peds exam 2
The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions?
"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup."
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?
"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."
The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever?
"Children who have this diagnosis may have had strep throat."
An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done?
"I always keep phenobarbital with me in case of a fever."
Gabapentin has been prescribed for a pediatric client. Which statement by the client indicates an understanding of teaching related to the medication?
"I can't take this medication within 2 hours of taking my antacid medication."
The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?
"I hate to think that I will need to be worried about my child having seizures for the rest of his life."
The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching?
"I need to watch for any new bruises or bleeding and let my health care provider know about it."
The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching?
"I should position him on his abdomen with knees bent."
While caring for a child who will be undergoing a lumbar puncture, the nurse explains the procedure to the infant's mother. Which statement by the mother would indicate a need for further education?
"I will cradle her in my arms after the procedure for at least 30 minutes."
The nurse is educating parents of a male infant with Chiari type II malformation. Which statement about their child's condition is most accurate?
"Take your time feeding your baby."
The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask?
"Tell me about the types of stools your child has been having."
A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond?
"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group."
The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond?
"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."
The nurse has performed discharge teaching for parents of a child diagnosed with epilepsy. The child has been prescribed Zonegran (zonisamide). Which comments by the parents indicate the need for further discharge teaching regarding this medication? Select all that apply.
"This medication can make our child very sedated so we need to monitor for this side effect." "We need to watch our child's gums for swelling since this commonly happens with this medicine." "We may need to add B-complex vitamin supplementation to our child's medications because this can help mange side effects."
The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information?
"Would you please describe the weakness you are seeing in your son?"
The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child?
"You may feel pressure on your hip during the procedure."
The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse?
1-week-old newborn whose oxygenation is not improving with oxygen
The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long?
7-14 days
After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify this as a neural tube defect.
Arnold-Chiari malformation
The nurse observes the interactions of parents with their infant who was born with a cleft lip. The mother is attempting to feed the baby, but does not make eye contact. The father is watching television with his back turned to the mother and baby. What psychosocial nursing intervention would be most helpful to this family?
Ask the parents if they have any questions regarding the care of their child.
Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition?
Assessing for the presence of femoral pulses
Volvus sign
Bilious vomit
The nurse is caring for a child with leukemia. The parent states a variety of symptoms. Which symptoms does the nurse identify as directly related to the child's cancer? Select all that apply.
Bruising Anorexia Sore throat Lymphadenopathy
The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way?
Cover the sac with a saline-moistened dressing.
A child presents with intermittent abdominal pain, severe anorexia, and diarrhea. The child's height and weight are significantly behind standards for age. There is skin breakdown in the anal region. The nurse explains that this presentation is consistent with which diagnosis?
Crohn disease
The mother of a newborn with a cleft lip reports she is having a hard time looking her baby. What is the best action by the nurse?
Encourage the mother to provide care for her infant.
The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of:
Ewing sarcoma
Celiac disease sign
Fatty stools
Sign of intussusception?
Knees to chest, currant stools
A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?
Notify the doctor immediately.
A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression.
Oriented to person, place, and time Disorientation Obtundation Stupor Coma
The nurse is evaluating the effectiveness of teaching provided to the parents of a school-age child prescribed liquid ferrous sulfate for iron-deficiency anemia. Which observations indicate that teaching has been effective? Select all that apply.
Parent places medication in orange juice. Child consumes fresh raw fruit and drinks water. Parent provides liquid-prepared medication to the child with a straw. Child goes to the bathroom to brush teeth immediately after taking the medication.
The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?
Place the child in a knee-to-chest position.
A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges?
Positive Kernig sign
A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first?
Prepare to administer factor replacement medication
Telltale signs for pyloric stenosis
Projectile vomiting and olive mass in URQ
A child, diagnosed with beta-thalassemia major is seen in the pediatric clinic. During the assessment, the nurse notices that the child's skin is darker than it was at the last visit. What action should the nurse take next?
Question the parent about the medications the child is taking.
A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client?
Reassess the client's testes at 6 months of age.
When preparing discharge instructions for the parents of an infant who has been diagnosed with hypospadias, the nurse should include which instruction in the teaching plan? Select all that apply.
Report any burning, itching, or discharge to a health care provider. Follow up with a primary care provider.
The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action?
Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone.
A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate?
Teach the child and his parents to keep a headache diary.
The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?
Tell me your concerns about your child's shunt.
A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents?
The VCUG will rule out vesicoureteral reflux.
The blood cell becomes an erythrocyte. Rank the following steps in the proper order of occurrence.
The bone marrow releases a stem cell. Thrombopoietin acts on the cell. The myeloid cell becomes a megakaryocyte. Erythropoietin helps the cell turn into a red blood cell.
A nurse is caring for an infant who just had open-heart surgery and the parents are asking why there are wires coming out of the infant's chest. What is the best response by the nurse?
These wires are connected to the heart and will detect if your infant's heart gets out of rhythm.
A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education?
This is caused by an opening that usually closes by 1 week of age.
A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse?
This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."
A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?
This test will check how blood is flowing through the heart.
The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy, the process of digitalization is done for which reason?
To build the blood levels to a therapeutic level
The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:
acute glomerulonephritis.
A 3-year-old child has been brought to the clinic for assessment of chronic constipation. After ruling out an organic cause, what will the nurse prioritize in the child's plan of care?
administering over-the-counter stool softeners but for no longer than 1 week
the nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?
antiemetic
The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority?
assess respiratory status
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition?
barium enema
The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child?
bleeding from intravenous sites
What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent?
body appearance changes very little
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?
cartilage
A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure?
change in level of consciousness
The nurse is assessing a child with aortic stenosis. Which findings would the nurse most likely assess? Select all that apply.
chest pain with activity dizziness with prolonged standing thrill palpated at base of heart
A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate?
creatinine clearance rate
The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered?
diazepam
The nurse is caring for a 6-year-old client diagnosed with acute renal failure. During assessment, the nurse notes: temperature 99.0°F (37.2°C), urine output less than 0.4 mL/kg/hr, blood pressure 130/88 mm Hg, periorbital edema, and respirations 28 breaths/minute. Which prescriptions will the nurse anticipate from the primary health care provider? Select all that apply.
furosemide dialysis serum electrolyte levels urinalysis labetalol
The nurse is caring for a child diagnosed with acute post-streptococcal glomerulonephritis. When assessing the child, what findings does the nurse anticipate? Select all that apply.
generalized edema weight gain headache
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?
iliac crest
A parent brings the 10-year-old child in to the clinic. The nurse notes: icteric sclera and skin, headache, anorexia, vomiting, and temperature 101.8°F (38.8°C). The parent states the child has had the symptoms since returning to the US from India a few days ago. The nurse will anticipate preparing the child for which test?
liver function tests
The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)?
macrocytic red blood cells (RBCs)
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:
notify a health care provider if the child develops an upper respiratory infection.
When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of what factor as the major mechanism involved?
obstruction of blood flow to the lungs
The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child?
painless, enlarged lymph node
What would be the most important measure to implement for an infant who develops heart failure?
placing the infant in a semi-Fowler position
When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover?
polycythemia
A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series of laboratory tests have been ordered. Which findings are consistent with this disease? Select all that apply.
reduced hemoglobin levels elevated erythrocyte sedimentation rate (ESR)
The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for:
seizures
The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?
spica cast
Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):
steroid
A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis?
tetralogy of Fallot
The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?
type II
The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain
video electroencephalogram
While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate?
vitamin B12 injections
The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?
"In most cases treatment is not necessary, only observation."
A 4-year-old child is scheduled for an echocardiogram. The nurse is explaining this procedure to the child's parents. Which information would the nurse likely include? Select all that apply.
"This test uses sound waves to check the heart structures." "This test should not cause your child any pain."
A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state:
"We should administer the drug on an empty stomach."
Which nursing diagnosis would best apply to a child with rheumatic fever?
Activity intolerance related to inability of heart to sustain extra workload
The nurse is preparing a care plan for a toddler diagnosed with cerebral palsy (CP). Which intervention would be appropriate for the nursing diagnosis of Risk for disuse syndrome related to spasticity of muscle groups? Select all that apply.
Administer carbidopa/levodopa as prescribed. Administer benzodiazepines as prescribed. Teach parents exercises and games to help prevent contractures.
A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection?
Avoid drawing a blood specimen from the right femoral vein before the procedure
A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?
Have the parent bring the child to the pediatric oncology clinic as soon as possible.
The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?
Impaired physical mobility related to a cast on the leg
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura?
Ineffective tissue perfusion related to poor platelet formation
The primary health care provider has prescribed intravenous furosemide for a child diagnosed with congestive heart failure (CHF). Which action will the nurse take when administering this medication?
Infuse no more than 4 mg per minute.
When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?
Monitor the site dressing and vital signs.
Thrush treatment
Mycostatin 4 per day after feeding
A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse?
The foreskin is needed for repair.
The nurse is caring for an adolescent who suffered an injury during a diving accident. During assessment the client is demonstrating the posturing in the figure. The nurse is aware that this type of posturing is the result of injury to what area?
brain stem
The nurse is assessing a child who is experiencing an acute splenic sequestration secondary to sickle cell disease. What treatment would be a priority?
emergent transfusion
The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is:
ensuring the parents know how to properly give antibiotics.
A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate?
esophageal atresia
The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen?
facial changes
The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder?
heart failure
The nurse is caring for a 6-month-old girl with diarrhea and dehydration. The mother is concerned because the girl has some patches on her tongue. Which feature indicates a geographic tongue rather than oral candidiasis (thrush)?
patches are light in color on the tongue
A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema?
weight, daily
The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction?
wheezing
When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education
"Most infants do not need surgical repair for this."
A child will be undergoing a Holter monitor test. Which statement by the parent indicates the need for further instruction?
"My child cannot have any thing to eat or drink after midnight the day of the test."
The young boy was involved in a motor vehicle accident and was admitted to the pediatric intensive care unit with changes in level of consciousness and a high-pitched cry. Which are late signs of increased intracranial pressure? Select all that apply.
The child's toes are pointed downward, his head and neck are arched backwards, and his arms and legs are extended. The child's heart rate is 56 beats per minute. The child's pupils are fixed and dilated.
A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia?
increased RBC
A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size?
constipation and bladder dysfunction
