PEDS Test 2 and on Review Questions

What is the nurse's best response to a parent who asks what can be done at home to help a child with upper respiratory infection (URI) symptoms and a fever to get better?

"Give your child small amounts of fluid every hour to prevent dehydration."

The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Understanding the timeline of repair, what should the nurse tell the parents?

"The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."

The nurse is caring for a child who has been in a motor vehicle accident. The child falls to sleep unless her name is called or she is gently shaken. This state of consciousness is referred to as:

obtunded

A child had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis reveals normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? A. Urinalysis, urine culture, VCUG. B. Evaluate for renal failure. C. Admit to the pediatric unit. D. Discharge home on an antibiotic.

A

Which of the following can lead to a possible diagnosis of HIV in a child?. Select all that apply: A. Repeated respiratory infections B. Intermittent diarrhea. C. Excessive weight gain. D. Irregular heartbeat. E. Poor weight gain.

A, B, E

The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis? A. "The baby is a fussy eater and does not want to eat." B. "The baby tends to have very forceful vomiting about 30 minutes after feeding." C. "The baby is always hungry after vomiting so I refeed." D. "the baby is happy in spite of getting really upset after spitting up."

C. "The baby is always hungry after vomiting so I refeed."

The parent of a child with influenza asks the nurse when the child is most infectious. What is the nurse's best response?

"24 hours before and after the onset of symptoms."

Which assessment is of greatest concern in a 15-month-old? A. The child in lying down, has moderate retractions, low-grade fever, and nasal congestion. B. The child is in the tripod position, has diminished breath sounds, and a muffled cough. C. The child is sitting up and has coarse breath sounds, coughing, and fussiness. D. The child is restless and crying, has bilateral wheezes, and is feeding poorly.

B. The child is in the tripod position, has diminished breath sounds, and a muffled cough.

Which breathing exercises should the nurse have an asthmatic 3-year-old child do to increase her expiratory phase?

Blow a pinwheel

What test provides a definitive diagnosis of Aplastic Anemia?

Bone marrow aspiration/biopsy

A 13-year-old with type 2 DM asks the nurse, "Why do I need to have this hemoglobin A1c test?" The nurse's best response is based on which of the following? A. To determine how balanced the child's diet has been. B. To make sure the child is not anemic. C. To determine how controlled the child's blood sugar has been over 2-3 months D. To make sure the child's blood ketone level is normal.

C

A teen is seen in clinic for a possible diagnosis of Hodgkins disease. The nurse is aware that which of the following symptoms should make the physicians suspect Hodgkins disease? A. Fever, fatigue, and pain in the joints. B. Anorexia with weight loss. C. Enlarged, painless, and movable lymph nodes in the cervical area. D. Enlarged liver with jaundice.

C

At a follow-up visit for an 8-year-old who is being evaluated for short stature, the nurse measures and plots the child's height on the growth chart. Which explanation should the nurse give the child and family? A. "We want to make sure you were measured accurately the last two visits." B. "We need to calculate how tall you will be when you grow to adult height." C. "We need to see how much you have grown since your last visit." D. "We need to know your height so that a dosage of medication can be calculated for you."

C

Select the best room assignment for a newly admitted child with bacterial meningitis. A. Semiprivate with a roomate who also has bacterial meningitis B. Semiprivate with a roomate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. C. Private room that is dark and quiet with minimal stimulation. D. Private room that is bright and colorful and has activities available.

C

A child has completed treatment for leukemia and comes to the clinic for a check-up. The parents express that they are glad their child has been cured of cancer and is safe from getting cancer later in life. Which of the following should the nurse consider in responding?

children surviving one cancer are at higher risk for developing another cancer

The parent's of a 4-year-old ask the nurse how to manage their child's constipation. What is the nurse's best response?

encourage the child to drink more fluids

What is the best method to prevent the spread of infection to an immunosuppressed child?

have everyone wash their hands before coming into contact with the child

The diet that produces anticonvulsant effects from ketosis consists of:

high fat and low carb foods

A child's parent asks the nurse what treatment the child will need for the diagnosis of strep throat. Which is the nurse's best response?

"Your child will need oral penicillin for 10 days and should feel better in a few days".

What can an ECG detect? Select all that apply. A. Tachycardia B. Dysrhythimias C. Cardiac output D. Systemic vascular resistance E. Supraventricular tachycardia F. Bradycardia G. Conduction delay

A,B,E,F,G

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? A. Maintain isolation precautions until 24 hours after receiving IV antibiotics B. IV fluids at 1 1/2 times regular maintenance. C. Neuro checks every hour D. Administer acetaminophen for temperatures higher than 38 degrees C.

B

A 10-kg toddler has a 24-hour urine output of 120mL. After calculating daily fluid maintenance, which would the nurse like the toddler's daily oral and IV fluid intake to be? 200 mL. 350 mL. 1000 mL 2000 mL

1000 ml

FLACC pain scale used for what ages?

2months-7years

FACES pain scale used for what ages?

3-7 years

The bladder capacity of a 3-year-old is approximately how much?

5 fluid ounces age of child +2 in ounces

A 7-year-old is diagnosed with central precocious puberty. The child is to receive a monthly IM injection of Lupron. The child has great fear of pain and needles and requires considerable stress reduction techniques each time an injection is due. What could the nurse suggest that might help manage the pain? A. Apply EMLA to the site 60 minutes before the injection. B. Have extra help on hand to hold the child down. C. Apply cold to the area prior to the injection. D. Identify a reward to bribe the child to behave during the injection.

A

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complication? Select all that apply: A. Anemia. B. Infection. C. Bone deformities. D. Polycythemia.

A, B

The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which question would be appropriate for the nurse to ask to obtain more information? Select all that apply: A. "Has there been a stressful event in the child's life, such as the birth of sibling?" B. "Does your child seem to be drinking more than usual?" D. "Is your child more irritable, and does your child seem to be in pain when urinating?" E. 'Has anyone else in the family had problems with accidents?"

A, B, C, D

Which of the following can be manifestations of leukemia in a child? Select all that apply: A. Leg pain. B. Fever. C. Excessive weight gain. D. Bruising. E. Enlarged lymph nodes.

A, B, D, E

Which child with asthma should the nurse see first? A. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. B. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally with an oxygen saturation of 93%. C. A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92%. D. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%.

A. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%.

Which child is at highest risk for requiring hospitalization to treat respiratory syncytial virus (RSV)? A. A 2-month-old who was born at 32 weeks. B. A 16-month-old with a tracheostomy. C. A 3-year-old with a congenital heart defect. D. A 4-year-old who was born at 30 weeks.

A. A 2-month-old who was born at 32 weeks.

The nurse is caring for a newborn with esophageal atresia. When reviewing the mother's history, which would the nurse expect to find? A. Maternal polyhydramnios. B. Pregnancy lasting more than 38 weeks. C. Poor nutrition during pregnancy. D. Alcohol consumption during pregnancy.

A. Maternal polyhydramnios.

Which would be an early sign of respiratory distress in a 2-month-old? A. Tachypnea. B. Tachycardia. C. Breathing shallowly. D. Bradycardia.

A. Tachypnea

Which approach would be best to use to ensure a positive response from a toddler? A. Assume an eye-level position and talk quietly. B. Call the toddler's name while picking him or her up. C. Call the toddler's name and say, "I'm your nurse." D. Stand by the toddler, addressing him or her by name.

A. assume an eye-level position and talk quietly

Which laboratory result will provide the most important information regarding the respiratory status of a child with an acute asthma exacerbation?

ABG

Which would the nurse expect to hear the parents of an infant with an incarcerated hernia report?

Acute onset of pain, abdominal distentio, and a mass that cannot be reduced.

The parent of a 2-year-old who is HIV+ questions the nurse about placing the child in day care. Which of the following is the best response? A. The child should not go to day care. There is a high risk for transmission of the disease. B. The child can be admitted to day care without restrictions and should be allowed to participate in all activities. C. The child can go to day care but should avoid physical activity. D. The child may go to day care, but the parent must inform all the parents at the day care that the child is HIV+.

B

What should the nurse assess prior to administering digoxin?

Apical pulse rate

A 6-year-old is diagnosed with growth hormone deficiency. A prescription is written for a dose of 0.025 mg/kg of somatotropin SQ three times weekly. The child weighs 59.4 lb. Which dose of medication should the nurse administer three times weekly? A. 0.5 mg B. 0.675 mg C. 1 mg D. 2 mg

B

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The child's platelet count is 20,000/mm3. Based on this lab finding, what information should the nurse provide to the child and parents? A. Isolation precautions should be started immediately. B. A soft toothbrush should be used for mouth care. C. The child's vital signs, including blood pressure, should be monitored every day. D. All visitors should be discouraged from coming to see the family.

B

The nurse is taking care of a 10-year-old diagnosed with Graves disease. Which could the nurse expect this child to have recently had? A. Weight gian, excessive thirst, and excessive hunger. B. Weight loss, difficulty sleeping, and heat sensitivity. C. Weight gain, lethargy, and goiter. D. Weight loss, poor skin turgor, and constipation.

B

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems are associated with sickle cell disease? Select all that apply: A. Polycythemia B. Kidney damage C. Thrombocytopenia D. Vaso-occlusive crisis E. Splenic sequestration

B, D, E

Which child is in the greatest need of emergency medical treatment? A. A 3-year-old with barky cough, afebrile, and mild intercostal retractions. B. A 6-year-old with high fever, no spontaneous cough, and frog-like croaking. C. A 7-year-old with an abrupt onset of moderate respiratory distress, a mild fever, and barky cough. D. A 13-year-old with a high fever, stridor, and purulent secretions.

B. A 6-year-old with high fever, no spontaneous cough, and frog-like croaking.

A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the IV line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which would the nurse expect to do immediately? A. Administer a bolus of D10W. B. Administer a bolus of normal saline. C. Administer a D5NS bolus. D. Offer the child Pedialyte.

B. Administer a bolus of normal saline.

BRAT

Bananas Rice Apples Toast These contribute to constipation

Which finding requires immediate attention in a child with glomerulonephritis? A. Sleeping most of the day, very "cranky" when awake. Blood pressure is 170/90. B. Urine output is 190mL in an 8-hour period and is the color of Coca-Cola. C. Complaining of a severe headache and photophobia. D. Refusing breakfast and lunch and stating he "just is not hungry."

C

An 18-month-old is brought to the clinic. His height is in the 50% and weight is in the 80%. The child is pale. The physical exam in normal. His hematocrit is 20%. Which of the following questions would assist with his diagnosis? Select all that apply: A. "How many bowel movements a day does you child have?" B. "How much did he weigh at birth?" C. "What does your child eat every day?" D. "How much milk does your child drink per day?"

C, D

The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type I DM. What information should the nurse provide about this condition?

Characterized mainly by insulin deficiency.

The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" Which is the nurse's best response? A. "Do not be had on yourself. It's easy to overlook something that has been growing for months when we see our children on a regular basis." B. "I understand you must be very upset. Your child would have had a better prognosis had yu caught it earlier. C. "It really takes a trained professional to recognize something like this." D. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

D

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a UTI? A. carfully cleanse the perineum front to back, and apply a urine collection bag to the perineum. B. Insert an indwelling foley, obtain the sample, and wait for results. C. Place a sterile cotton ball in the diaper, and obtain the sample with a syringe after the first void. D. Using a straight catheter, obtain the sample, and remove the catheter without waiting for the results of the urine sample.

D

Which of the following is the most common opportunistic infection in children infected with HIV? A. CMV B. Encephalitis C. Meningitis D. Pneumocystic pneumonia

D

A 10-year-old is being evaluated for possible appendicitis and complains of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a CBC has been obtained. The child vomits, finds the pain relieved, and calls for the nurse. What should be the nurse's next action? A. Cancel the ultrasound. B. Cancel the surgery. C. Prepare for a possible discharge of the patient. D. Immediately notify the physician of the child's status.

D. Immediately notify the physician of the child's status.

A nurse is doing discharge teaching with a parent who has a child with beta-thalassemia. The nurse informs the parent that the child is at risk for which of the following conditions? A. Hypertrophy of the thyroid B. Polycythemia C. Thrombocytopenia D. Chronic hypoxia and iron overload

D

The nurse caring for a patient with type I DM is teaching how to self-administer insulin. Which is the proper injection technique? A. Position the needle with the bevel facing downward before the injection. B. Spread the skin prior to injection. C. Aspirate for blood return prior to injection. D. Elevate the subcutaneous tissue before injection.

D

A school-age child is admitted to the hospital for a tonsillectomy. During the nurse's post-operative assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations would be of most concern to the nurse? A. The child's heart rate and blood pressure are elevated. B. The child complains of having a sore throat. C. The child is refusing to eat. D. The child is swallowing excessively.

D. the child is swallowing excessively

FLACC pain scale

Face Legs Activity Cry Consolability scores of 0-2 in each category 0=no pain 10=max pain

The school nurse notices that a 14-year-old who used to be an excellent student and very active in sports is losing weight and acting very nervous. The teen was recently checked by the PCP, who noted the teen had a very low level of TSH. The nurse recognizes that the teen has what condition?

Graves Disease

HR and BP when child is in pain

HR up BP - possibly high, but HR better determinant

During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to:

Hold the child in knee-chest position to decrease venous return

A child has been diagnosed with valvular disease following rheumatic fever. The nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery and childbirth. The parents indicate they understand when they say:

She will need to take antibiotics the rest of her life.

FACES pain scale

Numeric scale of 1-10 using descriptive drawings of faces for the child to point at. Usually 5 years old and up can accurately use this scale

A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. What is this defect known as?

PDA

A 10-year-old child is recovering from a severe sore throat. The child is complaining of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is:

Rheumatic Fever

What would the nurse advise the parent of a child with a barky cough that gets worse at night to do?

Take the child outside into the more humid night air for 15 minutes.

On exam, a nurse hears a murmur in a child with diarrhea and fever. The parent asks why the pediatrician never said anything about the murmur. The nurse explains:

The fever increases the intensity of the murmur

What would the school nurse expect in a student who has an insulin-to carbohydrate ratio of 1:10?

The student administers 1 U of regular insulin for every 10 grams of carbohydrate consumed.

The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition?

There is a lack of peristalsis in the large intestine and accumulation of bowel contents, leading to abdominal distention.

The nurse knows that young infants are at risk for injury from shaken baby syndrome because:

They have insufficient musculoskeletal support and a disproportionate head-to body ratio

True or false: For a newborn with hypoplastic left heart syndrome, Prostaglandin E may be given to keep the PDA open until surgery.

True

True or false: Indomethacin may be given to close a PDA in newborns.

True

The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability bringing the knees up the chest and crying, and periods of lethargy. The physician has ordered an enema. The parents ask the purpose of the enema. What is the nurse's best response?

"The enema will help confirm the diagnosis and has a good chance of fixing the intussusception."

Which manifestation suggests that an infant is developing necrotizing enterocolitis (NEC)? A. Absorption of bolus feeding a a faster rate than previous feedings. B. Bloody diarrhea. C. Increase bowel sounds. D. Appears hungry right before a scheduled feeding.

B. Bloody diarrhea.

Which finding would be of most concern in an infant with respiratory distress? Tachypnea. Mild retractions. Wheezing. Grunting.

Grunting

The parent of a 4-year-old brings the child to the clinic and tells the nurse the child's abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. What is most important when doing a physical exam on this child?

avoid palpation of the abdomen

The nurse is aware that cloudy cerebral spinal fluid (CSF) most likely indicates:

bacterial meningitis

The nurse is caring for a 6-month-old diagnosed with meningitis. When the child is placed in the supine position and flexes his neck, the nurse notes he flexes his knees and hips. This is referred to as:

brudzinski sign

An adolescent woke up complaining of intense pain and swelling of the scrotal area and abdominal pain. He has vomited twice. Which should the nurse suggest?

take him to the ER immediately (testicular torsion)

Which of the following factors need to be included in a teaching plan for a child with sickle cell crisis? Select all that apply: A. The child needs to be taken to a physician when sick. B. The parent should make sure the child sleeps in an air-conditioned room. C. Emotional stress should be avoided. D. It is important to keep the child well hydrated. E. It is important to make sure the child gets adequate nutrition.

A, C, D, E

Which are the most serious complications for a child with Kawasaki disease? Select all that apply? A. Coronary thrombosis B. Coronary stenosis C. Coronary artery aneurysm D. Hypocoagulability E. Decreased sedimentation rate

A,B,C

The nurse is interviewing the parent of a 9-year-old girl. The parent expresses concern because the daughter already has pubic hair and is starting to develop breasts. Which statement would be most appropriate? A. "Your daughter should get her period in approximately 6 months." B. "Your daughter is developing early and should be evaluated for precocious puberty." C. "Your daughter is experienceing body changes that are appropriate for her age." D. "Your duaghter will need further testing to determine the underlying cause."

C

Which signs best indicate increased cranial pressure (ICP) in an infant? Select all that apply: A. Sunken anterior fontanel B. Complaints of blurred vision C. High-pitched cry D. Increased appetite E. Sleeping more than usual

C, E

A 4-month-old has had vomiting and diarrhea for 24 hours. The infant is fussy, and the anterior fontanel is sunken. The nurse notes the infant does not produce tears when crying. What will help confirm the diagnosis of dehydration?

analysis of serum electrolytes

The nurse is caring for a 4-year-old who weighs 15kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 ml. What action does the nurse take?

this is normal so record it in the child's chart 150ml/10 hours = 15 should be 0.5-1ml/kg/hour