron deficiency anemia b. An adverse effect of the iron preparation c. An indicator of an iron preparation overdose d. An expected change caused by the iron preparation

ANS: D Rationale An adequate dosage of iron turns the stools a tarry black color. Tarry black stools are not sign of iron-deficiency anemia. Tarry black stools are not an adverse effect of the iron preparation but an expected effect. Tarry black stools are not an indicator of iron preparation overdose.

Which agent is associated with alteration of normal intestinal flora by antibiotics? a. Rotavirus b. Salmonella c. Escherichia coli d. Clostridium difficile

ANS: D Rationale Clostridium difficile is associated with alteration of normal intestinal flora by antibiotics. The most common causes of diarrhea in children are Salmonella and Escherichia coli; they are often foodborne.

Which process produces red blood cells? a. Erthrocytosis b. Leukocytosis c. Polycythemia d. Erythropoiesis

ANS: D Rationale Erythropoiesis is the production of red blood cells. Usually the term polycythemia is used instead of erthrocytosis for an increased number of erythrocytes (red blood cells). Leukocytosis is an increased number of leukocytes (white blood cells).

The nurse in emergency department is triaging patients. Which child must be seen first? a. A child with severe blood diarrhea b. A child with a severe burn on the leg c. A child screaming, crying, and holding the abdomen d. A child with stridor who appears anxious

ANS: D Rationale Using the ABC (airway, breathing, and circulation) prioritization approach, the child with stridor from a foreign body in the throat must be seen first. Stridor indicates partial or complete obstruction from the foreign body in the throat. A child with severe bloody diarrhea; a severe burn on the leg; and screaming, crying, and holding the abdomen are not priorities before airway obstruction.

What is the most effective treatment option for children with type 1 diabetes? a. Diet only b. Oral agents c. Insulin and diet d. Diet and oral agents

Rationale Insulin and dietary changes are the current treatment for children with type 1 diabetes. Dietary changes alone are not effective in treating type 1 diabetes. Oral agents are effective against type 2 diabetes, not type 1. Diet and oral agents are used to treat type 2 diabetes, not type 1 diabetes.

The nurse is caring for a child with leukemia. The patient has severe pain associated with weight loss following a chemotherapy treatment. What intervention does the nurse perform for improving the health status of the patient? a. Antibiotic therapy b. Parenteral therapy c. Nutritional therapy d. Ventilation therapy

ANS: C Rationale Children with chronic disorders require prolonged health care for reducing the side effects of the disease condition or the treatment. Disorders like leukemia require a prolonged chemotherapy regimen. Repeated chemotherapy may result in severe pain and is associated with conditions like weight loss. Interventions include nutritional therapy, preferable home-based nutritional therapy. Antibiotic therapy is used for patients with chronic microbial infections. Parenteral therapy includes administration of intravenous fluids and is used when enteral or oral nutrition is challenging. Ventilation therapy is provided for patients with respiratory disorders.

The diabetic child is admitted to the intensive care unit with a fever. Upon assessment, the nurse notes the child's respirations are deep and rapid. What is the priority nursing intervention for this child? a. Administer antibiotics to the child. b. Administer continuous intravenous insulin c. Determine the blood glucose level of the child d. Obtain a sample for arterial partial pressure of oxygen

Rationale Deep, rapid breathing in a diabetic child may reflect hyperventilation due to metabolic acidosis or diabetic ketoacidosis. Rapid assessment of the child is a priority nursing intervention. The blood glucose level must be determined at the bedside. Antibiotics are administered to the febrile child only after obtaining appropriate specimens for culture. Continuous intravenous insulin is administered after the initial rehydration; it should not be administered until blood glucose and urine ketone levels are obtained. A blood sample needs to be obtained for determining arterial partial pressure of oxygen as part of the rapid assessment of the child; however, the sample is obtained after determining the blood glucose level at the bedside.

Which findings during the assessment are appropriate for further evaluation when considering the possibility of urinary tract infection (UTI)? Select all that apply. a. Pale yellow urine b. Urinary incontinence c. Strong-smelling urine d. Specific gravity 1.018 e. Increase in voiding frequency

Rationale Incomplete emptying of the bladder provides an excellent medium for multiplication of bacteria. Incontinence in a toilet-trained child, increase in voiding frequency, and presence of strong-smelling urine indicate infection and need further evaluation. Normal urine is pale yellow with a specific gravity ranging from 1.016 to 1.022. UTI is indicated by cloudy urine with a high specific gravity indicating the presence of sediments and protein.

Which nursing measures are appropriate when caring for a 10-year-old child who is suffering from dyspnea, has difficulty in vocalizing, and has adventitious breath sounds? Select all that apply. a. Provide humidified oxygen b. Perform a thorough throat examination c. Perform suctioning of the airway as necessary d. Discourage coughing because it may irritate the throat e. Perform chest physiotherapy to facilitate secretion removal

ANS: A, C, E Rationale The child has respiratory discomfort. Humidified oxygen helps moisten secretions and prevents drying of the airway. If it is necessary, the nurse would perform secretions. The nurse would try to make efforts to keep the child's airways patent. Chest physiotherapy helps remove secretions. As the symptoms suggest, the child may have epiglottitis. If epiglottitis is suspected, the nurse would avoid throat examination to prevent airway compromise. The nurse would consider cough enhancement because a cough is a protective way of clearing secretions.

Which statement is appropriate for infectious mononucleosis? a. Human herpesvirus type 2 is the principal cause. b. Herpes-like Epstein-Barr virus is the principal cause. c. Diagnosis is established by a complete blood count, which reveals a characteristic leukopenia d. Diagnosis is established by clinical manifestations because diagnostic tests cannot confirm the diagnosis.

ANS: B Rationale Herpes-like Epstein-Barr virus accounts for most cases of mononucleosis. A complete blood count in an adolescent with mononucleosis would indicate a lymphocytic leukocytosis with atypical lymph, not leukopenia. The monospot test is a highly specific test for mononucleosis.

Which statement is appropriate when explaining the significance of white blood cells to a 10-year-old patient? a. They help in phagocytizing bacteria b. White blood cells help keep germs from causing infections c. They give immunity against bacterial infections d. White blood cells carry oxygen from the lungs to all parts of the body.

ANS: B Rationale It is important for a nurse to avoid using medical jargon when talking to children. She would explain medical terms in simple words that a child easily understands. Therefore the most appropriate response of the nurse is say that white blood cells help keep germs from causing infections. Although it is correct that white blood cells help in phagocytizing bacteria and give immunity against bacterial infections, these sentences contain medical jargon that is difficult for a child to understand. It is the function of red blood cells, not white blood cells, to carry oxygen from the lungs to all parts of the body.

Which frequent complication of treatment for childhood cancer results from neutropenia? a. Alopecia b. Infection c. Mood changes d. Nausea and vomiting

ANS: B Rationale Overwhelming infection is a frequent complication of treatment of childhood cancer secondary to neutropenia. Nausea and vomiting are a result of the side effects of the chemotherapy agents. Alopecia, not neutropenia, is a side effect of the chemotherapy agents. Mood changes are the result of chemotherapy agents and living with the disease, not a result of neutropenia.

Which early sign of bleeding is appropriate when caring for a child after a tonsillectomy? a. Bleeding gums b. Continual swallowing c. Bruising around the face d. Bleeding from the mouth

ANS: B Rationale The most obvious early sign of bleeding in the child who has just undergone a tonsillectomy is continual swallowing. Bleeding gums, facial bruising, and bleeding from the mouth are not the most obvious early signs of bleeding after a tonsillectomy.

Which is the most appropriate nursing intervention when caring for an infant with heart failure? a. Limit fluid intake b. Cluster the nursing activities c. Refrain from using an infant seat d. Replace oral feeding with gavage feeding

ANS: B Rationale When caring for an infant with heart failure, it is important to cluster nursing activities. This should be followed by long periods of undisturbed rest. When energy expenditures are limited, it helps to reduce the metabolic and oxygen needs of the infant. Fluids may be restricted in older children. However, fluid restriction in infants can cause difficulty in feeding. Infants should sit up in an infant seat or be held at a 45-degree angle. This allows for maximum chest expansion and reduces respiratory distress. In infants with feeding difficulties, gavage feeing through a nasogastric tube is given as a temporary supplement to oral feeding to ensure adequate calorie intake.

Which medications are diuretics used in the management of heart failure? Select all the apply. a. Digoxin b. Furosemide c. Chlorothiazide d. Potassium supplements e. Spironolactone

ANS: B, C, E Rationale Diuretics used in the management of heart failure includes furosemide (Lasix), chlorothiazide (Diuril), and spironolactone (Aldactone). Digoxin (Lanoxin) is not a diuretic. Potassium supplements are not diuretics; instead, they replace potassium lost as a result of taking potassium-depleting diuretics.

The nurse is assessing a child for pituitary hyperfunction. Which assessment finding does the nurse recognize as an effect of hyperpituitarism? Select all that apply. a. Absence of sexual maturation b. Overgrowth of the long bones c. Thickened, deeply creased skin d. Delayed dentition and tooth loss e. Malocclusion of teeth in enlarged jaw

ANS: B, C, E Rationale Excess growth hormone (GH) in the child with hyperpituitarism results in proportional overgrowth of the long bones. If oversection of GH occurs after epiphyseal closure, growth is in the transverse direction. Manifestations include separation and malocclusion of teeth in the enlarged jaw and thickened, deeply creased skin. Deficient secretion of pituitary gonadotropin-releasing hormones causes gonadotropin deficiency, with absence or regression of secondary sex characteristics. Thyroid-stimulating hormone deficiency hypopituitarism leads to delayed dentition and loss of teeth. Teeth may be overcrowded and malpositioned in an underdeveloped jaw.

Which are mechanisms or situations that contribute to water excess in a child? Select all that apply. a. Neglect b. Kidney disease c. Diabetes mellitus d. Loss from diarrhea e. Congestive heart failure f. Hypotonic fluid overload

ANS: B, E, F Rationale Kidney disease, hypotonic fluid overload, and congestive heart failure are mechanisms or situations that contribute to water excess in a child. Mechanisms or situation that contribute to water depletion in a child include neglect, diabetes mellitus, and loss from diarrhea.