Peds Exam 3 (Onc/Heme, GI, GU, Endo)
RN planning to collect a specimen from a male infant using a urine collection bag. Which of the following actions should the nurse take?
Wash and dry the genitalia, perineum, and surrounding skin thoroughly (to promote the application of the adhesive of the collection device)
Female adolescent being treated for frequent UTI. Which statement indicates possible cause of the UTIs? a. "I have BM every 4-5 days" b. "My mom taught me to wipe from front to back after going to the bathroom" c. "I urinate every 2-3 hr during the day" d. "I don't wear nylon underwear"
a. "I have BM every 4-5 days" Large stool masses might prevent complete emptying of the bladder and lead to urinary stasis and infection
dietary teaching for an adolescent w/ type 1 DM. Which response by the adolescent indicates understanding of the teaching? (SATA) a. "I should eat extra food on busy days when I am more active" b. "I should wait for 2 hr after eating before going swimming w/ my friends" c. "I should increase my intake of sugar-free fluids when I'm sick" d. "I should eat a snack 30 min before my baseball game starts" e. "I should have a 16oz sports drink if I start feeling weak or shaky"
a. "I should eat extra food on busy days when I am more active" c. "I should increase my intake of sugar-free fluids when I'm sick" d. "I should eat a snack 30 min before my baseball game starts" Recommended increase of carbs 10-15g per hr of moderate play/activity. Sugar-free fluids bc fluids flush out ketones to prevent dehydration (water, broth, tea).
RN teaching parents of a preschool-aged child abt the tx of pinworms. Which of the following statements by the parents indicates an understanding of the teaching? a. "I will give my child a dose of albendazole today and again in 2 weeks" b. "I will collect specimens immediately after my child has a BM" c. "I will give my child a tub bath twice each day" d. "I will place my child's bed linens in a sealed plastic bag for 7 days"
a. "I will give my child a dose of albendazole today and again in 2 weeks" (to eradicate the parasite and prevent reinfection)
RN providing teaching to parents of a school-age child w/ type 1 DM about managing hypoglycemia. Which response by the parent indicates an understanding of the teaching? a. "I'll make sure my child drinks 240 mL (8oz) of milk asap" b. "I'll give my child 2 units of reg insulin" c. "I'll insist that my child lie down to rest for 30 min" d. "I'll check my child's urine for glucose twice daily"
a. "I'll make sure my child drinks 240 mL (8oz) of milk asap" giving 10-15g of simple carbs like the milk will elevate the BG level and alleviate hypoglycemia Rest is important for overall health; but won't alleviate the symptoms
RN caring for a child who has a possible intussusception. Parents ask hoe the dx is determined. Which response should the RN make? a. "an abdominal ultrasound will confirm the pocket in the intestine" b. "genotyping will be done to identify this condition" c. "biopsy will be done on a small amt of tissue from the colon" d. "upper GI series should identify the area involved"
a. "an abdominal ultrasound will confirm the pocket in the intestine" intussusception is the invasion of a part of the intestine into another, creating a pocket. The presence of an intussusception is confirmed by an abdom x-ray, ultrasound, or CT scan
RN reviewing the med record of a 2 MO infant who has rotavirus. RN notes hgb level of 12g/dL and Hct of 51%. Which statement by the RN indicates an understanding of the lab values? a. "infant might be dehydrated" b. "Infant might be anemic" c. "infant might have received too much fluid" d. "infant might have leukemia"
a. "infant might be dehydrated" increased hct indicated dehydration. It raises when blood volume is decreased
child w/ bilateral pheochromocytoma. Which finding should the RN expect? a. HTN b. abdom obesit c. bradycardia d. loose stools
a. HTN (due to increased production of catecholamines) and sweating, wt loss, polyuria, tachycardia, constipation
RN providing teaching to parents of an infant W/ FTT. Which info should the RN include? a. add fortified rice cereal to the infant's formula b. alternate feeding between several fam members c. offer the infant juice between feedings d. provide feedings on demand rather than on a schedule
a. add fortified rice cereal to the infant's formula
RN caring for a child receiving tx for DKA and has a current BG of 250. Which action should the RN take? a. admin 5% dextrose in 0.9%NaCl by cont IV infusion b. give K as a rapid IV bolus c. admin 3 units of ultralente insulin subQ d. obtain an HbAlc level stat
a. admin 5% dextrose in 0.9%NaCl by cont IV infusion
RN caring for a child w/ sickle cell anemia and is experiencing a vaso-occlusive crisis. Which action should the RN take? a. administer ibuprofen b. limit daily fluid intake c. apply cold compresses to painful joints d. withhold live virus immunizations
a. administer ibuprofen (or acetaminophen) for mild-moderate pain. If not, can give opioids
Rn teaching parents of child w/ cystic fibrosis and a prolapsed rectum. The Rn should identify that which of the following is a cause of this complication? a. bulky stools b. weakened rectal sphincter c. elevated pancreatic enzymes d. decreased intra-abdom pressure
a. bulky stools
RN preparing to feed an infant w/ cleft lip and palate. Which of the following actions should the RN plan to take? a. burp the infant at least 2-3 times during the feeding b. remove the nipple from the infant's mouth if swallowing becomes audible c. stop the feeding if formula appears in the nasal cavity of the infant d. discourage the parents from participating in the feeding prior to a surgical repair
a. burp the infant at least 2-3 times during the feeding They will swallow an increased amt of air during feedings bc lack of separation between oral and nasal cavities. Should be burped after every ounce of formula consumed they're typically "noisy" feeders. Should watch for s/s distress (wrinkled brow, elevated brow, watering eyes). if noted, then remove the nipple and allow time for baby to swallow Formula is expected to appear in the nose
Nurses will need to teach the parents of the infant being treated for Hirschsprung disease (aganglionic megacolon) to: a. care for a temporary colostomy. b. thicken formula feedings. c. avoid use of a pacifier. d. carefully monitor heart rate.
a. care for a temporary colostomy. The aganglionic portion of the infant's colon will need to be removed. In most cases, bowel is allowed to rest and recoil for a period of time, necessitating a temporary colostomy. Later the colostomy can be closed and the two ends of the intestine rejoined. Thickening feedings will not relieve the colon distention and obstruction with stool. Pacifiers may be used and are soothing. Monitoring heart rate should not be necessary.
RN discussing the causes of chronic diarrhea w/ a pt. Which of the following conditions is caused by malabsorption? a. celiac disease b. ulcerative colitis c. Hirschsprung's disease d. Crohn's disease
a. celiac disease
PO and getting a unit of packed RBC during a surgical procedure. Which finding indicates the child is experiencing hemolytic transfusion rx? a. chills and flank pain b. pruritus and flushing c. rales and cyanosis d. bradycardia and diarrhea
a. chills and flank pain
Rn assessing an infant who has untreated congenital hypothyroidism. Which manifestation should the RN expect? a. constipation b. hyperreflexia c. oily skin d. hyperthermia
a. constipation and enlarged abdom, hyporeflexia, decreased muscle tone, dry, scaly skin, hypothermia, and cool extremities
Rn teaching the parents of a school-age child w/ celiac disease. Which food selected by the parent indicates an understanding? a. corn tortilla w/ black beans b. pizza c. canned soup d. hot dogs
a. corn tortilla w/ black beans all of the rest contain gluten
Rn caring for an adolescent w/ sickle cell anemia. Which manifestations is/are the result of chronic vaso-occlusive phenomena? (SATA) a. enlarged heart b. enuresis c. leg ulcers d. extrahepatic cholestasis e. retinal detachment
a. enlarged heart b. enuresis c. leg ulcers e. retinal detachment chronic vaso-occlusive phenomena results from the obstruction of organs by RBC, leading to stasis and enlargement of organs, infraction due to ischemia, and scarring. They would have intrahepatic cholestasis
RN working on a maternal-NB unit is teaching a group of newly licensed nurses about assisting new moms w/ BF. RN should include which infant conditions as a contraindication for BF? a. galactosemia b. hyperbilirubinemia c. glycogen storage disease d. hypothyroidism
a. galactosemia Infant w/ galactosemia cannot metab lactose. Breast milk contains lactose, which can lead to FTT, cirrhosis, developmental delays, and death. They are fed w/ formula made w/ milk substitutes
Which info regarding sexual maturation should the RN include? a. higher body fat content is associated w/ earlier onset of menarche b. pubic hair typically present prior to breast development c. ovulation begins after sexual maturation is complete d. Menarche signals the beginning of puberty
a. higher body fat content is associated w/ earlier onset of menarche Menarche is expected at 10.5-15.5 YO. Breast development begins 8-12 YO, then 2-6 months after they get pubic hair.
RN teaching an adolescent who was recently dx w/ type 1 DM. Which of the following insulin injection sites should the RN recommend that the pt use during basketball competitions? a. hip b. upper arm c. thigh d. lower leg
a. hip vigorous exercise can enhance the absorption of injected insulin from an involved extremity (involves both arms and legs)
RN creating plan of care of a child w/ aplastic anemia. Which intervention should the RN include? a. initiate protective-environment isolation for the child b. apply pressure for 1-2 min at the puncture site following blood specimen collection c. mix the child's ferrous sulfate elixir twice per day into a glass of milk for administration d. check the child's blood glucose level Q4hr
a. initiate protective-environment isolation for the child (consists of a private room w/ positive air pressure and no live flowers; RN must don a N95, gloves, gown prior to entering room) Aplastic anemia: decreased RBCs, platelets, and WBCs, causing immune suppression and increasing susceptibility to infection Apply pressure to puncture sites for at least 5 mins. Ferrous sulfate if for iron-deficiency anemia (not necessary intervention for this pt), and avoid mixing meds into liquid bc kid might not finish it
Infant experiencing dehydration. Which assessments is the RN's priority? a. measure the pt's weight daily b. check for tears c. palpate the fontanel d. assess skin turgor
a. measure the pt's weight daily
RN creating plan of care for a child w/ sickle cell anemia and is experiencing a vaso-occlusive crisis. Which intervention is the priority for the nurse to include? a. monitor the child's SpO2 level b. administer prescribed ABX c. increase the child's fluid intake d. apply warm compresses to the affected joints
a. monitor the child's SpO2 level ABCs: Promoting oxygen utilization prevents further sickling of the RBC and allows adequate O2 of the surrounding tissue (most priority) fluids to prevent dehydration and clumping of RBC Warm compress to joints to reduce pain and inflam
RN planning care for a 10 MO infant w/ suspected FTT. Which intervention should the RN include (SATA) a. observe the parents actions when feeding the child b. maintain detailed record of food and fluid intake c. follow the child's cues to time food and fluids d. sit beside the child's high chair for feedings e. play music videos during scheduled meal times
a. observe the parents actions when feeding the child b. maintain detailed record of food and fluid intake
Toddler w/ acute gastroenteritis. Which should the RN plan to provide for the child? a. oral rehydration solution b. bananas or applesauce c. chicken or beef broth d. hypertonic IV solution
a. oral rehydration solution to promote body's reabsorption of water and sodium. More effective and less traumatic than IV fluids for the TX of dehydration due to diarrhea and emesis Want to avoid sodium. BRAT (bananas, rice, applesauce toast/tea) diet is contraindicated bc it dosnt provide sufficient nutrition and electrolytes
RN teaching about home care to the guardian of an adolescent w/ hemophilia. Which pieces of info should the RN provide? a. participate in non-contact sports b. firm-bristled toothbrush c. administer aspirin for episodes of pain d. disposable razors for shaving
a. participate in non-contact sports (walking, bowling, golf) Contact sports may be allowed if they wear protective gear and receives routine recombinant factor VIII infusions Soft bristled toothbrush or sponge, electric razor to decrease risk of bleeding.
Rn assessing a 6 YO. Which finding requires further asessment? a. presence of sparse, fine pubic hair b. decreased head circumference compared to full height c. increased leg length in relation to height d. presence of loose central incisor
a. presence of sparse, fine pubic hair Precocious puberty (9 in boys, 8 in girls)
RN caring for a school-aged child w/ sickle cell anemia. Which action should the RN plan to take to help decrease the risk of vaso-occlusive crisis? a. provide adequate fluid intake throughout the day b. provide O2 at 2L/min via NC c. administer blood transfusion d. give ibuprofen to manage pain
a. provide adequate fluid intake throughout the day
RN planning care for a 4 YO child w/ nephrotic syndrome. Which action should the RN take? a. provide through skin care b. test for blood type and cross-match c. allow ample hydrating fluids d. maintain a low-carb diet
a. provide through skin care (important bc edema and risk of infection) may be on fluid restriction Protein, sodium, fat restrictions
parent states "my 6 YO child started wetting the bed after we brought her baby sister home. she hasn't done this in over a year." This behavior by the sibling is an indication of which defense mechanisms? a. regression b. repression c. rationalization d. identification
a. regression
RN caring for a school-aged child who has sickle cell anemia and was admitted for a vaso-occlusive crisis. Which of the following findings should the RN report immediately? a. slurred speech b. hgb level 9g/dL c. hematuria d. pain level of 7 on FACES scale
a. slurred speech (indicates stroke) rest is an expected finding for a pt with sickle cell anemia
Rn assessing a school-age child who has celiac disease. Which finding should the RN expect? a. elevated sweat chloride b. steatorrhea c. clubbing of the fingers d. jaundice
b. steatorrhea Celiac disease: malabsorption syndrome. Foul, fatty, frothy stool
RN teaching guardians of an infant who has milk GERD. Which instructions about feeding therapies should the Rn recommend?
"thicken feedings w/ rice cereal" (decreases infant's manifestations of GERD and promote wt gain if needed) NG tube if becomes severe and exhibits FTT Hold infant upright for at least 30 min after each feeding
congential hypothyroidism. What directions should the RN provide?
"will need to take thyroid hormone replacement for her entire life"
RN is caring for an infant w/ biliary atresia. Which manifestations should the RN expect? (SATA) a. yellow sclera b. rapid weight gain c. tar-colored stools d. abdom distension e. dark urine
a. yellow sclera d. abdom distension e. dark urine Biliary atresia is a progressive process that leads to the destruction of the biliary tree. Yellow sclera are manifestations resulting in cholestasis. Abdom distention is a manifsation of biliary atresia due to hepatomegaly. Dark urine is a manifestation due to conjugated bilirubin escaping from the liver and being excreted in the urine.
RN caring for an infant who has biliary atresia. Which manifestations should the RN expect (SATA) a. yellow sclera b. rapid weight gain c. tar-colored stools d. abdom distention e. dark urine
a. yellow sclera d. abdom distention e. dark urine Biliary atresia is a progressive process that leads to the destruction of the biliary tree.
RN teaching an adolescent pt w/ type 1 DM about managing hypoglycemia. Which of the following statements should the RN include in the teaching? a. "drink 8oz of regular soft drink" b. "Drink 4oz of OJ" c. "take 2 glucose tabs" d. "take 3 tsp of sugar"
b. "Drink 4oz of OJ" a. 6oz soft drink c. 4 glucose tabs d. 2 tsp sugar
RN teaching parents of a 10 YO child w/ iron-deficiency anemia. Which statement by a parent indicates an understanding of the teaching? a. "I will give my child an iron tab once each day at bedtime" b. "I will administer the iron tablet w/ OJ" c. "I will encourage my child to take an antacid w/ the iron tablet" d. "I will crush the iron tablet prior to giving it to my child"
b. "I will administer the iron tablet w/ OJ" (increases absorption) Should spread iron doses throughout the day to prevent gastric upset Antacids decrease the absorption
RN reviewing lab values of a child w/ diarrhea for past 24 hr. Which value for urine specific gravity should the RN expect? a. 1.010 b. 1.035 c. 1.020 d. 1.005
b. 1.035 Is a concentrated specific gravity, expected for dehydration.
RN providing teaching about foods high in fiber to parents of kids w/ chronic constipation. Which of the following foods should the RN recommend? a. 1/2 cup whole milk b. 1/2 cup cooked pinto beans c. 1 cup green leaf lettuce d. 1 cup apple juice
b. 1/2 cup cooked pinto beans (5g fiber) the rest have no fiber
RN is evaluating the outcome of surgery for an infant who had a bile duct obstruction. Which finding should indicate to the RN that the surgery was successful? a. infant's stool becomes fatty b. Color of the infant's stool is yellowish-brown c. infant's direct bilirubin level has increased d. Palpable mass is noted in the infant's RUQ
b. Color of the infant's stool is yellowish-brown Bc w/ the bile duct obstruction... will have clay color stools bc the flow of bili into the intestinal tract is blocked.
RN reviewing lab report of a toddler getting chemo for leukemia. Which lab value should the RN report to the MD? a. platelets 150,000/mm^3 b. Hgb 6g/dL c. WBC 6,000/mm^3 d. Potassium 4.5mEq/L
b. Hgb 6g/dL (below RR)
RN admitting child w/ acute lymphocytic leukemia. Which lab value should the RN expect? a. platelets 500,000 mm^3 b. RBC 2.5 million/uL c. WBC 4,000/mm^3 d. Hct 60%
b. RBC 2.5 million/uL (below the RR is expected) Low RBC, Low Platelets, High WBC, Low Hct
infant w/ acute gastroenteritis. Which finding should the RN identify as the priority? a. decreased skin turgor b. cap refil 5 sec c. HR 150/min d. dry mucous membranes
b. cap refil 5 sec Cap refil above 4 sec= severe dehydration and requires immediate intervention to prevent progression to hypovolemic shock
Child w/ acute glomerulonephritis. Which action should the RN take? a. maintain strict bed rest b. check BP Q4hr c. admin albumin Q8hr d. low-carb diet
b. check BP Q4hr (4-8hr) to monitor for HTN
RN assessing a child w/ stage 1 Hodgkin disease. Which finding should the RN expect? a. generalized petechiae b. enlarged lymph nodes c. chronic vomiting d. dependent edema
b. enlarged lymph nodes (painless)
RN teaching a 9YO child who has a new dx of DM. The RN should identify that school-age children are attempting to master which of the following developmental tasks? a. initiative vs. guilt b. industry vs. inferiority c. trust vs. mistrust d. identity vs. role confusion
b. industry vs. inferiority
RN is caring for a 4 week old infant who is 2 week PO surgical correction of biliary atresia. Which finding indicates that the surgery was successful? a. infant lost 2.2 kg (1lb) since the sugery b. infant has a total bilirubin level of 0.3 mg/dL c. infant has an aspartate aminotransferase (AST) leval of 200 units/L d. Infant's stools are gray in color
b. infant has a total bilirubin level of 0.3 mg/dL within expected reference range
toddler w/ gastroenteritis caused by salmonella. Which is the priority action? a. weigh the child b. initiate contact precautions c. establish skin care routine d. obtain a recent food history
b. initiate contact precautions Salmonella is a type of bacteria that is transmitted via contaminated feces, making contact precautions essential for preventing transmission.
Home health RN is developing a plan of care of a toddler who has hemophilia. Which of the following instructions for the parents should the RN include in the plan? a. admin low-dose aspirin for pain b. inspect toys for sharp edges c. perform passive ROM to the affected joint during a bleeding episode d. Avoid contact w/ people w/ upper resp infections
b. inspect toys for sharp edges
RN caring for an infant who has a tracheoesophageal fistula. Which action should the RN take? a. place the infant in a lateral position b. perform oropharyngeal suctioning c. abmin ranitidine orally d. thicken the infant's formula
b. perform oropharyngeal suctioning (to decrease risk of aspiration) Supine w/ HOB elevated Maintain NPO status
lab report of 2 YO child w/ diarrhea and vomiting for 24 hr. Which finding should the RN report to the provider? a. Hct 40% b. potassium 2.5 mEq/L c. serum creatinine 0.4 mg/dL d. BUN 6 mg/dL
b. potassium 2.5 mEq/L
RN assessing an adolescent who has appendicitis. Which manifestations should the RN expect? a. RUQ abdominal pain b. rigid abdomen c. hyperactive bowel sounds d. bradycardia
b. rigid abdomen and RLQ abdom pain, decreased/absent bowel sounds, tachycardia, rapid shallow breathing
RN caring for an infant following the surgical repair of a cleft lip and palate. Which action should the RN take? a. keep mouth open by using a tongue blade for 4 hr following surgery b. suction infant gently w/ bulb syringe PRN c. place infant in prone postion d. clean the infant's incision w/ chlorhexidine
b. suction infant gently w/ bulb syringe PRN (to maintain patent airway) No objects in infant's mouth during PO period to avoid trauma to incision. Upright position to facilitate drainage of secretions (prone, lead to aspiration) Clean site w/ sterile saline after each feeding and PRN
RN teaching parent of an infant who has a colostomy. Which of the following statements by the parent indicates an understanding of the teaching? a. "I wont dress my child in 1 piece outfits" b. "I need to buy diapers that are tighter than those my infant usually wears" c. "I need to apply paste to the back of the wafer on my child's appliance" d. "I will not need to toilet train my child"
c. "I need to apply paste to the back of the wafer on my child's appliance" (acts as a sealant to prevent skin breakdown) Dress infants in 1 piece outfits to restrict their hand from reaching the pouch. Use diapers larger.
RN providing PO teaching to the parents of a 3 MO infant recovering from an umbilical hernia repair. Which statement by the parents indicates an understanding of the teaching? a. "I will expect the site to bulge when my baby cries" b. "I will place a belly band around my baby's abdom" c. "I will fold my baby's diaper away from the incision" d. "I will bathe my child in the bathtub daily"
c. "I will fold my baby's diaper away from the incision" Crying can increase intra-abdom pressure, but dosnt result in bulging at the site Dont use belly band bc lead to bowel strangulation
RN providing discharge teaching to parent of school-aged child w/ leukemia and getting chemo. Which statement indicates an understanding of the teaching? a. "rectal temp daily" b. "make sure kid gets MMR vaccine this week" c. "inspect mouth everyday for sores" d. "Allow child to ride his bike tom"
c. "inspect mouth everyday for sores" leukemia= increased risk of mucositis; so check the mouth daily for lesions or ulcerations
RN teaching a school-age child w/ new dx of type 1 DM. Which statement should the RN make? a. "if u take too much insulin, drink a sugar-free cola" b. "u will need to decrease ur insulin dosage when u become a teenager" c. "u can use a vial of insulin for up to 30 days" d. "stop taking ur insulin if u are vomiting"
c. "u can use a vial of insulin for up to 30 days" (28-30 days stored at room temp/in fridge) insulin requirements increase during puberty due to a decreased sensitivity to insulin
A RN on a peds onc unit is helping the pts of a child who is terminally ill to prepare for the impending loss of their child. Which of the following statements should the RN make? a. "the nursing staff will bathe ur child and take care of this daily needs" b. "Ur child will be most comfortable in a low-stimulation environment" c. "would u like assistance in planning where ur child will die?" d. "would u like hospice to continue providing curative care in ur home?"
c. "would u like assistance in planning where ur child will die?" RN should inform the parent that they can choose to keep their child in a hospital setting or take them home to die. Rn should be aware that active participation in planning for the location of death promotes positive bereavement outcomes. Should provide assistance parents in making and implementing this plan.
RN reviewing the lab reports of a child w/ acute nephrotic syndrome who has been receiving prednisone PO for the past week. Which finding should the RN report to the provider? a. serum Na 142 b. Serum K 4 c. WBC count 3,000 d. platelet count 298,000
c. WBC count 3,000 Use of corticosterioids suppresses immune system and increases risk of infection
RN providing discharge teaching to the guardian of an infant following a hypospadias repair. Which of the following instructions should the RN include? a. clamp the infant's catheter for 30 min every day b. give the infant a tub bath once per day c. apply antibacterial ointment to the infant's penis once per day d. Decrease the infant's fluid intake for 3 days
c. apply antibacterial ointment to the infant's penis once per day (to decrease risk of infection) avoid clamping the catheter at any time. avoid tub baths until the cath and stent are removed. Increase fluid intake
RN teaching abt clinical manifestations of tracheomalacia to the parents of an infant who had tracheoesophageal fistula repair as a NB. Which finding should the RN include in the teaching? a. absence of bowel sounds b. neck contortions c. barking cough d. projectile vomiting
c. barking cough infants w/ tracheomalacia have a weakened trachea, leading to collapse. Manifestations include barking cough, stridor, wheezing, cyanosis, and apnea tracheoesophageal fistula: upper GI disorder; so bowel sounds present
3 MO infant who has an ileostomy. Which intervention should the RN include in the plan? a. avoid laying the infant on his abdom b. avoid tucking the appliance into the infant's diaper c. check the bag for stool Q4hr d. replace the appliance Q3 days
c. check the bag for stool Q4hr can lay on abdom bc ostomy has no nerves (=no pain). Tuck appliance to diaper to prevent accidental removal. Replace once a week.
RN on a peds unit caring for a group of clients. Which of the following findings should be the RN's priority? a. Child w/ asthma and SpO2 94% b. child w/ nephrotic syndrome and 1+ protein on urine dipsick c. child w/ sickle cell anemia and urine specific gravity of 1.030 d. Child who has insulin-dependent DM and a fingerstick glucose reading of 110mg/dL
c. child w/ sickle cell anemia and urine specific gravity of 1.030 Child who has sickle cell anemia must obtain adequate hydration bc dehydration can cause sickle cell crisis that can occlude the child's circulation
Toddler w/ phenylketonuria (PKU). Which foods should the RN recommend? a. whole milk b. ground beef c. cooked carrots d. eggs
c. cooked carrots
Toddler w/ gastroenteritis. Which finding indicated the toddler is experiencing severe dehydration? a. slight thirst b. cap refill of 3 sec c. deep, rapid resp d. decreased tear production
c. deep, rapid resp (and wt loss 10% or more, parched mucus membranes, tachycardia) The rest is for mild-moderate dehydration
Teaching guardian of child w/ DM about how to recognize DKA. Which finding should the RN identify as a manifestation of this complication? a. slow HR b. protruding eyeballs c. deep, rapid resp d. decreased UOP
c. deep, rapid resp (kussmauls) and ketones in urine, and fruity breath, rapid HR, sunken eyeball
6 YO child experiencing encopresis. Which action should the RN take? a. instruct the child's guardian to limit stool softener use to no more than twice per week b. encourage the child to attempt to have BM 4x per day c. determine if there are any recent stressors in the child's environ d. Urge the child's guardian to provide neg consequences when they have a bowel accident
c. determine if there are any recent stressors in the child's environ Tx: emptying the bowel of impacted stool, then admin of daily stool softeners for 2-3 months encourage child to attempt to have a BM 2x daily (helps to establish a regular pattern of defecation)
RN caring for an 8YO child who has sickle cell anemia. Which action should the RN take? a. apply cool compress to the painful area b. initiate contact isolation precautions c. give the child flavored popsicles d. administer phytonadione
c. give the child flavored popsicles (for hydration to prevent sickling) phytonadione: Warfarin antidote; dont give to kids w/ sickle cell anemia
School RN is providing care to a child who has a nosebleed. Which action should the RN perform? SATA a. place the child in a supine postion b. apply pressure to the child's nose using the thumb and forefinger c. have the child tilt his head back d. apply a warm cloth to the bridge of the child's nose e. keep the child calm
c. have the child tilt his head back e. keep the child calm
RN teaching parent abt pinworm testing. At which of the following times should the RN advise the parent to perform the tape test? a. immediately after the child has a BM b. after being on clear liquid diet for 24 hr c. immediately after the child wakes up in the morning d. After soaking for 20 mins in a warm bath
c. immediately after the child wakes up in the morning (and before they bathe/use the restroom) Test should be repeated 3 mornings in a row pt can be on regular diet.
Infant w/ gastroenteritis and is dehydrated. Which characteristics places the infant at a higher risk of electrolyte imbalances compared to an adult client? a. less extracellular fluid b. reduced body surface area c. longer intestinal tract d. decreased rate of metabolism
c. longer intestinal tract (results in greater fluid loss, esp through diarrhea)
RN is planning care for an adolescent w/ sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following interventions should the RN include in the plan? a. apply cold compress to extremities b. administer meperidine Q4hr until the crisis has resolved c. maintain the child on bed rest d. decrease fluid intake for 8 hr
c. maintain the child on bed rest (to minimize energy expenditure and avoid additional oxygen needs)
RN caring for a preschooler who is immediately PO removal of brainstem tumor. Which action should the RN take? a. have the child deep-breathe and cough Q1hr b. offer the child clear liquids 4 hr PO c. monitor the child's temp Q30min d. place the child in trendelenburg postion
c. monitor the child's temp Q30min Bc surgery on brainstem can cause hypothermia
RN caring for a 6 MO infant w/ Intussusception. Which action should the Rn take? a. prepare to admin high-dose sterioids b. give the child magnesium hydroxide PO c. prepare the child for a barium enema d. inform the parents that the child will need a colostomy
c. prepare the child for a barium enema Pressure created by a barium enema might force the bowl to resume a normal configuration. Some children w/ Intussusception are tx w/ the barium enema and don't require surgical intervention
Which lab result should the RN report to the provider? a. pt w/ bacterial pneumonia and a WBC count of 15,800/mm^3 b. pt w/ CKD and calcium level of 8.7mg/dL c. pt w/ DKA and BG of 375mg/dL d. pt w/ leukemia and a Hct of 32%
c. pt w/ DKA and BG of 375mg/dL The initial goal of therapy for DKA is BG <240. To accomplish this, the pt should get regular insulin via cont IV infusion, RN monitor BG Q1hr. Report BG to adjust insulin dosage
RN is admitting a child w/ a Wilms' tumor. Which action should the RN take a. initiate contact precautions b. explain to the parents that chemo will start 3 months after surgery c. put a "no abdom palpation" sign over the child's bed d. prepare the child for a spinal tap
c. put a "no abdom palpation" sign over the child's bed (bc palpation is not necessary to confirm dx and could prompt metastasis)
RN reviewing lab findings of a 6 MO who has acute renal failure. Which finding should the RN expect? a. BUN 5 b. Creatinine 0.2 c. sodium 125 d. Potassium 4.2
c. sodium 125 expect hyponatremia, elevated bun, elevated creatinine, hyperkalemia
6 MO admitted w/ acute vomiting and diarrhea. Which finding indicates that the infant has moderate dehydration? a. bulging anterior fontanel b. bradycardia c. tachypnea d. polyuria
c. tachypnea would have flat/sunken fontanel, increased HR, decreased UOP
Child w/ glomerulonephritis. Which action should the RN take? a. monitor BP 2x/day b. maintain child on bed rest for 3 days c. weigh child once/day d. increase daily intake of Na
c. weigh child once/day (to monitor fluid balance) Can have HTN (BP Q4hr). Should participate in activites as tolerated; bed rest not required. Regular diet, moderate sodium restriction
RN teaching group of parents of toddlers about G&D. A parent asks, "y does my child's abdom stick out?" Which replies should the RN provide? a. "u should give ur child a stool softner daily" b. "toddlers gain weight at a rapid pace" c. "u should have ur child assessed for spinal deformity" d. "toddlers don't have well-developed abdom muscles"
d. "toddlers don't have well-developed abdom muscles"
RN providing teaching to a 12 YO recovering from an acute episode of hemophillia A. Which statement should the RN include? a. "Have ur parent stretch and move ur legs for u" b. "apply heat to joints that become painful, stiff, and swollen" c. "take aspirin at the first sign of a HA" d. "u will be able to participate in physical activity"
d. "u will be able to participate in physical activity" (is important for the maintenance of joint mobility and muscle strengthening. Participation in non-contact sports and use of protective equipment; but avoid high-impact sports) Passive ROM not dome after a bleeding episode bc rebleeding can occur. Active motion best to allow activity to be tailored to the kids pain tolerance A manifestation of Hemophilia A is hemarthrosis (bleeding into a joint capsule). Resulting in numbness, tingle, pain, discoloration, warmth, swelling of the affected joint. Instruct the pt to rest the joint, elevate above heart level, apply ice to decrease the rate of bleeding into the joint capsule.
A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described? a. Refusal to eat b. Vomiting about 2 hours after feeding c. Chronic diarrhea d. Vomiting immediately after feeding
d. Vomiting immediately after feeding With pyloric stenosis the circular muscle pylorus is hypertrophied. This thickness causes gastric outlet obstruction. The condition is seen in younger infants starting at 3 to 6 weeks of age. The infant has projectile nonbilious vomiting. It occurs directly after eating and is not related to the feeding position. The infant is hungry shortly after eating. There is weight loss and/or dehydration. The treatment is a pyloromyotomy to reduce the increased size and increase the opening. Diarrhea is not associated with the disorder.
RN caring for a school-aged child who has hemophilia and fell on the playground. Reports pain 4/10. Which action should the RN take? a. administer a NDAID b. perform passive ROM exercises on the joint c. administer cryoprecipitate d. apply an ice pack to the joint
d. apply an ice pack to the joint (immediately following an injury, joint should be rested, elevated, and have ice applied to minimize bleeding into the joint) Dont give aspirin or NSAIDs bc can interfere w/ action of platelets Tx hemophilia w/ factor VIII replacement or a synthetic form of vasopressin
RN caring for a child who has epistaxis. Which action should the RN take? a. Administer aspirin b. Tilt the head back and apply pressure c. have child lie down and rest d. apply cont pressure to the lower part of the nose
d. apply cont pressure to the lower part of the nose W/ the child sitting up and breathing through the mouth, RN should apply cont pressure w/ the thumb and finger to the soft lower area of the nose for 10 mins (most nosebleeds stop within this time) - aspirin can increase bleeding - tilting head back (blood flow back to throat) = nausea - lying down increases risk of aspirating blood
Rn is assessing a preschooler who has HIV. Which manifestations should the RN expect? a. generalized petechiae b. jaundice c. obesity d. chronic diarrhea
d. chronic diarrhea
6 MO infant w/ moderate dehydration. Which finding should the RN expect? a. absent tears b. wt loss >10% c. lethargy d. dry mucous membranes
d. dry mucous membranes the rest is for severe dehydration
A 4-year-old boy with nephrotic syndrome has extensive edema. The best intervention to reduce periorbital edema would be to: a. apply cool, sterile soaks to his head. b. encourage him to eat low-protein foods. c. apply warm compresses to his eyes at bedtime. d. elevate the head of the bed.
d. elevate the head of the bed.
RN planning care for a 6 YO child on chemotherapy. The child has a high platelet count of 20,000/mm^3. Based on the lab value, which intervention should the RN include in the plan of care? a. provide foods high in iron b. avoid people who have infections c. administer PRN oxygen d. encourage quiet play
d. encourage quiet play (will lessen the pt's risk of injury, and reduce chance of hemorrhage; bc they have increased clotting) High platelets is not an indication of an anemic condition.
School-aged child who has acute post-step glomerulonephritis. Which manifestations should the RN expect? a. hypotension b. elevated serum lipid levels c. decreased serum potassium levels d. hematuria
d. hematuria and Elevated BP
RN preparing to admin an enema to a 10 MO infant. Which action should the RN plan to take? a. admin the enema using room temp tap water b. insert the tubing 7.5cm (3in) into the rectum c. position the infant sitting upright on a bedpan while admin the enema d. hold the infant's buttocks together after administering the fluid
d. hold the infant's buttocks together after administering the fluid (to maintain retention of the enema) Tap water is hypotonic and can cause a rapid fluid shift and fluid overload- Isotonic 0.9% NaCl should be used. Insert tubing 2.5cm (1in) Supine w/ buttocks over a bedpan and the head and back supported by pillows
RN teaching parents of child w/ nephrotic syndrome. Which instruction should the RN include in the teaching? a. restrict the K intake b. admin acetaminophen twice daily c. weigh child once each week d. keep child away from people who have an infection
d. keep child away from people who have an infection Corticosteroids are 1st line tx daily weight restrict Na; fluids (in severe cases)
RN reviewing lab findings of an adolescent who has acute renal failure. Which finding should the RN expect? a. hypokalemia b. hypercalcemia c. decreased plasma creatinine level d. metabolic acidosis
d. metabolic acidosis and hyperkalemia, hypocalcemia, elevated plasma creatinine level
8 YO child w/ acute glomerulonephritis. Which finding should the RN expect? a. hypotension b. stomatitis c. bloody diarrhea d. periorbital edema
d. periorbital edema and elevated BP
Child w/ acute glomerulonephritis. Which manifestation should the RN expect? a. hypokalemia b. decreased BP c. increased urine volume d. periorbital edema
d. periorbital edema swelling is usually worse in the mornings and spreads throughout the day to the genitalia, abdom, and extremities and reduced urine volume, HTN
RN caring for a child w/ suspected nephrotic syndrome. Which lab value should the RN expect? a. platelets 120,000 b. serum Na 160 c. Hgb 9 d. serum cholesterol 700
d. serum cholesterol 700 will have high serum cholesterol bc the increase in plasma lipids They will have increased platelets, low serum Na, and normal/elevated Hgb: bc of hemoconcentration.
RN preparing to obtain an antistreptolysin O (ASO) titer for a child who has acute glomerulonephritis. What's the purpose of this test? a. determine the level of abx in blood b. if they ever had measles c. verifies the amt of albumin in blood d. shows if they had a recent strep infection
d. shows if they had a recent strep infection For definitive diagnosis
Diet for child w/ glomerulonephritis
moderate sodium, potassium (kids w/ decreased UOP). - grilled chicken, fruits, apple juice bc kidneys are not functioning properly.
