PEDS Week 4- Book/Online
14. The nurse is caring for a 12-year-old boy who sustained major burns when he put charcoal lighter on a campfire. The nurse observes that he is "very brave" and appears to accept pain with little or no response. The most appropriate nursing action related to this is which of the following? A. Request a psychologic consultation. B. Ask the child why he doesn't have pain. C. Praise the child for ability to withstand pain. D. Encourage continued bravery as a coping strategy.
A A psychologic consultation will help the child verbalize fears. Children in this age group are concerned with physical appearance. The psychologists can help integrate the issues that the child is facing. It is likely that the child is having pain but not acknowledging the pain. If the child is feeling pain, the nurse should not praise him for hiding it. Encouraging continued bravery may not be an effective coping strategy if the child is in severe pain. (CH 24 pg 988)
6. A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions for acute diarrhea. Instructions to the mother about breastfeeding should include which of the following? A. Continue breastfeeding. B. Stop breastfeeding until the breast milk is cultured. C. Stop breastfeeding until diarrhea is absent for 24 hours. D. Express breast milk and dilute it with sterile water before feeding it.
A Breastfeeding is recommended for infants with acute diarrhea. Continued breastfeeding results in a reduced severity and duration of the illness. There is no need to culture breast milk. Early introduction of nutrients improves outcomes. Diluting expressed breast milk with sterile water before feeding should never be done. It can contribute to an electrolyte imbalance.(CH 26 pg 1063)
1. Which of the following types of diarrhea is commonly seen in malabsorption syndromes because the intestine cannot absorb nutrients or electrolytes? A. Chronic B. Secretory C. Acute D. Intractable diarrhea of infancy
A Chronic diarrhea is commonly seen in malabsorption syndromes. In disorders such as lactose intolerance, the intestine cannot absorb nutrients or electrolytes. Secretory diarrhea is usually caused by bacterial enterotoxins that stimulate fluid and electrolyte secretion. Acute diarrhea is caused by infectious agent in the gastrointestinal tract. Intractable diarrhea of infancy is a syndrome that occurs in the first few months of life and persists longer than 2 weeks with no recognized pathogens.(CH 26 pg 1058)
5. A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child begins with A. intravenous fluids. B. oral rehydration solution. C. clear liquids, 1 to 2 oz at a time. D. administration of antidiarrheal medication.
A In children with severe dehydration, intravenous fluids are initiated. Oral rehydration solution is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids usually have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.(CH 26 pg 1063)
13. An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. Which of the following is also important in her immediate care? A. Cool with a single application of tepid water. B. Encourage her to drink clear liquids. C. Remove her burned clothing and jewelry. D. Leave the rug in place until the ambulance arrives.
A In major burns, additional applications of cool water lead to a drop in body temperature and potential circulatory collapse. Nothing is given by mouth because of the risk of aspiration in the presence of a paralytic ileus. As much of her clothing should be removed as possible.(CH 24 pg 977)
11. Which of the following occurs in septic shock? A. Massive vasodilation B. Increased respiratory rate C. Decreased capillary permeability D. Increased systemic vascular resistance
A In septic shock, an infection triggers an inflammatory response, which results in massive vasodilation and increased capillary permeability. Respirations are not affected. Capillary permeability is increased. Vasodilation results in decreased systemic vascular resistance.(CH 24 pg 963)
3. What type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion?" A. Isotonic dehydration B. Hypotonic dehydration C. Hypertonic dehydration D. All types of dehydration in infants and small children
A Isotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. "Dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion" is a definition specific to isotonic dehydration.(CH 24 pg 952)
6. The nurse is assessing an infant brought to the clinic with diarrhea. He is lethargic and has dry mucous membranes. Which of the following should the nurse recognize as an early sign of dehydration? A. Tachycardia B. Bulging, tense fontanel C. Decreased blood pressure D. Capillary refill of less than 3 seconds
A Tachycardia is the earliest manifestation of dehydration. Fever and infection can also result in tachycardia, so these should be included in the assessment data. A bulging fontanel may be indicative of increased intracranial pressure, not dehydration. Decreased blood pressure is a late sign of dehydration. Capillary refill is slowed and more than 3 seconds in dehydration.(CH 24 pg 952)
3. Because children with celiac disease must limit their intake of products containing gluten in wheat, rye, oats, and barley, they are at risk for which of the following nutritional deficiencies? Select all that apply. A. Iron deficiency anemia B. Folic acid deficiency C. Zinc deficiency D. Vitamin A, D, E, and K deficiency E. Vitamin B12 deficiency
A, B, D
2. A 5-month-old infant is seen in the well-child clinic for a complaint of vomiting and failure to grow. His birth weight was 7 pounds, and he now weighs 8 pounds, 10 ounces. The infant's mother reports that he is taking 4 to 7 ounces of formula every 4 to 5 hours, but he "spits up a lot after eating and then is hungry again." The child is noted to be alert but appears malnourished. The mother reports his stools are brown in color, and he has 1 to 2 bowel movements every day. Based on these findings, the nurse anticipates the infant has: A. Meckel diverticulum B. Hypertrophic pyloric stenosis C. Intussusception D. Hirschprung disease
B
2. The greatest threat to life as a result of dehydration in children is: A. Oliguria B. Shock C. Arrhythmia D. Hypotension
B
5. A burn injury involving the epidermis and varying degrees of the dermal layer that is painful, moist, red, and blistered describes which of the following? A. Superficial or first-degree burn B. Partial-thickness or second-degree burn C. Full-thickness or third-degree burn D. Fourth-degree burn
B
5. The nurse caring for a 4-month-old infant with biliary atresia and significant urticaria can anticipate administering: A. Diphenhydramine B. Ursodiol (ursodeoxycholic acid) C. Loratidine D. Zantac
B
4. Rapid replacement of fluid is essential in the treatment of which of the following types of dehydration? A. Isotonic, osmotic B. Hypotonic, isotonic C. Osmotic, hypertonic D. Hypertonic, hypotonic
B In moderate to severe dehydration, rapid expansion of the intravascular space is necessary. Rapid replacement is indicated in isotonic dehydration. Osmotic is not a type of dehydration. Rapid replacement is contraindicated in hypertonic dehydration.(CH 24 pg 952)
12. Which of the following statements regarding burn injuries in children is correct? A. Burns are the most frequent cause of accidental death during childhood. B. The prognosis for a burned child is directly related to the amount of tissue destroyed. C. The standard "rule of nines" chart is typically used for assessing the size of a burn in small children. D. Children younger than age 2 years have significantly lower mortality rates than older children with similar burns.
B The prognosis of a child with a burn is directly related to the amount of tissue destroyed. The location of the wounds, age of the child, causative agent, respiratory involvement, general health of the child, and other injuries are also considered. Burned clothing is removed to prevent further damage from smoldering fabric and hot beads of synthetic fabric. Jewelry is removed to stop the transfer of heat from the metal to the skin. Burn and fire injuries are the third leading cause of unintentional injury-related death in children younger than the age of 14 years. The body proportions of the child are different from those of an adult. Use of the standard adult rule of nines will give an inaccurate estimate of the burn area. Physiologic factors, including greater relative percentage body water, minimum protein stores, and an immature immune response, contribute to a significantly higher mortality in children younger than age 2 years.(CH 24 pg 969)
6. Hepatitis A virus is transmitted by which of the following? Select all that apply. A. Breast milk from mother with HAV B. Ingestion of contaminated food C. Fecal-oral route D. Casual contact with infected person E. Blood transfusion
B, C
15. To prevent burns from hot water in the home, the nurse should recommend that families set their water heater thermostat to A. 38º C (100º F). B. 49º C (120º F). C. 60º C (140º F). D. 71º C (160º F)
B. . The recommended temperature to set water heaters is 120º F. A water heater can be set 10 degrees higher and still be safe. Temperatures of 60º C (140º F) to 71º C (160º F) are too high. At 140º F, submersion for 5 seconds will cause a burn.(CH 24 pg 992)
1. A 16-month-old has a history of diarrhea for 3 days with poor oral intake. He received intravenous fluids, has tolerated some oral fluids in the ED, and is being discharged home. Instructions for diet for this child should include: A. BRAT diet (bananas, rice, applesauce, and toast) for 24 hours, then a soft diet as tolerated B. Chicken or beef broth for 24 hours, then resume a soft diet C. Offer a regular diet as child's appetite warrants D. Keep on clear liquids and toast for 24 hours
C
1. The most common type of dehydration in children occurs when electrolyte and water deficits are present in approximately balanced proportions. This is called ________________ dehydration. A. Hypotonic B. Hypertonic C. Isotonic D. Hyponatremic
C
3. A 3-year-old boy is seen in the clinic at 8:30 pm with a history of vomiting for 2 days and poor oral intake; he has voided once since the previous day. Examination reveals a lethargic child sitting on the mother's lap. He has a capillary refill of 4 seconds, apical HR of 128, respiratory rate of 32, and poor skin turgor. Stated body weight is 25 kilograms. Based on this information, the nurse anticipates performing which of the following? A. Demonstrating to the mother how to give 5 to 10 ml of Pedialyte by mouth every 5 to 10 minutes B. Administering an intravenous fluid bolus of 450 ml of 5% dextrose in water over 60 minutes C. Administering an intravenous fluid bolus of 500 ml of 0.9% normal saline over 20 minutes D. Administering an intravenous fluid bolus of 1000 ml of 5% dextrose and 0.45% normal saline over 30 minutes
C
4. A 4-day-old infant is seen in the emergency department for a possible seizure earlier in the day. The infant was being breastfed but without much success, so an aunt gave him a bottle of water. The infant continued to cry, and the mother was too exhausted to breastfeed, so another bottle of water was given while someone went to the store to purchase infant formula. The pregnancy, delivery, and postpartum history reveal no particular problems for this term infant that might contribute to seizures. The physical exam is unremarkable, with the exception of hypertonic reflexes. The infant is awake, alert, and sucking on his fists. Diagnostic studies are obtained, including an EEG. The nurse anticipates which of the following as the possible explanation for the infant's condition? A. Serum potassium of 3.9 mEq B. Serum glucose of 69 mg C. Serum sodium of 118 mEq D. Arterial pH of 7.34
C
4. A formerly preterm infant who had surgery for necrotizing enterocolitis is now 6 months old and has short bowel syndrome. He is unable to absorb most nutrients taken by mouth and is totally dependent on parenteral nutrition, which he receives via a Broviac catheter. The clinic nurse following this infant is aware that this infant should be closely observed for the development of: A. Gastroesophageal reflux B. Chronic diarrhea C. Cholestasis D. Failure to thrive
C
6. A 10-year-old child suffered extensive second- and third-degree burns in an apartment fire. His weight is 75 pounds (34 kg). Fluid replacement therapy will optimally: A. Result in an hourly urine output of 1 ml/kg B. Result in an hourly urine output of 20 ml/kg C. Result in an hourly urine output of 30 ml/kg D. Maintain a systolic blood pressure in the 95th percentile for the child's weight
C
9. Enteral feedings are ordered for a young child with burns covering 40% of total body surface area. The nurse should know that A. oral feedings are contraindicated. B. enteral feedings must be stopped during painful procedures. C. presence of a paralytic ileus does not preclude use of enteral feedings. D. the feedings will be high carbohydrate and low protein.
C Because the small bowel maintains mobility and absorptive capabilities, the placement of a small-bore feeding tube into the duodenum allows for safe delivery of enteral nutrition during periods of paralytic ileus associated with sepsis, trauma, and anesthesia. Oral feedings are not contraindicated. This is encouraged; however, most children with burns are unable to consume sufficient calories by mouth. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended.(CH 26 pg 1114)
1. Which of the following is defined as the forces that favor filtration from the capillary? A. Diffusion and osmosis B. Active transport C. Capillary hydrostatic pressure and interstitial oncotic pressure D. Hydrostatic pressure
C Capillary hydrostatic pressure and interstitial oncotic pressure are forces that favor filtration from the capillary. Diffusion is the random movement of molecules from a region of greater concentration to regions of lower concentration, and osmosis is the physical force created by a solution of higher concentration across a semipermeable membrane. Active transport is movement of a substance against a pressure gradient from an area of lesser or equal concentration to an area of greater or equal concentration. A carrier substance is needed. Hydrostatic pressure is the pressure in the arterial portion of the circulatory system, which can push fluid through the capillary walls.(CH 24 pg 946)
5. Depression of the central nervous system (CNS), manifested by lethargy, delirium, stupor, and coma, is observed in which of the following? A. Metabolic acidosis B. Respiratory alkalosis C. Metabolic and respiratory acidosis D. Metabolic and respiratory alkalosis
C Hydrogen ion imbalances result in CNS involvement. Depression of the CNS, as manifested by lethargy, delirium, diminished mental capacity, stupor, and coma, is found in acidosis that is either metabolic or respiratory in origin. Respiratory acidosis can also manifest these clinical findings. Respiratory and metabolic alkalosis are reflected clinically by CNS excitation and stimulation, nervousness, tingling sensations, and tetany that may progress to seizures.(CH 24 pg 962)
7. The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. Which of the following should the nurse include? A. Give nothing by mouth for 24 hours. B. Avoid carbohydrate-containing liquids. C. Brush teeth or rinse mouth after vomiting. D. Give plain water until vomiting ceases for at least 24 hours.
C It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Ad libitum administration of glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrates to spare body protein and avoid ketosis.(CH 26 pg 1068)
9. Which of the following is a major complication of total parenteral nutrition in children? A. Anemia B. Asthma C. Liver disease D. Renal impairment
C Liver disease is the most important gastrointestinal complication of total parenteral nutrition. If present, anemia and asthma are not directly related to the total parenteral nutrition. Renal function is monitored to ensure electrolyte balance, but impairment is not an expected complication.(CH 24 pg 956)
4. Therapeutic management of the child with acute diarrhea and dehydration usually begins with which of the following? A. Clear liquids such as fruit juice and soft drinks B. Adsorbents, such as kaolin and pectin C. Oral rehydration solution D. Antidiarrheal medications such as paregoric
C Oral rehydration solution is the first treatment for acute diarrhea. Clear liquids are not recommended because they usually have a high carbohydrate content, low electrolyte content, and high osmolality. Adsorbents are not recommended. Antidiarrheals are not recommended because they do not get rid of pathogens.(CH 26 pg 1062)
2. Which of the following is the viral pathogen that frequently causes acute diarrhea in young children? A. Giardia organisms B. Shigella organisms C. Rotavirus D. Salmonella organisms
C Rotavirus is the viral pathogen that most frequently causes diarrhea in young children. Giardia is a bacterial pathogen that causes diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States. Salmonella is a bacterial pathogen that causes diarrhea.(CH 26 pg 1058)
7. When caring for a child with an intravenous infusion, the nurse should do which of the following? A. Change the insertion site every 24 hours. B. Use a macrodropper to facilitate the prescribed flow rate. C. Observe the insertion site frequently for signs of infiltration. D. Avoid restraining the child to prevent undue emotional stress.
C The nursing responsibility for intravenous therapy is to calculate the amount to be infused in a given length of time; set the infusion rate; and monitor the apparatus frequently, at least every 1 to 2 hours, to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. This exposes the child to significant trauma. If an infusion pump is not used, a minidropper (60 drops/ml) is the recommended intravenous tubing in children. The intravenous site should be protected. This may require soft restraints on the child.(CH 24 pp 985, 986)
8. Several types of long-term central venous access devices are used. Which of the following is a benefit of using an implanted port (e.g., Port-a-Cath)? A. Accessed without piercing skin B. Easy to use for self-administered infusions C. Easy access for blood work D. Catheter unable to dislodge from port even if the child "plays" with the port site
C The port is completely under the skin. Other advantages include cosmetic appearance and easy access for blood work and fluid and medication administration. The skin must be accessed with a special needle before the infusion can begin. Placement in the chest makes it difficult to use for self-administered injections. The catheter can be dislodged from the port if the child rubs the port site.(CH 24 pg 990)
3. A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which of the following conditions? A. Parasitic infection B. Fat malabsorption C. Protein intolerance D. Bacterial gastroenteritis
D Bacterial gastroenteritis is associated with neutrophils or red blood cells in the stool. The stool will be analyzed for ova and parasites when the bacterial and viral cultures are negative. Malabsorption is characterized by a pH of less than 6 and presence of reducing substances. Diarrhea that develops after introduction of cow's milk, fruits, or cereals may be related to protein intolerance.(CH 26 pg 1062)
8. The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The nurse should do which of the following first? A. Determine what the child has eaten. B. Administer diphenhydramine (Benadryl). C. Move the child to the nurse's office or hallway. D. Have someone call for an ambulance or paramedic rescue squad.
D Because the child is in severe respiratory distress, the nurse should remain with the child while someone else calls for the rescue squad. Because severe respiratory distress is occurring, treatment of the response is indicated first. The cause of the response can be determined later. Diphenhydramine will not be effective for this type of allergic reaction. The child should not be moved unless the child is in a place that puts the child at greater hazard.(CH 26 pg 1099)
10. Which of the following should the nurse recognize as an early clinical sign of compensated shock in a child? A. Confusion B. Sleepiness C. Hypotension D. Apprehension
D Early signs are vague and subtle, including apprehension, irritability, normal blood pressure, narrowing pulse pressure, thirst, pallor, and diminished urinary output. Confusion, sleepiness, and hypotension are later signs of shock.(CH 24 pg 960)
2. In which of the following conditions is the fluid requirement for children decreased? A. Burns B. Fever C. Vomiting D. Increased intracranial pressure
D When there is a risk of increased intracranial pressure, the child's fluid balance is carefully monitored to ensure that only required fluids are given. With burns, fever, and vomiting, the child loses fluids at a greater than expected rate. Supplemental fluids need to be given to avoid the risk of dehydration.(CH 24 pg 947)
