Peds final

The nurse is caring for a child who has received significant partial-thickness burns to the lower body. What is the priority assessment in the first 24 hours after injury? a. Fluid balance. b. Wound infection. c. Respiratory arrest. d. Separation anxiety.

a. In the child with a serious burn, fluid balance is of priority importance in the first few days of care.

A child with leukemia received chemotherapy about 10 days ago. She presents today with a temperature of 100.4°F, an absolute neutrophil count of 500, and mild bleeding of the gums. What is the priority nursing intervention? a. Administer IV antibiotics as ordered. b. Provide vigorous oral care frequently with a firm toothbrush. c. Monitor pulse and blood pressure for changes. d. Administer packed red blood cell transfusion.

a. The neutropenic child must have IV antibiotics started as soon as possible in the event of fever to prevent overwhelming infection and sepsis.

The nurse is caring for a child who has just been admitted to the pediatric unit with sickle cell crisis. He is complaining that his right arm and leg hurt. What is the priority nursing intervention? a.Administer pain medication every 3 hours intravenously until pain is controlled. b.Perform passive range of motion of the arm and leg to maintain function. c.Try acetaminophen for pain first, moving up to opioids only if needed. d.Use narcotic analgesics and warm compresses as needed to control the pain.

a. The priority in a sickling crisis is to bring pain under control quickly as this brings the child relief; also, the significant stress resulting from pain can contribute to the further sickling of cells.

A child born with a single transverse palmar crease, a short neck with excessive skin at the nape, a depressed nasal bridge, and cardiac defects is most likely to have which autosomal abnormality? a. Trisomy 21 b. Trisomy 18 c. Trisomy 14 d. Trisomy 13

a. These are some of the characteristics of trisomy 21 (Down syndrome). Trisomy 21 is also associated with some degree of mental retardation and other health problems such as cardiac defects, visual and hearing impairment, intestinal malformations, and an increased susceptibility to infections.

The mother of a child with hypogammaglobulinemia reports that her child had a fever and slight chills with an intravenous gammaglobulin infusion last month. She wants to know what other course of treatment might be available. What is the best response by the nurse? a. Administration of acetaminophen or diphenhydramine prior to the next infusion may decrease the incidence of fever or chills. b. Giving the gammaglobulin intramuscularly is recommended to prevent a reaction. c. Talk to her physician or nurse practitioner about alternative medications that may be used to boost the gammaglobulin level in the blood. d. If the child is no longer experiencing frequent infections, then the IV infusions may not be necessary.

a. Use of antipyretics and antihistamines prior to administration of intravenous immunoglobulin may decrease the incidence of fever or chills with the infusion.

The nurse is caring for a 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? a. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." b. "I know it will be important for me to catheterize my child for the rest of her life." c. "I will make sure that I always use latex-free catheters." d. "I will wash the catheter with warm soapy water after each use."

b. Children with adequate upper extremity function and normal intelligence usually learn to catheterize themselves around age

The nurse is caring for a child with Down syndrome. What should the nurse's focus be? a. Teaching hygiene skills to the child in order to increase self-esteem b. Screening for anomalies and teaching about prevention of respiratory infection c. Finding opportunities to increase socialization for the child and family d. Expecting walking at age 1 year and toilet training completion at age 2 years

b. Down syndrome is associated with multiple congenital anomalies, particularly cardiac and gastrointestinal defects. Children with Down syndrome also suffer much more frequent respiratory infections than typical children do. Children with Down syndrome achieve developmental skills later than typical children; they should be referred to early intervention services and have an individualized education plan in place once they have entered the public school system.

The nurse is caring for a 6-year-old with juvenile idiopathic arthritis. The mother states that she has trouble getting her daughter out of bed in the morning and believes the girl's behavior is due to a desire to avoid going to school. What is the best advice by the nurse? a. Refer the girl to a psychologist for evaluation of school phobia related to chronic illness. b. Administer a warm bath every morning before school. c. Give the child her prescribed NSAIDs 30 minutes before getting out of bed. d. Allow her to stay in bed some mornings if she wants.

b. Heat or warmth helps ease the stiffness resulting after a period of inactivity in a child with juvenile arthritis.

The nurse is teaching about skin care for atopic dermatitis. Which statement by the parent indicates that further teaching may be necessary? a. "I will use Vaseline or Crisco to moisturize my child's skin." b. "A hot bath will soothe my child's itching when it is severe." c. "I will buy cotton rather than wool or synthetic clothing for my child." d. "I will apply a small amount of the prescribed cream after the bath."

b. Hot baths should be avoided, as they are more dehydrating to the skin. Warm baths are preferred, followed by patting the child dry and rubbing on a small amount of prescribed cream, then a liberal amount of fragrance-free moisturizer. Wool clothing should be avoided in the child with atopic dermatitis.

A mother brings her 4-day-old infant to the clinic with vomiting and poor feeding. The newborn was healthy at birth. The nurse should suspect: a. Sturge-Weber syndrome b. An inborn error of metabolism c. Trisomy 18 d. Turner syndrome

b. In many cases of inborn errors of metabolism, a newborn who was healthy at birth will present with lethargy, poor feeding, apnea or tachypnea, recurrent vomiting, altered consciousness, failure to thrive, seizures, septic appearance, or developmental delay.

A varsity high-school wrestler presents with a "rug burn" type of rash on his shoulder that is not healing as expected, despite use of triple antibiotic cream. Two other wrestlers on his team have a similar abrasion. What infection should the nurse be most concerned about, based on the history? a. Tinea cruris. b. MRSA. c. Impetigo. d. Tinea versicolor.

b. MRSA may be nonresponsive to antibiotic ointments and is becoming common in the community, particularly among athletes. Impetigo is a possibility, although it is usually responsive to antibiotic cream. Tinea cruris and tinea versicolor also would not improve with an antibiotic cream, as they are fungal infections, but the description of the skin lesion does not fit.

A mother has received instructions about avoiding wheat and soy allergens. Which response by the mother would indicate that further education is needed? a. "I will not feed my child any breads made with wheat flour." b. "I will allow my child to eat semolina pasta, the kind he loves." c. "I will not feed my child shakes made with soy protein." d. "I will read labels to be sure I am avoiding wheat and soy."

b. Semolina contains wheat and thus should be avoided by those with a wheat allergy. Educate families about hidden sources of allergens.

The nurse is caring for a child with Turner syndrome admitted to the unit for treatment of a kidney infection. What characteristics associated with this syndrome may the nurse expect to find upon assessment? a. Microcephaly, polydactyly b. Low-set ears, cleft lip c. Short stature, webbed neck d. Gynecomastia, taller than average

c. A child with Turner syndrome presents with characteristic features, such as short stature and a webbed neck. Also seen in children with this syndrome are a low posterior hairline, wide-spaced nipples, edema of the hands and feet, amenorrhea, no development of secondary sex characteristics, sterility, and perceptual and social skill difficulties. Gynecomastia and taller-than-average height are characteristics seen in children with Klinefelter's syndrome.

What is the priority nursing intervention for the child recently admitted with Guillain-Barré syndrome? a. Perform range-of-motion exercises. b. Take temperature every 4 hours. c. Monitor respiratory status closely. d. Assess skin frequently.

c. Although range of motion and skin integrity are also important, the progressive paralysis may lead to respiratory distress/arrest, so monitoring for respiratory involvement is critical.

The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality? a. Encourage follow-through with physical therapy exercises. b. Restrict the child to a special needs classroom. c. Encourage after-school activities within the limits of the child's abilities. d. Ensure the school is aware of the child's capabilities.

c. Children in wheelchairs enjoy activities such as choir, Scouts, and art classes, just as typical children do. Sometimes additional modifications may need to be made for the child to succeed in the activity.

A 14-year-old with systemic lupus erythematosus wants to know how to care for her skin. What should the nurse teach this adolescent? a. Careful sun tanning will give her skin an attractive color. b. No special skin care is needed. c. Use sunscreen daily to avoid rashes. d. Use makeup to camouflage the butterfly rash on her face.

c. Children with SLE experience photosensitivity that results in skin rashes. Daily sunscreen use (minimum SPF 15) is recommended.

A 14-year-old with thalassemia asks for your assistance in choosing her afternoon snack. Which choice is the most appropriate? a. Peanut butter with rice cake. b. Small spinach salad. c. Apple slices with cheddar cheese. d. Small burger on wheat bun.

c. Children with thalassemia should avoid foods that are high in iron. Spinach, peanut butter, a burger, and whole-grain bread are high in iron. Apples and cheese are not.

A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history? a. Age that the child learned to walk b. Parents' expectations of the child's development c. Functional status related to eating and mobility d. Birth history to identify cause of cerebral palsy

c. Each child with cerebral palsy has individual strengths. The nurse must know this child's functional status, as mobility and feeding may both be affected in the child with cerebral palsy.

A 5-year-old has been diagnosed with Wilms tumor. What is the priority nursing intervention for this child? a. Educate the parents about dialysis, as the kidney will be removed. b. Measure abdominal girth every shift. c. Avoid palpating the child's abdomen. d. Monitor BUN and creatinine every 4 hours.

c. Excessive palpation of the abdomen in a child with Wilms' tumor can cause seeding of the tumor, leading to metastasis.

The nurse is caring for a child in the emergency department who was bitten by the family dog, who is fully immunized. What is the priority nursing action? a. Administer rabies immunoglobulin. b. Refer the child to a counselor. c. Assess the depth and extent of the wound. d. Administer a tetanus booster.

c. Fully assess the extent of the wound before initiating other care. A full assessment allows the nurse to determine the next course of action.

A child with cancer is receiving chemotherapy, and his mother is concerned that the nausea and vomiting associated with chemotherapy are reducing his ability to eat and gain weight appropriately. What is the most appropriate nursing action? a. Administer an antiemetic at the first hint of nausea. b. Offer the child's favorite foods to encourage him to eat. c. Start antiemetic drugs prior to the chemotherapy infusion. d. Maintain IV fluid infusion to avoid dehydration.

c. Give the antiemetic prior to the chemotherapy drug to prevent nausea and vomiting.

A child with hemophilia fell while riding his bicycle. He was wearing a helmet and did not lose consciousness. He has a mild abrasion on his knee that is not oozing. He is complaining of abdominal pain. What is the priority nursing assessment? a. Perform neurologic checks. b. Assess ability to void frequently. c. Carefully assess his abdomen. d. Examine his knee frequently.

c. The child's complaint of abdominal pain indicates that undetected bleeding may be present in the abdomen. Determining whether internal bleeding is present would take priority over the knee abrasion, which has nearly stopped bleeding.

A child on the pediatric unit has morning laboratory results of Hgb 10.0, Hct 30.2, WBC 24,000, and platelets 20,000. What is the priority nursing assessment? Assess for pallor, fatigue, and tachycardia. Monitor for fever. Assess for bruising or bleeding. Determine intake and output.

c. The extremely low platelet count places the child at significant risk for bleeding, so this takes priority over borderline anemia and possibility of infection.

The nurse working in a women's health clinic determines that genetic counseling may be appropriate for a woman: a. Who just had her first miscarriage at 10 weeks b. Who is 30 years old and planning to conceive c. Whose history reveals a close relative with fragile X syndrome d. Who is 18 weeks pregnant and whose triple screen came back normal

c. The family history plays a critical role in identifying genetic disorders. A history of a previous child, parents, or close relatives with an inherited disease, congenital anomalies, metabolic disorders, developmental disorders, or chromosomal abnormalities can indicate an increased risk of genetic disorders; therefore, referral to genetic counseling is appropriate.

The nurse is caring for an infant on the pediatric unit who has a very red rash in the diaper area, with red lesions scattered on the abdomen and thighs. What is the priority nursing intervention? a. Administer griseofulvin with a fatty meal. b. Institute contact isolation precautions. c. Apply topical antibiotic cream. d. Apply topical antifungal cream.

d. An angry red rash with satellite lesions is typical of diaper candidiasis. Topical antifungal preparations are indicated.

You are counseling a couple, one of whom is affected by neurofibromatosis, an autosomal dominant disorder. They want to know the risk of transmitting the disorder. The nurse should tell them that each offspring has a: a. One in four (25%) chance of getting the disease b. One in eight (12.5%) chance of getting the disease c. One in one (100%) chance of getting the disease d. One in two (50%) chance of getting the disease

d. Autosomal dominant inheritance occurs when a single gene in the heterozygous state is capable of producing the phenotype. The affected person generally has an affected parent, and an affected person has a 50% chance of passing the abnormal gene to each of his or her children.

A child with leukemia has the following a.m. laboratory results: Hgb 8.0, Hct 24.2, WBC 8,000, platelets 150,000. What is the priority nursing assessment? a. Monitor for fever. b. Assess for bruising or bleeding. c. Determine intake and output. d. Assess for pallor, fatigue, and tachycardia.

d. The Hgb and Hct indicate anemia, which results in fatigue, pallor, and tachycardia.

A 4-month-old infant born to an HIV-infected mother is going into foster care because the mother is too ill to care for the child. The foster mother wants to know if the infant is also infected. What is the best response by the nurse? a. "It's too early to know; we have to wait until the infant has symptoms." b. "Since the mother is so ill, it's likely the child is also infected with HIV." c. "The ELISA test is positive, so the child is definitely infected." d. "The PCR test is positive; this indicates HIV infection, which may or may not progress to AIDS."

d. The PCR tests for actual HIV genetic material in the child. A positive PCR test indicates active infection.

A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. He has an ineffective cough. Lung auscultation reveals diminished breath sounds. What is the priority nursing intervention? a. Apply supplemental oxygen. b. Notify the respiratory therapist. c. Monitor pulse oximetry. d. Position for adequate airway clearance.

d.Positioning for airway clearance is the priority intervention, although suctioning may also be required. Interventions for airway maintenance take priority over other issues.