Practice questions Peds Exam 3
A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby. The nurse should stress which teaching point?
"It is important that the harness be worn continuously."
The nurse is assessing an infant at a well-check visit. The infant's mother states that she is worried about her child's feet because they are so flat and wide. What is the appropriate response by the nurse?
"Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months."
The school nurse cares for children with overuse injuries and refers them for treatment. Which statements accurately describe conservative interventions to prevent or care for these types of injuries? Select all that apply.
-Encourage 1 to 2 days off per week of competitive athletics. -Apply ice to the injured area to reduce inflammation. -Perform appropriate stretching during a 20-to 30-minute warmup
The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.
-The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. -New drainage is seeping out from under the cast. -The boy's toes are light blue and very swollen
The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child? a. Handling the cast with open palms when moving the arm. b. Using only a draw sheet to move the casted arm. c. Encouraging the child to move the arm slowly up and down to help the cast dry. d. Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm.
. Handling the cast with open palms when moving the arm.
The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?
Blowing cool air with a fan or hair dryer may relieve the feeling.
A genetic motor neuron disease that affects the spinal nerves' ability to communicate with the muscles. It is inherited via an autosomal recessive mechanism.
Cerebral Palsy
The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?
Creatine Kinase
True/False: In order to determine the extent of the limitation in the child with slipped capital femoral epiphysis (SCFE), gently perform passive range of motion.
False
True/False: Scoliosis usually causes back pain
False
In 1879, neurologist Sir William Richard Gowers described the most significant ________ sign as the characteristic patterns observed in patients with Duchenne muscular dystrophy wherein they 'climb up' their thighs with the aid of their hands to overcome the weakness of their pelvic and proximal lower limb muscles.
Gower's
A 5-year-old child is in traction and at risk for impaired skin integrity due to pressure. Which intervention is most effective?
Inspect the child's skin for rashes, redness, irritation, or pressure sores
The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?
Muscle biopsy
What are the two tests to check for developmental dysplasia of the hip?
Ortolani and Barlow
A term used to describe a range of nonspecific clinical symptoms characterized by abnormal motor pattern and postures caused by nonprogressive abnormal brain function.
Spinal Muscular Atrophy
The nurse is observing a child walk down stairs using a swing-through gait. What action by the child is correct?
The child places the crutches on the lower step before placing the good foot down between the crutches.
A nurse caring for a child wearing a brace to correct scoliosis provides patient and family teaching for home care of the brace. Which of the following would the nurse most likely include in the teaching plan? Select all that apply a. "Be sure to avoid sitting in one position for long periods of time." b. "Loosen the brace during meals if necessary." c. "Schedule wearing the brace during waking hours for best therapeutic results." d. "Wear a 100% cotton T-shirt under the brace to absorb moisture." e. "Take a shower instead of a bath to stimulate the skin." f. "Gradually decrease wearing time so the skin can develop tolerance."
a. "Be sure to avoid sitting in one position for long periods of time." b. "Loosen the brace during meals if necessary." d. "Wear a 100% cotton T-shirt under the brace to absorb moisture."
The nurse is caring for a child who has been pronounced brain dead. The family has made the decision to donate the child's organs. Ventilator support continues while waiting for organ procurement. The child's aunt asks the nurse, "Why is the ventilator still on?" Which response by the nurse would be most appropriate? a. "The ventilator is supplying oxygen to the organs that will be donated soon; it is not to preserve life." b. "The ventilator is keeping the child alive until it is time to procure the organs for donation." c. "The ventilator is in place to make the child comfortable until the organ donation team is ready." d. "The ventilator is supplying the brain with oxygen so the nerve cells will survive."
a. "The ventilator is supplying oxygen to the organs that will be donated soon; it is not to preserve life."
A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used? a. Auscultation b. Palpitation c. Observation d. Inspection
a. Auscultation
A nurse is reading a journal article about congenital heart defects. Which of the following would the nurse expect to be discussed in the article related to defects associated with increased pulmonary blood flow? Select all that apply. a. Patent ductus arteriosus b. Ventricular septal defect c. Tricuspid atresia d. Tetralogy of Fallot e. Atrial Septal Defect (ASD)
a. Patent ductus arteriosus b. Ventricular septal defect e. Atrial Septal Defect (ASD)
Which of the following are defects of Tetralogy of Fallot? a. pulmonary stenosis b. ASD c. VSD d. overriding aorta e. right ventricular hypertrophy
a. pulmonary stenosis c. VSD d. overriding aorta e. right ventricular hypertrophy
A nurse is caring for an infant who is experiencing heart failure. Which of the following would the nurse most likely include in the infant's plan of care? Select all that apply. a. Providing large, less frequent feedings b. Administering oxygen therapy c. Administering diuretic therapy d. Placing the infant in a prone position
b. Administering oxygen therapy c. Administering diuretic therapy
When caring for a child with a cast the nurse will perform frequent checks to identify signs of compromise including: (Select all that apply) a. shortened capillary refill b. increased pain c. pale skin color d. cool skin e. decreased pulse
b. increased pain c. pale skin color d. cool skin e. decreased pulse
Skin care after cast removal includes: (select all that apply) a. scrub the skin to remove the brown flaky skin b. soak with warm water daily c. allow the child to gently scratch the skin d. apply moisturizing lotion e. encourage activity
b. soak with warm water daily c. allow the child to gently scratch the skin d. apply moisturizing lotion e. encourage activity
The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? a. Check pulses above the catheter insertion site for strength and quality. b. Allow early ambulation to encourage activity participation. c. Assess extremity distal to the insertion site for temperature and color. d. Change the dressing to evaluate the site for infection.
c. Assess extremity distal to the insertion site for temperature and color.
A child on the pediatric unit has morning laboratory results of Hgb 10.0, Hct 30.2, WBC 24,000, and platelets 20,000. What is the priority nursing assessment? a. Assess for pallor, fatigue, and tachycardia. b. Monitor for fever. c. Assess for bruising or bleeding. d. Determine intake and output.
c. Assess for bruising or bleeding.
A 5-year-old has been diagnosed with Wilms tumor. What is the priority nursing intervention for this child? a. Educate the parents about dialysis, as the kidney will be removed. b. Measure abdominal girth every shift. c. Avoid palpating the child's abdomen. d. Monitor BUN and creatinine every 4 hours.
c. Avoid palpating the child's abdomen.
The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention? a. "Would you like a coloring book?" b. "Do you want a book to read?" c. "You are too big to suck your thumb." d. "Let's ask your parents to bring your friends for a visit."
d. "Let's ask your parents to bring your friends for a visit."
A child with leukemia has the following AM laboratory results: Hgb 8.0, Hct 24.2, WBC 8,000, platelets 150,000. What is the priority nursing assessment? a. Monitor for fever. b. Assess for bruising or bleeding. c. Determine intake and output. d. Assess for pallor, fatigue, and tachycardia.
d. Assess for pallor, fatigue, and tachycardia.
Which of these strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy? a. Walker b. Manual wheelchair c. Motorized wheelchair d. Long leg braces
d. Long leg braces
This condition occurs when a parent or sibling inadvertently injures a child while pulling their arm causing the ligament surrounding the radial head to stretch, displacing the radial head, causing the ligament to become trapped in the joint.
subluxation of the radial joint
A child with leukemia received chemotherapy about 10 days ago. She presents today with a temperature of 100.4°F, an absolute neutrophil count of 500, and mild bleeding of the gums. What is the priority nursing intervention? a. Administer IV antibiotics as ordered. b. Provide vigorous oral care frequently with a firm toothbrush. c. Monitor pulse and blood pressure for changes. d. Administer packed red blood cell transfusion.
a. Administer IV antibiotics as ordered.
The nurse is providing care to a child who has undergone a cardiac catheterization and is being discharged. Which of the following would the nurse include in the teaching plan for the parents? Select all that apply. a. Inspecting the catheterization site daily for the first week b. Using a sponge bath or shower for the first 2 days c. Reporting an increase in numbness in the affected extremity d. Avoid pain relievers such as acetaminophen and ibuprofen
a. Inspecting the catheterization site daily for the first week b. Using a sponge bath or shower for the first 2 days c. Reporting an increase in numbness in the affected extremity
A nurse is talking with a child who is dying and his parents. Which of the following would be most effective in promoting appropriate communication? Select all that apply. a. Maintain eye contact with the child and family. b. Use medical terminology to emphasize the seriousness. c. Allow time for questions from the parents and the child. d. Encourage the use of play for the child to express his feelings. e. Distract the family from sharing their stories and sadness.
a. Maintain eye contact with the child and family. c. Allow time for questions from the parents and the child. d. Encourage the use of play for the child to express his feelings.
Which of the following are associated with Legg-Calve Perthes disease? a. Painless limp b. avascular necrosis of the femoral head c. most often affects males between 4 and 8 years old d. viral etiology e. over time the femoral head reforms f. treatment usually includes anti-inflammatory medications, brace, avoidance of contact sports.
a. Painless limp b. avascular necrosis of the femoral head c. most often affects males between 4 and 8 years old e. over time the femoral head reforms f. treatment usually includes anti-inflammatory medications, brace, avoidance of contact sports.
After teaching a group of nursing students about the core principles of palliative care, the instructor determines that the teaching was successful when the students identify which of the following as a core principle? Select all that apply. a. Respect for the child's preferences and choices b. Provision of episodic care c. Acknowledgment of caregiver concerns d. Development of supportive systems for policy making e. Implementing the use of discipline-specific resources
a. Respect for the child's preferences and choices c. Acknowledgment of caregiver concerns d. Development of supportive systems for policy making
A child with heart failure is receiving digoxin therapy and will be discharged home on that therapy. After teaching the parents about the drug, the nurse determines that the teaching was successful when the parents identify which of the following as a sign of digoxin toxicity? Select all that apply. a. Vomiting b. Anorexia c. Constipation d. Increased heart rate
a. Vomiting b. Anorexia
A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal? a. development of gross motor movement b. enhance feeding capabilities promote c. optimal self-care ability d. development of fine motor skills
a. development of gross motor movement
The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess? a. obesity from overeating b. clubbing of the nail beds c. squatting during play activities d. exercise intolerance
a. obesity from overeating
Which of the following might be signs of pediatric heart disease? a. poor feeding b. failure to thrive c. sweating during feeding in infancy d. excessive weight gain e. cyanosis f. fatigue
a. poor feeding b. failure to thrive c. sweating during feeding in infancy e. cyanosis f. fatigue
Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? a. previous streptococcal throat infection b. history of open heart surgery at 5 years of age c. playing too much soccer and not getting enough rest d. exposure to a sibling with pneumonia
a. previous streptococcal throat infection
A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as: a. significant bending without actual breaking. b. incomplete fracture. c. bone that breaks into two pieces. d. bone buckling due to compression.
a. significant bending without actual breaking.
Which of the following should be included in parent teaching for a child with congenital heart disease? a. weigh child once a week b. allow activity as tolerated c. notify provider if fever d. allow frequent rest periods e. avoid frequent handwashing
a. weigh child once a week b. allow activity as tolerated c. notify provider if fever d. allow frequent rest periods
The nurse is caring for a 2-year old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? a. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." b. "I know it will be important for me to catheterize my child for the rest of her life." c. "I will make sure that I always use latex-free catheters." d. "I will wash the catheter with warm soapy water after each use."
b. "I know it will be important for me to catheterize my child for the rest of her life."
The nurse is caring for a 6-year-old with juvenile idiopathic arthritis. The mother states that she has trouble getting her daughter out of bed in the morning and she and the health care provider believe the girl's behavior is due to a desire to avoid going to school. What is the best advice by the nurse? a. Refer the girl to a psychologist for evaluation of school phobia related to chronic illness. b. Administer a warm bath every morning before school. c. Give the child her prescribed NSAIDs 30 minutes before getting out of bed. d. Allow her to stay in bed some mornings if she want
b. Administer a warm bath every morning before school.
The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality? a. Encourage follow-through with physical therapy exercises. b. Encourage after-school activities within the limits of the child's abilities. c. Restrict the child to a special needs classroom. d. Ensure the school is aware of the child's capabilities.
b. Encourage after-school activities within the limits of the child's abilities.
While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? a. Provide supplemental oxygen by face mask. b. Place the infant in a knee-to-chest position. c. Administer a dose of IV morphine sulfate. d. Begin cardiopulmonary resuscitation.
b. Place the infant in a knee-to-chest position.
A child is brought to the clinic for an evaluation. The nurse suspects that the child has leukemia based on assessment of which of the following? Select all that apply. a. Weight gain b. Splenomegaly c. Lymphadenopathy d. Increased platelet count e. Elevated leukocyte count
b. Splenomegaly c. Lymphadenopathy e. Elevated leukocyte count
A child with cancer is receiving chemotherapy, and his mother is concerned that the nausea and vomiting associated with chemotherapy are reducing his ability to eat and gain weight appropriately. What is the most appropriate nursing action? a. Administer an antiemetic at the first hint of nausea. b. Offer the child's favorite foods to encourage him to eat. c. Start antiemetic drugs prior to the chemotherapy infusion. d. Maintain IV fluid infusion to avoid dehydration.
c. Start antiemetic drugs prior to the chemotherapy infusion.
A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. He has an ineffective cough. Lung auscultation reveals diminished breath sounds. What is the priority nursing intervention? a. Apply supplemental oxygen. b. Notify the respiratory therapist. c. Monitor pulse oximetry. d. Position for adequate airway clearance.
d. Position for adequate airway clearance.
The nurse is caring for a terminally ill child who is preparing to return home and attend school half-days. The patient is excited about returning to school and seeing friends. Which of the following nursing interventions is the most beneficial for this patient? a. Tell the patient you are happy for them. b. Ask the patient if attending school is a wise decision. c. Inform the patient of the many dangers that school can pose at this time. d. Prepare the patient for the questions and reactions of friends, teachers, and other students.
d. Prepare the patient for the questions and reactions of friends, teachers, and other students.
A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? a. gallop and rales b. blood pressure discrepancies in the extremities c. right ventricular hypertrophy on ECG d. heart murmur
d. heart murmur
An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? a. to wear the brace a maximum of 20 hours each day b. that secondary sex changes will stop until the brace is removed c. to stand absolutely still when not wearing the brace d. to continue with age-appropriate activities
d. to continue with age-appropriate activities
The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?
Gowers sign
Which of the following drugs are included in the treatment of juvenile idiopathic arthritis? Select all that apply. a. NSAIDS b. corticosteroids c. methotrexate d. acetaminophen e. etanercept
a. NSAIDS b. corticosteroids c. methotrexate e. etanercept
The nurse is providing palliative care to a 5-year-old child. When developing the child's plan of care, the nurse understands that a child of this age views death as which of the following? a. Separation b. Temporary state c. Irreversible d. Permanent
b. Temporary state
The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to: a. ensure proper bone alignment. b. promote healing. c. prevent edema. d. discourage infection.
c. prevent edema.
Which of the following are disorders with decreased pulmonary blood flow? a. tetralogy of fallot b. ASD c. VSD d. tricuspid atresia e. patent ductus arteriosus (PDA)
a. tetralogy of fallot d. tricuspid atresia
A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history? a. Age that the child learned to walk b. Parents' expectations of the child's development c. Functional status related to eating and mobility d. Birth history to identify cause of cerebral palsy
c. Functional status related to eating and mobility
The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents? a. "You will need to see a physical therapist for stretching and strengthening exercises." b. "NSAIDs can help with pain control and inflammation." c. "Ice will help reduce the inflammation." d. "You and your coaches need to understand that you cannot play soccer for at least six weeks."
d. "You and your coaches need to understand that you cannot play soccer for at least six weeks."
The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel? a. Ambulate the children twice daily to promote mobility. b. Encourage commode use to promote bowel function. c. Provide diversionary activities, as the children must stay flat on their backs. d. Assist with log-rolling the children every 2 hours.
d. Assist with log-rolling the children every 2 hours.
