PNE193-Unit 3 Exam (Abuse, GI/Endocrine, Genitourinary, Musculoskeletal, and Integumentary Disorders, Communicable Diseases)
What are the signs and symptoms of acute glomerulonephritis?
-Periorbital edema -smokey brown or bloody urine -oliguria -elevated BUN and creatinine -hyperkalemia -hypertension.
What are the signs and symptoms of minimal change nephrotic syndrome?
-peri-orbital edema (decreases throughout the day) -edema to lower extremities and genitalia -weight gain over a period of days or weeks -ascites -pale skin -irritable, lethargic -frothy, dark colored urine -poor appetite (anorexia) -decreased urinary output -BP within range or slightly below (HTN is a rare finding in MCNS)
What is acute glomerulonephritis?
Allergic reaction to streptococcal infection affecting glomerular tissue. The glomeruli are inflamed, which impacts the kidneys ability to filter the urine properly
What is Nephrotic Syndrome?
Alterations in the glomerular membrane allow proteins, especially albumin, to pass into the urine, resulting in decreased serum osmotic pressure
What is the treatment for a urinary tract infection?
Antibiotics
who is most commonly affected by acute glomerulonephritis?
Boys aged 3-7 years old.
What precautions should be taken after Wilm's Tumor surgery?
Contact sports should be avoided to prevent damage to the remaining kidney.
The nurse is educating a family on celiac disease. Which is conclusive and confirms the diagnosis? noted symptoms of steatorrhea improvement of general well-being when on a gluten-free diet biopsy of the intestine through endoscopy showing changes in villi serum screening of immunoglobulin G
Correct Response:biopsy of the intestine through endoscopy showing changes in villi Rationale: All of the options relate to ways of determining if there is a possibility that a client has celiac syndrome. Conclusive diagnosis is made with an endoscopy and biopsy of the intestine.
A nurse assesses a client who is reporting calf pain and a very sore leg. The client has a temperature of 101°F (38.3°C). X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and the erythrocyte sedimentation rate is elevated. What condition do these symptoms suggest? Legg-Calvé-Perthes disease osteomyelitis muscular dystrophy compartment syndrome
Correct Response:osteomyelitis Rationale: Osteomyelitis is a bone infection usually caused by Staphylococcus aureus, which causes leg pain and fever. Lab work reflects an elevated leukocyte count and an increased erythrocyte sedimentation rate. X-rays look normal until 5 to 10 days after onset of symptoms.
The parents of a school-aged client diagnosed with acute glomerulonephritis are asking when their child can increase activity. Which instruction is most accurate? after antibiotics are fully completed when fatigue has diminished when the client is afebrile when gross hematuria has subsided
Correct Response:when gross hematuria has subsided Rationale: The nurse is most accurate to state that the client's activity level can increase from bed rest to limited activity after gross hematuria has subsided. It is important for the client to not get fatigued. It is good that the client is afebrile and appropriate to finish all antibiotics.
What are the signs and symptoms of a urinary tract infection in older kids and adults?
Dysuria, urgency, bedwetting, etc.
What is another name for Wilm's Tumor?
Nephroblastoma.
Which assessment finding is clinically significant for early nephrotic syndrome?
Periorbital edema
Why is it important to avoid unnecessary handling of the abdomen in Wilm's Tumor?
Rupture can cause the tumor to spread.
What are the treatment options for Wilm's Tumor?
Surgery, radiation, and chemotherapy.
Is Wilm's Tumor genetic?
Yes, it is genetic.
How can a urinary tract infection be prevented?
-Cleanse perineum with each diaper change -avoid bubble bath -urinate immediately after a bath -wear white cotton underwear and loose-fitting pants -drink adequate fluids and avoid caffeine.
What is the expected recovery time for acute glomerulonephritis?
1 year.
when do symptoms of acute glomerulonephritis typically appear?
1-3 weeks after a strep infection
How is Wilm's Tumor usually discovered?
2/3 of tumors are discovered before the child turns 3, either by a mass in the abdomen noted by a parent or during a routine checkup.
At an obstetric visit 28 weeks into her pregnancy, an expectant mother tells the nurse that her friend's newborn has a soft spot on his head. She is concerned that something is wrong with this baby and is worried the same thing could happen to her child. The best explanation the nurse could offer this expectant mother regarding the bones in the skull would be which statement? "Bone takes a long time to develop; the skull bones will be stronger and more solid than bones that are completely formed at birth." "Most babies are born without the soft spot, but if they have one it will be checked." "The bones remain soft until the brain is completely developed to make sure the skull is large enough to accommodate a large brain." "The softer spot and unclosed sutures in the skull allow the bones to move as they need to so that the baby's head can move through the narrow birth canal."
Correct Response:"The softer spot and unclosed sutures in the skull allow the bones to move as they need to so that the baby's head can move through the narrow birth canal." Rationale: The bones of the skull give shape to the head. The areas where these bones meet are called suture lines. These suture lines have not yet ossified, or hardened into bone, during fetal life. Because these suture lines are not fused, during delivery the bones of the skull can move and overlap, allowing for the head to pass through the birth canal. Within the first 2 years of life, these suture lines or fontanels fuse together.
The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply. Wear sterile gloves when removing or touching the cast. Check capillary refill time in the both arms. Wear a protective gown when moving the child's arm. Document any signs of pain. Monitor the color of the nail beds in the right hand.
Correct Response:Check capillary refill time in the both arms. , Document any signs of pain. , Monitor the color of the nail beds in the right hand. Rationale: The most important function for the nurse in caring for a child in a cast is frequent neurovascular checks. The nurse should monitor for increased pain and edema, a pale or blue color to the extremities, skin coolness, numbness or tingling, poor capillary refill, and decreased pulse strength. Increased pain, especially unrelieved with pain medications, can indicate serious complications such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary as the cast is not sterile.
A young boy fell off of his bike and injured his arm. X-rays indicate that he has a greenstick fracture. His parents ask the nurse the meaning of this term. What is the nurse's best response? The two parts of the fractured bone are only partially separated in his forearm. The fractured bone is totally separated from the other part of the bone in his forearm. The fracture occurred from the bone bending and then breaking apart. Your son's arm has sustained a twisting fracture.
Correct Response:The two parts of the fractured bone are only partially separated in his forearm. Rationale: A greenstick fractures is a type of incomplete fracture that occurs when the bone bends and partially cracks due to decreased ossification. The bone fragments remain partially connected.
An adenosarcoma found in the region of the kidney in a child would most likely be: Ewing sarcoma. leukemia. osteosarcoma. Wilms tumor.
Correct Response:Wilms tumor. Rationale: Wilms tumor is an adenosarcoma in the kidney region, one of the most common abdominal neoplasms of early childhood.
How does Wilm's Tumor affect the kidneys?
It seldomly affects both kidneys and the tumor is encapsulated.
treatment includes maintaining fluid volume and managing hypertension
glomerulonephritis
what is the physical appearance of kidneys with acute glomerulonephritis?
pale and enlarged
What is enuresis?
uncontrolled or unintentional urination that occurs after a child is beyond an age at which bladder control has been achieved (bed-wetting)
What are possible causes of enuresis?
-Diabetes -UTI =constipation -sleeping too soundly -rigorous toilet training before the child was physically ready -sexual abuse.
What are the treatment measures for acute glomerulonephritis?
-Limit physical activity until hematuria subsides -limit exposure to infection -examine urine regularly -restrict sodium, potassium, and fluids -strict I&Os -antihypertensive medication -diuretics.
What are some treatments for enuresis?
-Rule out physical cause -limit fluids before bed -enuresis alarm.
How is Nephrotic syndrome classified? what are the classifications?
-according to the amount of membrane destruction MCNS (minimal change nephrotic syndrome) FGS (focal glomerulosclerosis) MPGN (membranoproliferative)
At what age do many children acquire complete nighttime bladder control?
5-7 years old.
How long does the acute phase of acute glomerulonephritis last?
6-8 weeks.
The nurse is teaching parents about the care of diaper rash. The nurse would be concerned about the parents' level of understanding if they made which statement? "I should be certain to use fabric softener in the care of the infant's clothes." "I need to wash and rinse clothes thoroughly to be sure all of the detergent is washed out." "I should only use ointments and creams as instructed by the health care provider." "I should not overdress the infant."
Correct Response:"I should be certain to use fabric softener in the care of the infant's clothes." Rationale: Fabric softeners should be avoided because their use can result in skin irritation in the infant. Clothing and other baby items should be washed and rinsed thoroughly. Overdressing should be avoided as sweating irritates the rash, and only ointments and creams that are recommended by health care personnel should be used on the infant.
The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child? Eyes Abdomen Fingers Sacrum
Correct Response:Eyes Rationale: The symptoms of nephrotic syndrome include periorbital edema upon awakening with progressive edema throughout the day in all extremities and abdomen. Ascites can develop in the abdomen and the nurse should assess the child regularly for this development. The child with nephrotic syndrome generally does not have sacral edema, unless the edema is extreme and has not been treated.
The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this? Spiral Greenstick Epiphyseal Complete
Correct Response:Greenstick Rationale: Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through (i.e., looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse). A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.
The nurse is triaging clients as they come in to an urgent care facility. Which assessment finding is clinically significant for early nephrotic syndrome? Facial puffiness Periorbital edema Sacral edema Edema in the hands
Correct Response:Periorbital edema Rationale: Periorbital edema and edema in the ankles are the initial presenting symptoms. As the swelling advances, the edema becomes generalized with a pendulous abdomen full of fluid. Edema in the scrotum also appears. Edema in the hands, sacrum and facial puffiness can be a progression of the disease.
In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? Change the infant's diet to one that is lactose-free. Assist in doing a barium enema procedure on the infant. Medicate the infant with analgesics. Prepare the infant for surgery.
Correct Response:Prepare the infant for surgery. Rationale: In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception.
A young child has just been admitted to the emergency department with a burn that encompasses the epidermis and the underlying dermis. From which type of burn does this child suffer? Third-degree or full-thickness burn First-degree or superficial burn Fourth-degree or fat-layer burn Second-degree or partial-thickness burn
Correct Response:Second-degree or partial-thickness burn Rationale: A burn that encompasses the epidermis and the underlying dermis is a second-degree burn. A first-degree burn would only involve the epidermis, and a third-degree burn would involve nerve endings as well as destruction of the epidermis and dermis. A fourth-degree burn would extend even deeper into the fat layer.
The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction? Skin traction Dunlop traction Skeletal traction Balanced suspension traction
Correct Response:Skin traction Rationale: Traction is used to provide immobilization to reduce or immobilize a fracture, align an injured extremity or allow the extremity to be restored to the normal length. The types of traction include skin, skeletal and suspension. The types of skin traction include Bryant, Russell, Buck, cervical and side arm 90-90. In these types of traction some type of tape, rubber, plastic or manufactured material is attached to the skin. A weight is attached via pulley which indirectly exerts pull on the musculoskeletal system. Dunlop is a form of skeletal traction. Balanced suspension uses a series of weights and pulleys to align the hip, femur or tibia.
An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants? Escherichia coli Group A beta hemolytic strep Methicillin-resistant Staphylococcus aureus (MRSA) Staphylococcus aureus
Correct Response:Staphylococcus aureus Rationale: Staphylococcus aureus is the most common cause of impetigo in infants. MRSA is a hospital-associated infection (HAI), group A beta hemolytic strep is seen in older children, and Escherichia coli is not frequently associated with impetigo.
A 3-year-old child is admitted after being severely burned. The nurse collects the following data. What finding would be most important for the nurse to report immediately? The child's pain level is a 7 on a 10-point pain scale. The child's respiratory rate is 42 breaths/min. The child's hourly urinary output is 150 ml. The child's temperature is 101.2°F (38.4°C).
Correct Response:The child's respiratory rate is 42 breaths/min. Rationale: An increase in the respiratory rate after a severe burn may be an indication of possible serious respiratory complications and should be reported immediately in case an endotracheal tube needs to be inserted. A temperature of 101.2°F (38.4°C) would be expected with a burn. A child who has just been severely burned would be expected to have a lower urine output not higher. An hourly urine output of 150 ml exceeds the expected output of a 3-year-old child. That child should be producing 1 to 2 ml/kg/hr. A normal 3-year-old child would weigh approximately 30 lb (13.6 kg), which means the output should be around 27 ml/hr. Fluid replacement for the burned child aims to have a urine output of 1 to 2ml/kg/hr. The pain rating of 7 would be expected in severe burns.
The nurse is presenting information related to intestinal parasite infections to a group of community health nurses. One member of the group asks the nurse how she might know if a child had a pinworm infestation. The nurse correctly answers this question by stating which of the following? Many times children with pinworms have abdominal cramps, diarrhea, and weight loss. There are not usually symptoms when a child has pinworms. They are found by finding eggs on microscopic examination of the feces. The primary symptom of pinworms is intense perianal itching. Most often children with pinworms complain of itching on their feet.
Correct Response:The primary symptom of pinworms is intense perianal itching. Rationale: Intense perianal itching is the primary symptom of pinworms.
The child who has a fracture of the lower extremity or a lower leg injury is usually fitted with, and taught how to use, which type of crutches? forearm crutches trough crutches axillary crutches Canadian crutches
Correct Response:axillary crutches Rationale: The most common type of crutches are axillary crutches, which are principally used for temporary situations such as children with fractures of the lower extremities and other lower leg injuries.
In the child diagnosed with miliaria rubra, a rash that appears as pinhead-sized reddened papules usually is most noticed in which areas of the body? folds of the skin and around the neck arms and lower legs scalp and top of the feet genital and anal areas
Correct Response:folds of the skin and around the neck Rationale: The rash appears as pinhead-sized erythematous (reddened) papules. It is most noticeable in areas where sweat glands are concentrated, such as folds of the skin, the chest, and around the neck. It usually causes itching, making the child uncomfortable and fretful.
The nurse is collecting data on a child who has been brought to the clinic. The child has urticaria, pruritus, stomach pains, and respiratory symptoms. The nurse recognizes that the clinical manifestations noted in this child are commonly seen in which disorder? calcium insufficiency protein malnutrition food allergies vitamin deficiency
Correct Response:food allergies Rationale: Common symptoms of food allergies are urticaria (hives), pruritus (itching), stomach pains, and respiratory symptoms.
Which congenital condition leads to the infant being hungry, irritable, losing weight, and rapidly becoming dehydrated with the potential of metabolic alkalosis? intussusception pyloric stenosis colic aganglionic megacolon
Correct Response:pyloric stenosis Rationale: This clinical picture includes assessment findings consistent with pyloric stenosis. These infants are very hungry yet once they eat, regurgitate the feeding leading to the infant being irritable, losing weight, and becoming dehydrated. The infant with aganglionic megacolon has a main symptom of constipation. Intussusception is a painful telescoping of the bowel. Colic has similar symptoms but primarily includes bouts of abdominal pain.
What is pyelonephritis?
Inflammation of the kidney with abrupt high fever.
What is the recommended approach for Wilm's Tumor treatment?
Kidney and tumor are removed as soon as possible to prevent rupture of the capsule.
What is Wilm's Tumor?
Most common malignant renal tumor of early life.
The nurse is doing client teaching with a child who has been placed in a brace to treat scoliosis. Which statement made by the child indicates an understanding of the treatment? Wearing this brace only during the night will not be so embarrassing." "When I start feeling tired, I can just take my brace off for a few minutes." "At least when I take a shower I have a few minutes out of this brace." "I am so glad I can take this brace off for the school dance."
Correct Response:"At least when I take a shower I have a few minutes out of this brace." Rationale: The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. For curves 25-40 degrees the recommended treatment is bracing. The brace must be worn 23 hours per day. The child needs to be taught that the brace must be worn at all times, during the day as well as the night. Compliance, especially with adolescents, is difficult due to peer pressure. The other issues with compliance include being hot and being uncomfortable.
A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group? "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often." "Problems with the kidneys raise the risk for infection because there is a problem with producing white blood cells." "The kidneys help get rid of carbon dioxide from the body, so kidney problems can affect our child's breathing." "We should expect problems with too much fluid in the brain because the kidneys are not able to keep the fluid in balance."
Correct Response:"The kidneys help control blood pressure, so our child's blood pressure needs to be checked often." Rationale: Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. Therefore, monitoring blood pressure is important. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acids-bases. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli in the lungs. Cerebrospinal fluid circulates through the brain and spinal cord.
The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care? Intravenous fluids Foley catheter placement Abdominal palpation Supine positioning
Correct Response:Abdominal palpation Rationale: Abdominal palpation is contraindicated preoperatively in a client with a Wilms tumor. Cells may break loose and spread the tumor. Intravenous fluids and supine positioning are appropriate in the client's care. A Foley catheter is typically not placed.
A 5-year-old girl is being admitted with a possible diagnosis of child abuse. The child has bruises in various places on her body that the caregiver attributes to the child playing soccer. Bruises associated with child abuse would likely be found in which areas of the body? forehead elbows knees thighs
Correct Response:thighs Rationale: Bruises that occur in areas of soft tissue, such as the abdomen, buttocks, genitalia, thighs, and mouth, may prompt suspicions of child abuse.
What is the cause of nephrotic syndrome?
Unknown, often follows viral infection
How is a urinary tract infection diagnosed?
Urinalysis with culture and sensitivity to identify the specific bacteria
An 8-year-old child has had skin testing done for allergies. After a review of the results, it is decided that the child will undergo hyposensitization therapy. The parents are asking the nurse questions about the purpose of this therapy and what to expect. Which information will the nurse include when teaching the parents and child about this therapy? "Your child will have to remain in the office for about one-half hour after each treatment." "Initially the dose will be high and then be gradually decreased." "The risk for a severe allergic reaction is high, but the benefits are greater." "This therapy works better than trying to avoid the allergens."
Correct Response:"Your child will have to remain in the office for about one-half hour after each treatment." Rationale: Hyposensitization is performed for the allergens that produce a positive reaction on skin testing and for those allergens that are impossible to avoid. The allergist sets up a schedule for injections in gradually increasing doses until a maintenance dose is reached. The client should remain in the health care provider's office for 20 to 30 minutes after the injection in case any reaction occurs. Reactions are treated with epinephrine. Severe reactions in children are uncommon, and hyposensitization is considered a safe procedure with considerable benefit for some children.
The nurse is conducting a presentation for a group of nurses who work with adolescents. The group discusses dysmenorrhea. Which statement is mostaccurately related to dysmenorrhea? Genetic abnormalities are the most common cause of dysmenorrhea. Common symptoms of dysmenorrhea are weight gain and mood swings. Dysmenorrhea can result from diaphragms or tampons being left in place too long. A contributing factor in dysmenorrhea is the increased secretion of prostaglandins.
Correct Response:A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. Rationale: The increased secretion of prostaglandins, which occurs in the last few days of the menstrual cycle, is thought to be a contributing factor in primary dysmenorrhea. Tampons or diaphragms being left in too long are related to pelvic and vaginal infections, not dysmenorrhea. Dysmenorrhea is the pain associated with smooth muscles. The weight gain and mood swings are related to hormonal changes during this time. Genetic abnormalities do not contribute to dysmenorrhea.
The nurse is teaching a group of peers regarding different types of fractures seen in children. Which statement best describes a complete fracture? A fracture in which the bone breaks into two pieces An incomplete fracture of the bone A fracture in which the bone buckles rather than breaks A fracture in which the bone bends without breaking
Correct Response:A fracture in which the bone breaks into two pieces Rationale: A fracture in which the bone breaks into two pieces is called a complete fracture. A fracture in which the bone bends without breaking is called a plastic or bowing deformity. A fracture in which the bone buckles rather than breaks is called a buckle fracture. An incomplete fracture of the bone is called a greenstick fracture.
The school nurse has been told that a 7-year-old child is the subject of bullying. How best does the nurse approach the situation? Have a discussion between the bully and the child about friendship. Directly ask the child if he or she is bullied. Ask the child a general statement such as "How is everything going?" Ask the child if he or she knows what bullying is.
Correct Response:Ask the child a general statement such as "How is everything going?" Rationale: The school nurse is correct to ask the child some general questions in the event the client may bring up the topic. This also provides the opportunity to develop a therapeutic relationship. A 7-year-old child may be shy if directly asked about being bullied or what bullying is. By having both the child and the bully into the office to talk about friendship indicates that the child has done something wrong.
The nurse is caring for a child admitted with second-degree (partial-thickness) burns. What is most characteristic of this type of burn? Blisters appear. Pain is minimal. Muscle damage occurs. Skin is red and edematous.
Correct Response:Blisters appear. Rationale: In first-degree (superficial) burns, the injury is only to the epidermis. The burns are very painful, red, and dry. In second-degree (partial-thickness) burns, the injury is to the epidermis and part of the dermis. These burns are painful, edematous, have a wet appearance and form blisters. In third-degree (full-thickness ) burns, the dermis, epidermis and hypodermis are all involved. There may or may not be pain. These burns are red and edematous and may have peeling, charred skin. Muscle damage can occur.
The mother of a child who has sustained a fractured leg is worried how long her child will be unable to walk without crutches. The nurse would explain to the mother that the child should be walking independently soon due to what reason? Children do not feel as much pain as adults. A child weighs less than an adult so the child can walk earlier. Children are less compliant and tend to quit using the crutches. Children's bones heal faster than adults.
Correct Response:Children's bones heal faster than adults. Rationale: Fractures in children heal faster, are generally less complicated, and occur for different reasons than fractures in adults. Thus, children rehabilitate faster than most adults. Children feel pain just like adults. Weight does not lessen the time required for crutches. Compliance is not an issue.
Which is most important for caregivers to consider when caring for a newborn with colic? Colic is temporary; disappears around 3 months of age. The newborn is most likely hungry so try to feed. Holding and rocking the newborn is the best option. The caregivers can change formula to test food allergies.
Correct Response:Colic is temporary; disappears around 3 months of age. Rationale: It is most important for the caregiver to realize that colic is temporary and usually disappears around 3 months of age. Colic does not mean that parenting skills are inadequate. Colic does not indicate that the newborn is hungry; often crying after feeding is an indicator of hunger. There is no single treatment that is consistently successful. It is not advised that the caregiver change formula without health care provider guidance.
Which nursing interventions are most helpful for the 6-week-old who continues to vomit stomach contents after feeding? Select all that apply. Lay infant flat after day feedings. Complete daily weights. Thicken formula with rice cereal. Offer small, frequent feedings. Place infant in a side-lying position.
Correct Response:Complete daily weights. , Thicken formula with rice cereal. , Offer small, frequent feedings. , Place infant in a side-lying position. Rationale: The infant is experiencing gastroesophageal reflux (GER). It is most helpful to add rice cereal to thicken formula, which decreases the risk of aspiration. Although most children are placed in the supine position for daytime and nighttime sleeping, the child with GER is placed in a prone position with the head elevated after daytime feedings and for several hours before the client goes to sleep at night to lessen the reflux of stomach acid. Daily weights are completed to monitor growth. Small frequent feedings aid in digestion.
The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? Severe constipation with occasional ribbon-like stools Forceful vomiting followed by the child being eager to eat again Bouts of diarrhea with failure to gain weight Effortless vomiting just after the child has eaten
Correct Response:Effortless vomiting just after the child has eaten Rationale: The child with GER usually gains weight and feeds well. It must be determined if there are underlying symptoms or complications that might suggest GERD. In the child with GERD, almost immediately after feeding, the child vomits the contents of the stomach. The vomiting is effortless, not projectile in nature. The child with GERD is irritable and hungry, but may refuse to eat. Aspiration after vomiting may lead to respiratory concerns, such as apnea, wheezing, cough, and pneumonia. Failure to thrive and lack of normal weight gain occurs. Symptoms seen in the older child may include heartburn, nausea, epigastric pain, and difficulty swallowing. Forceful vomiting with the child wanting to eat shortly after vomiting is associated with pyloric stenosis. Severe constipation with ribbon-like stools would be indicative of Hirschsprung disease. Bouts of diarrhea with failure to gain weight is associated with Crohn disease.
The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client? Plan to add additional weights as the fracture heals, usually once per day. Remove traction weights once per shift for 30 minutes and then replace them. Have the unlicensed assistive personnel remove the weights daily and encourage the child to move around in bed. Ensure traction weights are hanging freely, not touching the bed or floor.
Correct Response:Ensure traction weights are hanging freely, not touching the bed or floor. Rationale: Traction is used as a pulling force on an extremity or body part. For it to be effective, the weights need to hang freely at all times and the ropes need to remain in the pulley grooves. The weights are not replaced or removed during traction. The child can move all extremities except the affected one(s). The child remains in traction until healing occurs, a cast is applied, or surgical repair is performed.
The nurse is caring for a 7-month-old female infant diagnosed with a urinary tract infection (UTI). The parents are upset as this is the infant's second UTI with a fever. Which instruction is most helpful? Select all that apply. After 3 days on antibiotics, the infection is clear. UTI's are common in male infants at this age. Female urethras are shorter and straighter than males. A fever is commonly noted with a UTI. Change diapers promptly, especially after bowel movements.
Correct Response:Female urethras are shorter and straighter than males. , A fever is commonly noted with a UTI. , Change diapers promptly, especially after bowel movements. Rationale: Urinary tract infections are common in females in the "diaper age" because the female urethras are shorter and straighter than in the males. This poses a potential for infection. Males have a higher rate of UTI's in the first 4 months. A fever is common with this diagnosis. Changing the diapers promptly eliminates the time that the infant is exposed to E-coli. The infant may feel better after 3 days of antibiotic use but it takes a full course of antibiotics to clear an infection.
A fiberglass cast is being applied to a preschool-age child who broke her arm. What information would influence the type of cast that the physician would apply? Select all that apply. Fiberglass casts come in many colors, making them fun for the child. Handling of a plaster of Paris cast requires handling with only open palms. Fiberglass casts dry much faster than plaster of Paris casts. The plaster of Paris cast weighs less than the fiberglass cast. Clients with fiberglass casts are less likely to experience compartment syndrome.
Correct Response:Fiberglass casts come in many colors, making them fun for the child. , Handling of a plaster of Paris cast requires handling with only open palms. , Fiberglass casts dry much faster than plaster of Paris casts. Rationale: Plaster of Paris casts weigh much more than fiberglass casts. One advantage of fiberglass is that it comes in a variety of colors and patterns, which is much more desirable for children. Another advantage is the speed of drying of the fiberglass cast. By the time it is applied, fiberglass is essentially dry, while plaster of Paris takes 24 or more hours to dry. Because they stay wet longer, plaster casts must be handled very carefully so as not to make indentations. The type of cast applied has no effect on the occurrence of compartment syndrome.
The community nurse receives a call from a local day care center. One of the children in the center has been diagnosed with impetigo. Which information related to impetigo will the nurse provide to the day care center? The facility staff should wear masks until all children and adults are healthy. Impetigo cannot be treated with medication and has to run its course. Impetigo is highly contagious and can spread quickly. Impetigo usually develops because of sensitivity to pollens and molds.
Correct Response:Impetigo is highly contagious and can spread quickly. Rationale: Impetigo is a highly contagious skin infection and can spread quickly. It usually appears as red sores on the face, especially around a child's nose and mouth, and may appear on the hands and feet. The sores burst and develop honey-colored crusts. It is spread by person-to-person contact, not droplet; therefore, masks are not indicated. It is treated with antibiotics, generally penicillin. The cause is not pollens or molds; it is bacterial.
The nurse is caring for a 6-month-old infant who has been nutritionally deprived. The infant appears weak and uninterested in eating. Which nursing interventions are most helpful? Select all that apply. Limit feedings to approximately 20 minutes. Prop the bottle in the crib for accessibility. Schedule feedings every 2 to 3 hours. Be relaxed when feeding to promote relaxation. Use a hard, small-holed nipple.
Correct Response:Limit feedings to approximately 20 minutes. , Schedule feedings every 2 to 3 hours. , Be relaxed when feeding to promote relaxation. Rationale: It is most important to provide a calm, relaxing environment when feeding the infant. Feedings should be a time of human interaction; never prop a bottle. Use a soft, large hole (large enough to allow the formula to drip without pressure) nipple. Hard, small-holed nipples cause frustration and expend excess energy to suck. Feedings are scheduled every 2 to 3 hours lasting 20 to 30 minutes because most babies can handle small feedings better than larger ones.
The caregiver of a 2-year-old child reports to the nurse that the child vomits at least five or six times a day, sometimes continuously. The child is admitted for observation and the mother continues to report the child is vomiting, but the nurses never see the child vomit or any evidence the child has vomited. The child will likely be found to have: gastroenteritis. a congenital disorder. Munchausen syndrome by proxy. a head injury.
Correct Response:Munchausen syndrome by proxy. Rationale: In caregiver-fabricated illness, also known as Munchausen syndrome by proxy, one person either fabricates or induces illness in another to get attention. When a caregiver has this syndrome, he or she frequently brings the child to a health care facility and reports symptoms of illness when the child is actually well. The child's mother is most often the person who has the syndrome.
A preschool-aged client is in an external fixator for a fractured pelvis and the mother is frightened of performing pin site care for the child. How would the nurse help this parent learn to care for her child? Select all that apply. Perform pin site care every 4 hours. Observe for any signs of inflammation such as odor or drainage. Have the mother do a return demonstration of cleaning the pins. Allow the child to do his own pin site care. Use alcohol to clean off the exudate that may accumulate around the pins.
Correct Response:Observe for any signs of inflammation such as odor or drainage. , Have the mother do a return demonstration of cleaning the pins. Rationale: Pin sites are easy targets for infection and must be kept clean. Pins are cleaned every 8 hours, not 4 hours. Each institution has policy and procedure to guide the methodology of pin site care but alcohol is never used since it would burn and be painful. Since the child is young, he will not do his own pin site care; the parent needs opportunities to practice cleaning the pins while still in the hospital so as to be comfortable doing it at home alone. The nurse always looks for signs of infection while doing pin site care.
The nurse is caring for an infant admitted with a retinal hemorrhage. Which condition will the child most likely be evaluated for? amblyopia caregiver-fabricated illness (formerly Munchausen syndrome by proxy) Shaken baby syndrome vehicle accident
Correct Response:Shaken baby syndrome Rationale: Abusive head trauma or shaken baby syndrome occurs when a small child is shaken by the arms or shoulders in a repetitive, violent manner. Shaking causes a whiplash-type injury to the child's neck. In addition, the child may have edema to the brain stem and retinal or brain hemorrhages.
The elementary school teacher invites the nurse into the classroom to observe a pupil's interaction when completing an assignment. Which characteristic alerts the school nurse that the child may be the victim of emotional abuse? The child lets others make decisions. The child wants to change the project. The child appears shy with others. The child is fretful and worried about the project.
Correct Response:The child is fretful and worried about the project. Rationale: When completing group work there can be many dynamics in the classroom; however, the child should not be fretful and worried about the project. This indicates that something else is the cause of the worry. The teacher and school nurse work together to help the child as needed.
In caring for a child in traction, which intervention is the highest priority for the nurse? The nurse should clean the pin sites at least once every 8 hours. The nurse should provide age-appropriate activities for the child. The nurse should record accurate intake and output. The nurse should monitor for decreased circulation every 4 hours.
Correct Response:The nurse should monitor for decreased circulation every 4 hours. Rationale: Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.
What occurs in the gastrointestinal system of the child with Hirschsprung disease? There is a relaxed sphincter in the lower portion of the esophagus. There is a partial or complete mechanical obstruction in the intestine. There is a severe narrowing of the lumen of the pylorus. There is an invagination or telescoping of one portion of the bowel into a distal portion.
Correct Response:There is a partial or complete mechanical obstruction in the intestine. Rationale: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. A narrowing of the lumen of the pylorus is associated with pyloric stenosis in young infants. The telescoping of the bowel is intussusception. The relaxed sphincter in the lower portion of the esophagus is related to gastrointestinal reflux disorder.
The public health nurse is providing immunizations to a family that includes three children. Which requires investigation for possible child neglect? The children's clothes are dirty and the oldest child is not wearing a coat. The clothing appears tattered and shoes appear large on the children. Two have an ear infection (in one of which the eardrum is ruptured) and one has scabies. The children state having peanut butter and jelly sandwiches for supper.
Correct Response:Two have an ear infection (in one of which the eardrum is ruptured) and one has scabies. Rationale: The picture of the family is concerning, but actual neglect manifests when children have health issues and the family does not seek the medical care needed. All the children, although brought for immunizations, have medical issues. The eardrum being ruptured indicates that the child may have had this condition for some time. Further investigation is needed. Nutritional counseling and instruction on finding inexpensive age-appropriate clothing, or making sure that the family utilizes social services to assist with obtaining supportive services, may be indicated. Overall poor hygiene issues need to be addressed.
A 2-month-old infant has been diagnosed with seborrheic dermatitis (cradle cap). The nurse is educating the parent about care of the child. Which instructions would the nurse include? Select all that apply. Use a fine-tooth baby comb after washing the hair. Apply mineral oil to loosen the crusts. Wash the child's hair every day. Carefully but vigorously wash the area of the "soft spot." Remove the crust all at one time to prevent recurrence.
Correct Response:Use a fine-tooth baby comb after washing the hair. , Apply mineral oil to loosen the crusts. , Wash the child's hair every day. , Carefully but vigorously wash the area of the "soft spot." Rationale: Attempts to loosen the crust all at one time should be avoided to prevent further excoriation. The other choices are appropriate care for the infant with cradle cap.
n caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care? Weighing on the same scale each day Testing the urine for glucose levels regularly Ambulating 3 to 4 times a day Increasing fluid intake by 50 ml per hour
Correct Response:Weighing on the same scale each day Rationale: The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss. The child with nephrotic syndrome is very edematous so increasing fluid intake would be counterproductive to care needed. In nephrotic syndrome the urine is tested for protein, not glucose. Ambulation is important for all but it is not specific to the child with nephrotic syndrome.
A 6-year-old child is playing. Which play scenarios witnessed by the nurse are indicative that the child is sexually abused? Select all that apply. stating that boys and girls love each other wanting to play house with the girl having a baby arranging dolls in unnatural positions for play playing with a boy and girl doll in a sexually graphic manner using inappropriate adult language
Correct Response:arranging dolls in unnatural positions for play , playing with a boy and girl doll in a sexually graphic manner , using inappropriate adult language Rationale: Children should have no knowledge of the particulars of sexual activity at age 6. If they do, it is inappropriate. Playing with dolls in a sexually graphic manner or placing the dolls in unnatural positions identifies that the child has been exposed to sexual activity. Using adult language also identifies inappropriate exposure. Common contact is saying that boys and girls love each other, or wanting to play house and having the girl have a baby. This can be reflective of what is happening in the house.
the nurse completes a 1-month-old's feeding and sits the infant up to burp. The infant vomits back the feeding. Which is the nurse's primary concern? stomach irritation aspiration stunted growth nutritional deficiency
Correct Response:aspiration Rationale: The primary concern for the nurse is that the infant aspirates vomit into the lungs. Aspiration after vomiting may lead to respiratory concerns such as apnea and pneumonia. Nutritional deficiencies may occur if the vomiting continues. This is a concern but not the primary concern. Stomach irritation and stunted growth is not a typical concern at this time.
The nurse is collecting data on a child recently diagnosed with acute glomerulonephritis. Which clinical manifestation was likely noted in this child? hypotension increased nocturia decreased specific gravity bloody urine
Correct Response:bloody urine Rationale: The presenting symptom in the child with acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody.
The nurse is collecting data on a child with a diagnosis of atopic dermatitis. While interviewing the caregiver, the nurse will direct questions to the caregiver recognizing that which common allergens are involved in eczema? Select all that apply. cow's milk cotton oatmeal red meat nylon animal dander
Correct Response:cow's milk , nylon , animal dander Rationale: Atopic dermatitis causes extreme itching and reddened, inflamed skin. It is caused by a reaction to an antigen. It is relapsing and remitting. The most common food allergens are eggs, wheat, milk, and peanuts. There are also large reactions to tomato juice and orange juice. The most common environmental factors are mold, dust mites, and cat dander. Wool, nylon, and plastic can also cause reactions. It is recommended the child sleep in loose cotton clothing and cotton bedsheets. Wool tends to cause more itching and holds in the heat. Nylon is synthetically made and the child can have a reaction to the materials used. Nylon clothing also tends to hold in heat. Red meat is not known to cause reactions.
The condition in which one or both of the testes do not descend in the male infant is referred to as: orchiopexy. cryptorchidism. hydrocele. enuresis.
Correct Response:cryptorchidism. Rationale: When one or both of the testes do not descend, the condition is called cryptorchidism. An orchiopexy is the surgical procedure to pull the testes down into the scrotal sac. If the undescended testicle is left untreated it can cause sterility in the adult male. A hydrocele is fluid in the scrotal sac. It generally resolves without surgery. Enuresis is nighttime bed-wetting.
A nurse is assessing a child whom the nurse suspects is a victim of physical abuse. Assessment reveals numerous bruises on the thighs and upper back in various stages of healing. The child's caregiver is present in the examination room. Which aspect of care is the priority? ensuring that the child remains safe documenting the assessment findings providing physical contact if the child accepts it assigning different nurses to care for the child
Correct Response:ensuring that the child remains safe Rationale: Although documenting the findings and providing physical contact with the child are important, the child's safety is the priority and the utmost concern. One nurse should be assigned to care for the child so that the child can relate to one person consistently.
A nurse has been asked to conduct a presentation on human trafficking. When preparing the presentation, the nurse will include which factor(s) as placing individuals at risk? Select all that apply. female gender, between 12 to 16 years of age male gender, between 15 to 18 years of age history of child abuse (child mistreatment) lack of adequate family support high level of education
Correct Response:female gender, between 12 to 16 years of age , history of child abuse (child mistreatment) , lack of adequate family support Rationale: Although trafficking can happen in any community and individuals of any age, race, gender, or nationality may be victims, women and children are the most frequent victims. Often poverty and lack of economic opportunities cause vulnerability and allow these individuals to be tricked and to become stuck in trafficking situations. Other risk factors that may lead to human trafficking include being a young girl (ages 12 to16 years old are at greatest risk), rural location, lack of education, disability, inadequate family support and protection, runaway or throwaway youth, migrant workers, and a history of childhood abuse (mistreatment).
What is one of the most commonly reported communicable diseases in the United States? measles gonorrhea syphilis mononucleosis
Correct Response:gonorrhea Rationale: Gonorrhea is one of the most commonly reported communicable diseases in the United States.
A child is admitted to the burn unit with a full-thickness or third-degree burn over 35% of the body. Which infection prevention measures would the health care team use with this child? Select all that apply. head cover frequent handwashing mask gown shoe covers
Correct Response:head cover , frequent handwashing , mask , gown Rationale: Shoe covers are not required; however, health care providers should frequently wash the hands and use gowns, masks, and head dressings.
The nurse is caring for a child with a severe burn. The treatment for this child during the first 48 hours will most likely be related to: wound care. graft placement. curling ulcer. hypovolemic shock.
Correct Response:hypovolemic shock. Rationale: In severe burns the increased capillary permeability results in vasodilation. This increases hydrostatic pressure in the capillaries, causing water and electrolytes to leak out of the vasculature and resulting in edema. Around 48 to 72 hours, the capillary permeability returns to normal causing severe diuresis. Hypovolemic shock is the major manifestation in the first 48 hours in massive burns. As extracellular fluid pours into the burned area, it collects in enormous quantities, dehydrating the body. Wound care and graft placements are part of burn care, but they are not the priority in the first 48 hours after the burn. A curling ulcer is an acute gastric erosion from complications of severe burns causing ischemia and cell necrosis of the gastric mucosa.
When living in a household with substance use, which parental characteristic provides the leading negative effect? inability to provide financially for the family inability to attend the child's school functions inability to provide consistent parenting inability to provide any love or attention
Correct Response:inability to provide consistent parenting Rationale: The leading negative effect when living with a parental substance user is the inability to provide consistent parenting. The children live in unpredictability, not knowing if the parent will be overindulgent and provide love and affection or be unreasonable and angry. The effect of not providing financially may or may not be the case. The parent provides love and attention and can attend school functions when not using alcohol or drugs.
An adolescent girl is going to be treated for a severe case of acne vulgaris. A pregnancy test should be done prior to the adolescent starting treatment with: isotretinoin. benzoyl peroxide. erythromycin. tretinoin.
Correct Response:isotretinoin. Rationale: Isotretinoin is a drug used to treat cystic acne after at least 3 months of antibiotic therapy has not been successful. Isotretinoin is a pregnancy category X drug. It must not be used at all during pregnancy because of serious risk of fetal abnormalities. Tretinoin is used to treat severe acne vulgaris. Instruction for the use of this medication include using sunscreen. Benzoyl peroxide can be used for mild acne and can be used with topical antibiotics. Erythromycin is an antibiotic that has no pregnancy contraindications. It is used for many skin infections.
A young boy is being evaluated for muscular dystrophy. What physical symptoms would be assessed for in this client? Select all that apply. mild intellectual disability difficulty rising from the floor hip and groin pain scoliosis progressive muscle weakness
Correct Response:mild intellectual disability , difficulty rising from the floor , progressive muscle weakness Rationale: Muscular dystrophy is a progressive X-lined recessive disease that results in increasing muscle weakness, lordosis, mild intellectual disability, and a shortened lifespan. Hip and groin pain is seen in patients with Legg-Calvé-Perthes disease.
The nurse is caring for a child with type 1 diabetes mellitus. The nurse notes the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. Which prescription from the primary health care provider will the nurse question? intravenous fluid replacement serum ketone testing regular insulin per sliding scale IV monitor glucose level every 3 hours
Correct Response:monitor glucose level every 3 hours Rationale: The client is experiencing diabetic ketoacidosis (DKA), which is the result of fat catabolism. It is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). The nurse would question only checking the glucose level every 3 hours as it should be assessed at least hourly to ensure the client's level does not fall more than 100 mg/dL (5.55 mmol/L) per hour. A too-rapid decline in blood glucose predisposes the child to cerebral edema. Fluid therapy is given to treat dehydration, correct electrolyte imbalances (sodium and potassium due to osmotic diuresis), and improve peripheral perfusion. Administration of regular insulin, given intravenously, is preferred during DKA. Ketones would be assessed either in the urine or blood to see how much the client is spilling.
The nurse is reviewing lab work prior to shift handoff on a client with a subnormal urine output. Which is the nurse most correct to report? glycosuria polyuria pyuria oliguria
Correct Response:oliguria Rationale: A subnormal urine output is termed as oliguria. Polyuria is the excessive or abnormally large production of urine. Pyuria is the presence of pus in the urine. Glycosuria is the excretion of glucose in the urine.
The nurse is caring for a client newly diagnosed with acute glomerulonephritis? When receiving the pediatric client's history, which is anticipated? fatigue from viral infection onset 3 days ago onset of a streptococcus infection last week increased thirst, sweating, and shakiness since yesterday a sports injury to the kidney two weeks ago
Correct Response:onset of a streptococcus infection last week Rationale: The nurse is correct to anticipate a streptococcus infection 1 to 3 weeks prior to the diagnosis of acute glomerulonephritis. The presenting symptom is typically gross bloody urine. Acute glomerulonephritis is not related to a kidney infection, does not exhibit symptoms similar to diabetes, or a recent viral infection.
The nurse is caring for a newborn who was delivered vaginally. The infant has a white coating in the mouth that looks like milk curds. The nurse suspects that the infant has: atopic dermatitis. oral candidiasis (thrush) caused by Candida albicans. tinea capitis caused by Microsporum audouinii. pediculosis.
Correct Response:oral candidiasis (thrush) caused by Candida albicans. Rationale: Newborns can be exposed to a candidiasis vaginal infection in the mother during delivery. Oral candidiasis (thrush) appears in the child's mouth as a white coating that looks like milk curds.
Which type of nutrition does the nurse anticipate initiating when an infant with gastroenteritis and dehydration begins solid foods? half strength infant formula oral rehydration solutions the normal formula clear liquids
Correct Response:oral rehydration solutions Rationale: The nurse is correct to anticipate that oral rehydration fluids such as Pedialyte, Rehydralyte, or Infalyte are initiated. Once the infant is able to tolerate the solution, either a half-strength formula or full-strength formula will be considered. Typical clear liquids such as apple juice or broths are not part of the rehydration diet.
Which health care provider order is the nurse correct to question if provided for a pediatric client with suspected appendicitis? provide heat to abdomen withhold analgesics maintain NPO status record I & O
Correct Response:provide heat to abdomen Rationale: Due to the diagnosis of suspected appendicitis, the nurse would question an order to provide heat to the abdomen. Heat may cause a rupture of the appendix. All of the other orders are consistent with needed care.
A child diagnosed with acute glomerulonephritis will most likely have a history of: recent illness such as strep throat. hearing loss with impaired speech development. a sibling diagnosed with the same disease. hemorrhage or history of bruising easily.
Correct Response:recent illness such as strep throat. Rationale: Symptoms of acute glomerulonephritis often appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat. The causative agent is group B hemolytic streptococcus. The treatment for glomerulonephritis includes maintaining fluid volume and managing hypertension. Glomerulonephritis is not contagious, so the child would not have acquired it from a sibling. Glomerulonephritis only affects the kidney, so hemorrhage, bruising, hearing loss, or speech development would not be associated with the disease.
The nurse is documenting specifics of inappropriate sexual contact between a neighbor and a 13-year-old. Which terminology is most accurate? sexual abuse incest sexual assault sexual exploitation
Correct Response:sexual assault Rationale: Sexual assault is sexual contact made by someone who is not functioning in a caregiver role, such as a neighbor. Sexual abuse is the sexual contact between a child and the parents or family members in the home. Sexual exploitation is treating someone unfairly for self-benefit such as money or resources. Incest is the sexual contact between family members not married to each other.
Which type of fracture is most indicative of child abuse (child maltreatment)? spiral fracture complex fracture hairline fracture compound fracture
Correct Response:spiral fracture Rationale: Signs of possible evidence of child abuse include spiral fractures of the long bones. A fracture of this nature is not common in children. The other types are not consistent with abuse.
The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is: projectile stools. severe diarrhea. steatorrhea. currant jelly stools.
Correct Response:steatorrhea. Rationale: Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis. Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.
Which adolescent behavior is most common if the parents have substance use problems? telling everyone of the parental issues being clingy to teachers at school taking on adult responsibilities staying away from the house
Correct Response:taking on adult responsibilities Rationale: It is very common for the adolescent to take on parental roles in the home hoping that the parents will change their behavior. These children do not want negative attention to come to the family; thus, they keep to themselves and do not tell others of the difficulty at home.
The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. What is the most important reason the child needs increased fluids? to dilute the urine and flush the bladder to fill the bladder so a specimen can be obtained to decrease the pain of urination to prevent the child from developing a fever
Correct Response:to dilute the urine and flush the bladder Rationale: Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder.
Which action is most helpful in encouraging the expression of feelings in a pediatric client who is abused? talking in a private space interacting with other victims of abuse using play to reduce stress providing a hug or caring behaviors
Correct Response:using play to reduce stress Rationale: It is most helpful to reduce stress in the client by means of play. Frequently, play can help the client work through the abuse and express feelings. Talking in a private space inhibits communication as the client may feel afraid of the stranger or afraid that he or she is going to get in trouble. Support groups are helpful in adolescent clients. Once the adolescent feels safe in the group, he or she can feel comfortable with recounting his or her experience. Physical caring behaviors can be appropriate depending upon the relationship with the client.
What are the indicators of a urinary tract infection in a urine sample?
White blood cells in the urinalysis and bacteria growth in the culture
The nurse is caring for a child who has been referred to the health care facility by a school nurse, who suspects the child may have been living in a home where domestic violence has occurred. Which symptom reported by a family member might indicate this possibility? The child has been overly active and vocal. The child has edema in the arms and legs. The child has loss of vision and intellectual disability. The child has not been sleeping well and has been wetting the bed.
orrect Response:The child has not been sleeping well and has been wetting the bed. Rationale: Children affected by domestic violence may show signs and symptoms that result from the violent situation. These symptoms may be referred to as symptoms of posttraumatic stress disorder and may include the inability to sleep, bedwetting, temper tantrums, withdrawal, and feelings of guilt for not being able to protect himself or herself. The school-age child may have academic problems, frequent absences, behavior issues, or self-isolation. The older child will often use drugs or alcohol; get into legal trouble, many times by committing a crime against another person; or attempt suicide.