Peds Exam 2

Parents bring a 3-year-old to the Emergency Department stating that the child just had her first seizure. The seizure lasted less than 5 minutes, and involved jerking movements over the entire body. Prior to the seizure, the child had been sick and started running a fever. Based on the description, the nurse suspects that the child experienced which type of seizure? a. Generalized b. Febrile c. Status epilepticus d. Partial

b. Febrile Rationale: Febrile seizures usually are associated with fevers. A generalized or partial seizure also has the jerking movements, but is not necessarily associated with a fever. Status epilepticus is when the seizure lasts longer than 30 minutes.

The nurse teaches a parent of a child with sickle-cell anemia (SCA) about prevention of the cells from sickling. Which of the following prevention teaching would be recommended? Select all that apply. a. Avoid pain medications. b. Keep the child well hydrated. c. Give antibiotics daily. d. Administer IV fluids once a week. e. Get the pneumococcal vaccine.

b. Keep the child well hydrated. c. Give antibiotics daily. e. Get the pneumococcal vaccine. Rationale: Keeping the child well hydrated, getting the pneumococcal vaccine, and giving prophylactic antibiotics will all help prevent the cells from sickling. Pain meds should be used for any pain the child has and the child only needs an IV if there is a fluid deficit.

A nurse obtains a history from a single, breastfeeding mother with a small 3-month-old infant who has been vomiting. Which of the following would give the nurse an indication this infant had severe dehydration? a. The pulse is elevated. b. The infant is having a seizure. c. Mucous membranes are dry. d. Decreased skin turgor

b. The infant is having a seizure. Rationale: Seizure activity is usually not noted until the child is in severe dehydration. Poor skin turgor, dry mucous membranes, and an elevated pulse can all be seen with moderate dehydration.

A child with hemophilia wants to participate in sports. Which sport should the nurse recommend as most appropriate for the child? a. Biking b. Running c. Baseball d. Swimming

d. Swimming Rationale: Swimming provides a safe way to exercise for a child. Biking, running, and baseball all are sports that may increase bleeding due to the impact placed on joints.

. A client with hemophilia has a veryswollen knee after falling from bicycleriding. Which of the following is the firstnursing action? a)initiate an IV site to begin administration ofcryoprecipitate b) type and cross-match for possibletransfusion c) monitor the client's vital signs for the first5 minutes d) apply ice pack and compression dressings tothe knee

Answer D rest, ice, compression, and elevation (RICE)are the immediate treatments to reduce theswelling and bleeding into the joint. Theseare the priority actions for bleeding intothe joint of a client with hemophilia.

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. Which of the following statement by the parent would indicate a correct understanding of the teaching? a. "I should gently massage the skin under the straps once a day to stimulate circulation." b. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." c. "I should remove the harness several times a day to prevent contractures." d. "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."

ANS: A To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder, since this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.

What clinical manifestations suggest hydrocephalus in an infant? a. Closed fontanel, high-pitched cry b. Bulging fontanel, dilated scalp veins c. Constant low-pitched cry, restlessness d. Depressed fontanel, decreased blood pressure

ANS: B Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel, high-pitched cry, constant low-pitched cry, restlessness, depressed fontanel, and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

A mother has just given birth to an infant with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" The most appropriate nursing action is to: a.encourage mother to express her feelings. b.explain in simple language that the baby has a cleft lip. c.provide emotional support until practitioner can talk to mother. d.tell mother a pediatrician will talk to her as soon as the baby is examined.

ANS: B It is best to explain in simple terms the nature of the defect and to reinforce and help clarify information given by the practitioner before the infant is shown to the parents. Parents may not be ready to talk about their feelings during the first few days after birth. The nurse should provide information about the child's condition while waiting for the practitioner to speak with the family after the examination. The mother needs simple explanations of what is wrong with her child during this period of waiting.

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include which of the following? a. Arm restraints, postural drainage, mouth irrigations b. Cleansing suture line, supine and side-lying position, appropriate analgesia c. Mouth irrigations, prone position, cleansing suture line d. Supine and side-lying positions, postural drainage, arm restraints

ANS: B The suture line should be cleansed gently after feeding. The child should be positioned on back, on side, or in infant seat. The child is medicated with appropriate analgesia to calm him or her. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. There is no reason to perform mouth irrigations, and the child should not be placed in the prone position where injury to the suture site can occur. Arm restraints are used according to local practice.

A client and her husband are positivefor the sickle cell trait. The client asks thenurse about chances of her children havingsickle cell disease. Which of the following isappropriate response by the nurse? a)one of her children will have sickle cell disease b) only the male children will be affected c) each pregnancy carries a 25% chance of thechild being affected d) if she had four children, one of them wouldhave the disease

Answer C In autosomal recessive traits, both parentsare carriers. There is a 25% chance with eachpregnancy that a child will have the disease.

Caring for the newborn with a cleft lip and palate before surgical repair includes which of the following? a. Gastrostomy feedings b. Allowing little or no sucking c. Providing satisfaction of sucking needs d. Keeping infant in near-horizontal position during feedings

ANS: C Using special or modified nipples for feeding techniques helps to meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. The child requires both nutritive and nonnutritive sucking. Feeding is best accomplished with the infant's head in an upright position.

The nurse teaches the parents of aninfant with developmental dysplasia of thehip how to handle their child in a Pavlikharness. Which of the followinginterventions would be most appropriate? a)fitting the diaper under the straps b) leaving the harness off while the infant sleeps c) checking for the skin redness under strapsevery other day d) putting powder on the skin under the strapsevery day

Answer A The Pavlik harness is worn over a diaper. Knee socks are alsoworn to prevent the straps and foot and leg pieces fromrubbing directly on the skin. For maximum results, the infantneeds to wear the harness continuously. The skin should beinspected several times a day, not every other day, for signs ofredness or irritation. Lotions and powders are to be avoidedbecause they can cake and irritate the skin. (Hip dysplasia is acondition in which the head of the femur is improperly restedin the acetabulum, or hip socket of the pelvis. Thecharacteristic manifestations are as follows: asymmetry of thegluteal and thigh folds; limited hip abduction in the affectedhip; apparent shortening of the femur on the affected side(Galeazzi sign and Allis sign); weight bearing causes titling ofthe pelvis downward on the unaffected side (Trendelenbergsign); Ortolani click (in infant under 4 weeks of age).

While assessing a newborn with cleft lip,the nurse would be alert that which of thefollowing will most likely be compromised? a.Sucking ability b. Respiratory status c. Locomotion d. GI function

Answer A. Because of the defect, the child will be unable tofrom the mouth adequately around nipple, therebyrequiring special devices to allow for feeding andsucking gratification. Respiratory status may becompromised if the child is fed improperly or duringpostoperative period, Locomotion would be aproblem for the older infant because of the use ofrestraints. GI functioning is not compromised in thechild with a cleft lip.

When assessing a 12 year old child withWilm's tumor, the nurse should keep in mindthat it most important to avoid which of thefollowing? a)measuring the child's chestcircumference b) palpating the child's abdomen c) placing the child in an uprignt position d) measuring the child's occipitofrontalcircumference

Answer B The abdomen of the child with Wilm's tumorshould not be palpated because of the dangerof disseminating tumor cells. The child withWilm's tumor should always be handled gentlyand carefully

Which of the following health teachingsregarding sickle cell crisis should beincluded by the nurse? a)it results from altered metabolism anddehydration b) tissue hypoxia and vascular occlusion causethe primary problems c) increased bilirubin levels will causehypertension d) there are decreased clotting factors with anincrease in white blood cells

Answer B tissue hypoxia occurs as a result of thedecreased oxygen-carrying capacity of the redblood cells. The sickled cells begin to clumptogether, which leads to vascular occlusion

When providing postoperative care for thechild with a cleft palate, the nurse shouldposition the child in which of the followingpositions? a.Supine b. Prone c. In an infant seat d. On the side

Answer B. Postoperatively children with cleft palate shouldbe placed on their abdomens to facilitate drainage.If the child is placed in the supine position, he orshe may aspirate. Using an infant seat does notfacilitate drainage. Side-lying does not facilitatedrainage as well as the prone position

A school-aged client admitted to thehospital because of decreased urine outputand periorbital edema is diagnosed withglomerulonephritis. Which of the followinginterventions would receive the highestpriority? a)assessing vital signs every four hours b) monitoring intake and output every 12hours c) obtaining daily weight measurements d) obtaining serum electrolyte levels daily

Answer C The child will glomerulonephritis experiences aproblem with renal function that ultimatelyaffects fluid balance. Because weight is thebest indicator of fluid balance, obtaining dailyweights would be the highest priority.

A 4 year old with hydrocephalus isscheduled to have a ventroperitoneal shunt inthe right side of the head. When developingthe child's postoperative plan of care, thenurse would expect to place the preschooler inwhich of the following positions immediatelyafter surgery? a)on the right side, with the foot of the bedelevated b) on the left side, with the head of the bedelevated c) prone with the head of the bed elevated d) supine, with the head of the bed flat

Answer D For at least the first 24 hours after insertionof a ventriculoperitoneal shunt, the child ispositioned supine with the head of the bed flatto prevent too rapid decrease in CSF pressure. Arapid reduction in the size of the ventricles cancause subdural hematoma. Positioning on theoperative site is to be avoided because it placespressure on the shunt valve, possibly blockingdesired drainage of CSF. With continuedincreased ICP, the child would be positioned withthe head of bed elevated to allow gravity to aiddrainage.

When developing the teaching plan forthe parents of a 12 month old infant withhypospadias and chordee repair, which ofthe following would the nurse expect toinclude as most important? a)assisting the child to become familiar with hisdressing so he will leave them alone b) encouraging the child to ambulate as soon aspossible by using a favorite push toy c) forcing fluids to at least 250 ml/day by offeringhis favorite juices d) preventing the child from disrupting thecatheter by using soft restraints

Answer D The most important consideration for asuccessful outcome of this surgery is maintenanceof the catheters or stents. A 12 month old likes toexplore his environment. Applying soft restraintswill prevent the child from disrupting thecatheter.

A nurse is assigned to care for a client with nephrotic syndrome. The nurse assesses which important parameter on a daily basis? a) weight b) albumin levels c) activity tolerance d) blood urea nitrogen (BUN) level

a) weight

A 6-month-old infant is admitted with severe dehydration. Effectiveness of therapy is evaluated with which of the following assessment measures? Select all that apply. a. Evaluate level of consciousness continuously. b. Document mucous membrane moisture every shift. c. Record intake and output accurately. d. Daily weights on the same scale, same time, with no clothes. e. Document abdominal girth every shift.

a. Evaluate level of consciousness continuously. b. Document mucous membrane moisture every shift. c. Record intake and output accurately. d. Daily weights on the same scale, same time, with no clothes. Rationale: All of the choices represent assessment measures that measure the effectiveness of therapy except abdominal girth, which does not provide information regarding hydration status.

A nurse is obtaining a nursing history on an 18-month-old with diarrhea. Which of the following questions might help to identify the cause of the problem? Select all that apply. a. Has the child been on antibiotics recently? b. Has the child traveled recently? c. Do any other family members have diarrhea? d. Does the child have any food sensitivities? e. Has the child taken diphenhydramine in the past week?

a. Has the child been on antibiotics recently? b. Has the child traveled recently? c. Do any other family members have diarrhea? d. Does the child have any food sensitivities? Rationale: A complete history of the child with diarrhea is important to finding the cause. Questions should cover recent travel, medication use, exposures, and foods eaten. Diphenhydramine is an antihistamine that does not cause diarrhea. Similar symptoms in other family members suggest infectious etiology.

A 4 year-old boy is brought to the pediatrician's office because he woke up with swelling around his eyes. On PE the pediatrician notes scrotal edema, erythematous throat and BP of 80/50. The next diagnostic test should be: a.C3 and a chest x-ray because the most likely diagnosis is acute glomerulonephritis b.Dipstick the urine for protein because the most likely diagnosis is minimal change nephrotic syndrome c.Complements and anti-dsDNA antibodies because the most likely diagnosis is SLE d.Skin tests to find out what the child is allergic to

b.Dipstick the urine for protein because the most likely diagnosis is minimal change nephrotic syndrome

The neonatal nurse explains to new parents that infants are at greater risk for fluid and electrolyte imbalance than older children. Which of the following parent comments would indicate that further education is needed? a. Infants have a higher metabolic rate than older children do. b. Infants lose water through their skin and they have a larger proportion of skin surface area than older children do. c. Infants maintain their temperature by losing heat through their heads. d. An infant has little body water for reserve, as compared with an adult.

c. Infants maintain their temperature by losing heat through their heads. Rationale: Losing heat through their heads will have minimal affect on fluid loss in infants. All the other answers are true.

A client has been admitted to the hospital with a diagnosis of acute glomerulonephritis. During history-taking the nurse first asks the client about a recent history of: a) bleeding ulcer b) deep vein thrombosis c) myocardial infarction d) streptococcal infection

d) streptococcal infection

The parent of a child diagnosed with sickle-cell anemia asks the nurse about air travel with the child. Which of the following is the best response? a. "Flying will present a risk for infection secondary to crowds." b. "Flying does not pose any particular risks for the child with SCA." c. "Air travel is not recommended because of the unavailability of emergency medical care while in flight." d. "Flying at high altitudes can be associated with less available oxygen, causing increased sickling."

d. "Flying at high altitudes can be associated with less available oxygen, causing increased sickling." Rationale: High altitude increases the demand for O2, which is impaired. Flying can cause an increase in sickling. Flying does not increase risk for infections or dehydration.

Which intervention would the nurse include in care of an infant following surgical repair of a cleft lip? a. Position the infant in the supine position for feedings, to avoid aspiration. b. Let the infant touch the suture lines as a means of self-comfort. c. Use a special feeding device with shorter nipples. d. Administer pain medications as ordered.

d. Administer pain medications as ordered. Rationale: Special feeding devices with long nipples usually are used, and the infant is fed in the sitting position to avoid aspiration. Some soft restraints may be used to prevent the infant from touching the suture line.

A nurse is caring for an infant with myelomeningocele following surgical postoperative repair. Which of the following would be an important nursing intervention for this patient? a. Place the infant in a supine position with head elevated. b. Measure the head circumference every other day. c. Perform aggressive range-of-motion exercises to lower extremities. d. Assess the surgical site for cerebral spinal fluid leakage and symptoms of infection.

d. Assess the surgical site for cerebral spinal fluid leakage and symptoms of infection. Rationale: After surgery, the site should be checked for cerebral spinal fluid leakage and infection. Head circumference should be measured daily for signs of increased developing hydrocephalus. No ROM to hips; place the patient in an abducted position to prevent congenital hip dysplasia. The child should never be placed supine prior to surgery, due to the location of the lesion.

A nurse is assessing a 3-year-old for hemolytic uremic syndrome (HUS). Which assessment finding would be most characteristic of HUS? a. Diarrhea b. Fever c. Severe cough d. Oliguria

d. Oliguria Rationale: HUS is characterized by the classic triad of symptoms: thrombocytopenia, hemolytic anemia, and acute renal failure. Severe cough, fever, or diarrhea alone is not a sign of HUS. The problem usually is preceded by a urinary tract infection, upper respiratory infection, or acute gastroenteritis 1-2 weeks prior to the HUS.

Which consideration would be important in planning nursing care for an infant following surgical insertion of a ventriculoperitoneal shunt? a. Pain relief interventions are not utilized routinely for infants. b. Administration of intravascular volume expanders is necessary to maintain shunt function. c. Some nuchal rigidity is expected after this procedure. d. The infant is placed in a flat supine position immediately after surgery.

d. The infant is placed in a flat supine position immediately after surgery. Rationale: There are no surgical sites in the foot for ventriculoatrial shunt surgery. Volume expanders are not indicated, and can increase risk of increased ICP. The child's pain always should be managed, regardless of age. The infant never should have nuchal rigidity; it indicates meningeal irritation due to infection or increased ICP. The infant is placed in a flat position and the head of the bed gradually is elevated to prevent rapid cerebrospinal fluid drainage.