HESI Pediatric Evolve Peds practice 164 Questions with Verified Answers,100% CORRECT

HESI Pediatric Evolve Peds practice 164 Questions with Verified Answers When taking the health history of a child, the nurse know what which finding is an early indication of hypothyroidism in children? - CORRECT ANSWER Cessation of growth in a child that had been normal The nurse received a lab report stating a child w/ asthma has theophyline level of 15 mcg/dl. What action will the nurse take? - CORRECT ANSWER Pass the information on in the report. a.i. Therapeutic levels of theophylline is 10-20 mcg/dl, so the child's level is w/in the therapeutic rage. this information evaluates the prescribed therapy and should be communicated in the nurse's report. Surgery is being delayed for an infant with undescended testes. In collaboration w/ the health care provider and the family, which prescription should the nurse anticipapte? - CORRECT ANSWER trial of human chorionic gonadotrophic hormone a.i A trial of HCG may aid in testicular descent, but does not replace surgical repair for true undescended testes. (cryptorchidism: may be found in the inguinal canal due to exaggerated creamasteric reflex Which menu selection by a child w/ celiac disease indicates to the nurse that the child understands necessary dietary considerations? - CORRECT ANSWER a. Oven baked potato chips & cola a.i. Celiac disease causes an intolerance to the protein gluten found in oats, rye, wheat, and barley. The child should avoid any produces containing these indredients to avoid symptoms such as diarrhea. The mother of a 2-year-old boy consults the nurse about her son's increased temper tantrums. The mother states, "yesterday he threw a fit in the grocery store, and I did not know what to do. I was so embarrassed. What can I do if this occurs again?" Which recommendation is best for the nurse to provide this mother? - CORRECT ANSWER a. Walk away from him and ignore the behavior a.i. The best approach for a toddler is to ignor the attention-seeking behavior. The parents should be somewhat nearby, w/in view of the child but should avoid reinforcing the behavior in any way. Tantrums can sometimes be avoided by talking to the child before the situation occurs Which restraint should be used for a toddler after a cleft palate repair? - CORRECT ANSWER a. Elbow a.i. Elbow restraints prevent children from bending their arms and brining their hands to the oral surgical site, (A) restrains the hands but the child can bend and bring their head to their ands. (B) is used during procedures (mummy). (D)-jacket, restrains the body torso and is not appropriate The mother of a 4-year-old child asks the nurse what she can do to help her other children cope with their sibling's hospitalizations. Which is the best response that the nurse should offer? - CORRECT ANSWER a. Encourage the mother to have the children visit the hospitalized sibling. a.i. Needs of a sibling will be better met with facture information and contact w/ the ill child, so siblings visitation should be encouraged (D). Parents are experts on their children and should determine when their children are old enough to visit. (A) in the hospital/ Separation fr. a family & home (B) may intensify fear & anxiety (suggest that the child visit a grandmother until the sibling returns home. Children may have difficulty expressing questions (C) ask the mother if the child asks when the sibling will be discharged, so the support of parents & other caregivers are needed to help alleviate their fears. The nurse is giving preoperative instruction to a 14-year-old female client who is scheduled for surgery to correct a spinal curvature. Which statement by the client best demonstrates that learning has taken place? - CORRECT ANSWER a. I understand that I will be in a body cast and I will show you how you taught me to turn a.i. Outcome of learning is best demonstrated when the client not only verbalizes an understand, but can also provide a return demonstration During administration of a blood transfusion, a child complains of chills, headache, and nausea. Which action should the nurse implement? - CORRECT ANSWER a. Stop the infusion immediately and notify the healthcare provider a.i. The child is exhibiting signs of a reaction to the blood transfusion. The blood transfusion should be stopped immediately and the healthcare provider notified ©. After the transfusion is discontinused, IV access should be maintained. (A) w/ fluids that do not introduce any more cellular products. (B & D) place the child @ risk for further blood reactions The clinic nurse is taking the hx for a new 6-month-old client. The mother reports that she took a great deal of aspirin while pregnant. Which assessment should the nurse obtain? - CORRECT ANSWER a. Type of reaction to loud noises a.i. Ototoxicity diminishes hear acuity and causes symptoms of tinnitus and vertigo in older children who can express subjective symptoms, so assessing the infant's reation to loud noises (A) helps to determine an infant's risk for hearing deficit r/t to a hx of the mother taking ototoxic drug, such as aspirin, while pregnancy (B,C,D are not assoc w/ the exposure to aspirin in utero The mother of a preschool aged child asks the nurse if it is all right to administer Pepto Bismol to her son when he has a "tummy ache" After reminding the mother to check the label of all OTC drugs for the presence of aspirin, which instruction should the nurse include when replying to this mother's question? - CORRECT ANSWER a. Do not give if the child has chickenpox, the flu, or any other viral illness a.i. Pepto Bismol contains aspirin and there is the potential of Reye's syndrome (B). (a) is a common effect of peptobismol and does not warrant discontinuation. Pepto Bismol can be used by children (C). Pepto Bismol does not cause rebound hyperacidity (D) complication of antacids containing calcium A 3 moth old infant develops oral thrush. Which pharmacologic agent should the nurse plan to administer for treatment of this disorder? - CORRECT ANSWER a. Nystatin (Mycostatin) a.i. Nystatin (mycostatin) (A) is an antifungal drug that is effective in treating thrush, an oral fungal infection The nurse is developing a plan of care for a 3 yr old who is scheduled for a cardiac catherization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement? - CORRECT ANSWER a. C-give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there a.i. Familizaring the child and mother w/ the department will help decrease anxiety of the child and mother (who may have more anxiety than the child). Three is a difficult age to undergo a procedure that requires cooperation. Restraints and possible sedation may be required A 3 yr old boy is brought to the ER because he swallowed an entire bottle of children's vitamin pills. Which intervention should the nurse implement first? - CORRECT ANSWER a. B-determine the child's pulse and respirations a.i. The most important principle in dealing w/ a poisoning is to treat the child first, not the poison. Initiate immediate life support measures w/ assessment of VS (B), in particular, respirations. Inserting an airway or initiating mechanical ventilation may be necessary. Assessment and identification of the poison should occur prior to A. (C & D after assessing the airway.) A 4- year- old girl continues to interrupt her mother during a routine clinic visit. The mother appears irritated w/ the child and asks the nurse, "Is this normal behavior for a child this age?" The nurse's response should be based on which information? - CORRECT ANSWER a. A- children need to retian a sense of initiative w/o impinging on the rights and privileges others a.i. Children aged 3-6 are in Erickson's initiative vs. guilt stage, which is characterized by vigorous, intrusive behavior, enterprise, and strong imagination. At this age, children develop a conscience and must learn to retain a sense of initiative w/o impinging on the rights of others The nurse is planning the care of a 2 year old w/ severe eczema on the face, next, and scalp fr. scratching the affected areas. Which nursing intervention is most effective in preventing further excoriation due to the purities? - CORRECT ANSWER a. C- place elbow restraints on the child's arms. a.i. Elbow restraints prevent arm flexion and scratching of involved area, but do not inhibit use of the nads for play activities. Others can be removed easily a 6- year old admitted to the pediatric unit after falling of a bicycle. Which intervention should the nurse implement to assist the child's adjustments to hospitalization? - CORRECT ANSWER a.Explain hospital schedules to the child, such as mealtimes. Altered daily schedules and loss of rituals are upsetting to children and increase separation anxiety, and active sensitivity to the needs of children can minimize the negative effects of hospitalization. Explaining the hospital schedules (A) and establishing an individual schedule familiarizes the child to the hospital environment and decreases anxiety. A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most important instruction for the nurse to include in this client's teaching plan? - CORRECT ANSWER a. A- Use sunscreen when lying by the pool a.i. Photosensitivity is a common side effect of tetracycline HCL (AchromycinV) therapy. Severe sunburn can occur w/ minimal sun exposure and clients should be instructed to avoid sunlight and to use sunscreen The nurse is caring for a 12 year-old w/ Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication? - CORRECT ANSWER a. B- changes in LOC a.i. The child must be monitored for S/S of hyponatremia, which creates secondary central nervous system alterations such as changes in LOC, seizure coma. A child falls on the playground and is brought to the school nurse w/ a small lacreration on the forearm. Which action should the nurse implement first? - CORRECT ANSWER a. C-Wash the wound gently w/ mild soap and water a.i. A small, superficial laceration to the skin should be washed gently w/ mild soap and water for several minutes, followed by thorough rinsing. A 6-month-old infant w/ congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse warrants immediate intervention? - CORRECT ANSWER a. A- Apical heart rate of 60 a.i. A heart rate of 60 is much lower than normal for a 6-month old and warrants immediate intervention. The normal heart rate for a 6 month old is 80-150 when awake, and a rate of 70 while sleeping is considered w/in normal limits. To assess the effectiveness of an analgesic administered to a 4-yr old, what intervention is best for the nurse to implement? - CORRECT ANSWER a. A- use a happy-face/sad face pain scale. a.i. A 4 year old can readily identify w/ simple picures to show the nurse how he/she is feeling. Could be used to validate what the child is telling the nurse via the "faces" pain scale, but it is best to elicit the child's assessment of his/her pain level (C-assess for changes in the child's vs), may not accurately reflect the effectiveness of pain medication as they can also be affected by other variables, such as fear The nurse is assessing an 8 month old child who has a medical diagnosis of tetrology of Fallot. Which symptom is the client most likely to exhibit? - CORRECT ANSWER a. D-clubbed fingers a.i. Tetrology of fallot, a cyanotic heart defect, causes clubbing of fingers and toes due to tissue hypoxia Which action by the nurse is most helpful in communicating w/ a preschool aged child? - CORRECT ANSWER a. B- use a doll to play and communicate a.i. Communicating through play w/ a doll or other toy gives time for the child to feel comfortable w/ a stranger Preoperative nursing care for a child w/ Wilm's tumor should include which intervention? - CORRECT ANSWER a. D-put a sign on the bed reading, "DO NOT PALPATE ABDOMEN" a.i. Prevention of abdominial palpation minimizes the risk of rupturing the encapsulated tumor and subsequent metastasis. The nurse is preparing a health teaching program for parents of toddlers and preschoolers and plans to include information about prevention of accidental poisonings. It is most important for the nurse to include which instruction? - CORRECT ANSWER a. B- store all toxic agents and medicines in locked cabinets. a.i. The only reliable way to prevent poisoning in young children is to make them inaccessible The nurse observes a 4 yr old boy in a daycare setting. Which behavior would the nurse consider normal for this child? - CORRECT ANSWER a. C- demonstrates aggressiveness by boasting when telling a story a.i. C- 4yr old children are aggressive in their behavior and enjoy "tale telling" A 2 yr old child w/ Down syndrome is brought to the clinic for his regular physical examination. The nurse knows which problem is frequently associated w/ Down syndrome? - CORRECT ANSWER a. A- congenital heart disease a.i. Is the most common assoc w/ defect in children w/ Down Syndrome In developing a teaching plan for a 5 year old child w/ diabetes, which component of diabetic management should the nurse plan for the child to manage first? - CORRECT ANSWER a. C-process of glucose testing a.i. Developmentally a 5 yr old has the cognitive and psychomotor skills to use a glucometer and to read the number (it is especially helpful if the nurse presents this activity as a game The nurse is assessing a 13 yr old girl w/ susptected hyperthyroidism. Which question is most important for the nurse to ask her during the admission interview? - CORRECT ANSWER a. B-are you experiencing any type of nervousness? a.i. Assessing the client's physiological state upon admission is priority, and nervousness, apprehension, hyperexcitability, and palpitations are signs of hyperthyroidism, but assessing loss (even w/ a hearty appetite) (A) occurs in those w/ hyperthyroidism, but assessing the client's neurological state has a higher priority. Hormone replacement is not administered to a client who is already producing too much thyroid The mother of a 6 month old asks the nurse when her baby will get the first MMR vaccine. Based on the recommended childhood immunization schedule published by the CDC, which response is accurate? - CORRECT ANSWER a. (b) the MMR vaccine should be given no sooner than 12 months of age, and ideally between 12 & 15 months of age. (a) 3-6 months should not receive the MMR vaccine due to the presence of maternal antibodies. MMR is not routinely administered @ 18-24, but others like dTaP and Hep B may be given at that time. A 16 y old is brought to the ER with a crushed leg after falling off a horse. The adolescent's last tetanus toxoid booster was received 8 ys ago. What action should the nurse take? - CORRECT ANSWER a. C- administer the tetanus toxoid booster. a.i. After the completion of the initial tetanus immunization schedule, the recommended booster for an adolescent or adult if every 10 years or less if a traumatic injury occurs that is contaminated by dirt, feces, soil, or saliva, such as puncture or crushing injuries, avulsions, wounds fr. missiles, burns or frostbite. The adolescent's injury is considered a contaminated wound requiring prophylactic therapy, so the tetanus toxoid booster should be administered A 6 month old returns fr. surgery w/ elbow restraints in place. What nursing care should be included when caring for any restrained child? - CORRECT ANSWER a. B- remove restraitnts one at a time and provide range of motion exercises a.i. Removing restraints one at a time (B) is safer than removing all of them at once. The child needs to exercise and should not be kept in restraints at all times A 17 yr old male student reports to the school clinic one morning ofr a scheduled health exam. He tells the nurse that he just finished football practice and is on his way to class. The nurse assess his VS: temp 100, pulse, 80, RR 20, and BP is 122/82. What is the best action for the nurse to take? - CORRECT ANSWER a. A- tell the student to proceed directly to his regulary scheduled class. a.i. The student has just completed football practice, and increased muscle activity increases body heat production. A temp of 100F is NORMAL for this student @ this time. The student should attend class The nurse is planning care for school-aged children @ a community care center. Which activity is best fo the children? - CORRECT ANSWER a. B- playing follow the leader a.i. School aged children strive for independence and productivity (ericksons industry vs. inferiority) & enjoy individual & group activites r/t real life situation, such as playing follow the leader A full term infant is admitted to the newborn nursery. After careful assessment, the nurse suspects that the infant may have esophageal atresia. Which symptoms are this newborn likely to exhibit? - CORRECT ANSWER a. A- choking, coughing, and cyanosis a.i. Includes the "3 Cs" of esophageal atresia caused by the overflow of secretions into the trachea. The nurse is assessing the neurovascular status of a child in Russell's traction. Which finding should the nurse report to the healthcare provider? - CORRECT ANSWER a. A- Pale bluish coloration of the toes a.i. Russell's skin traction is used for fractures of the femur in young children and adolescents whose growth plates remain open and is applied to the lower leg using moleskin and elastic wrap bandages, which can compress the perineal nerve and arteries that supply the foot. Assessment of adequate circulation, movement, & sensation of the toes and skin distal to the application is make to identify compromised blood flow, so cyanosis should be reported immediately A 5 month old is admitted to the hospital w/ vomiting and diarrhea. The pediatrician prescribes dextrose 5% and 0.25% normal saline w/ 2 mEq KCL/100 ml to be infused @ 25 ml/hour. Prior to initiating the infusion, the nurse should obtain which assessment finding? - CORRECT ANSWER a. B - Serum BUN & Creatinine levels a.i. Reguardless of a client's age, adequate renal function must be present before adding potassium ot IV fluids, is important in determining the need for fluid replacement When assessing a child w/ asthma, the nurse should expect intercostals retractions during - CORRECT ANSWER a. A-inspiration a.i. Intercostals retractions result fr. respiratory effort to draw air into restricted airways The nurse is having difficulty communicating w/ a hospitalized 6 yr old child. Which approach by the nurse is most helpful in establishing communication? - CORRECT ANSWER a. A- engage the child through drawing pictures a.i. Drawing pictures is a valuable fr. non verbal communication. As the nurse & child look at the drawings, a verbal story can be told that projects the child's thinking The vital signs of 4 yr old child w/ polyuria are: BP 80/40, pulse, 118, and Resp. 24. The child's pedal pulses are present w/ a volume of +1, and no edema is observed. What action should the nurse implement first? - CORRECT ANSWER a. B- Start an IV infusion of normal saline a.i. The current VS readings and the decreased peripheral pulse volume indicate that the child is experiencing fluid volume deficit due to the polyuria, so the priority action is to restore fluid volume A hospitalized 16 yr old male refuses all visits fr. his classmates because he is concerned about his distorted appearance. To increase the clients social interaction, what intervention is best for the nurse to initiate? - CORRECT ANSWER a. C- Arrange for an internet connection in the client's room for email communication a.i. Body image and peer acceptance are key concerns for the adolescent © allows for social interaction w/o face to face contact, thus protecting his self image while also promoting social interaction Which class of antiinfective drugs is contraindicated for use in children under 8 yrs of age? - CORRECT ANSWER a. B- tetracyclines a.i. Tetracyclines cause enamel hypoplasia & tooth discoloration in children under 8 yrs of age Which measures should be used to accurately calculate a pediatric medication dosage? - CORRECT ANSWER a. A, C, F a.i. A- a child's height & weight, C- Body surface area of child, F- nomogram determined mathematical constant During discharge teaching of a child w/ juvenile rheumatoid arthritis, the nurse should stree to the parents the importance of obtaining which diagnostic testing? - CORRECT ANSWER a. B- eye exams a.i. Visual changes leading to blindness an occur in children w/ JRA/ Regular eye exams can help to prevent this complication A burned child is brought to the ER. In estimating the percentage of the body burned, the nurse uses a modified "rule of nines" Which part of a child's body is calculated as a larger percentage of total body surface than an adult's? - CORRECT ANSWER a. A-Head & Neck a.i. A child's head & neck are proportionately larger to their body than and adult's. The standard "Rule of nines" is inaccurate for determining burned body surface areas w/ children, and must be modified for use with children. Specially designed charts for children and are commonly used to determine body surface are involvement The parents of a 3 week old infant report that the child eats well but vomits after each feeding. What information is most important for the nurse to obtain? - CORRECT ANSWER a. A- description of vomiting episodes in past 24 hrs a.i. A description of the vomiting episodes will assist the nurse in determining the reason for the symptoms, which may be helpful in developing a plan of care for this infant/ An infant is born w/ a ventricular septa defect (VSD) and surgery is planned to correct the defect. The nurse regcognizes that surgical correction is designed to achieve which outcome? - CORRECT ANSWER a. prevents the return of oxygenated blood to the lungs Closure of VSDs stops oxygenated blood fr. being shunted fr. the left ventricle to the right ventricle. VSDs are acyanotic defects, which means that no unoxygenated blood enters the systemic circulation is common w/ tetrology of Fallot, which is a cyanotic defec A premature newborn girl, born 24 hours ago, is diagnosed w/ a patent ductus arteriosus PDA and placed under an oxygen good @ 35%. The parents visit the nursery and ask to hold her. Which response should the nurse provide to the parents? - CORRECT ANSWER a. B- oxygen hood is holding the baby's oxygen level just at the point which is needed. You may stroke and talk to her. a.i. The baby is @ 35% which is must more than room air (21%) and at this time the baby should not be moved fr. under the hood. The nurse should offer the parents an alternative such as to stroke and reassure the infant. When discussing discipline with the mother of a 4 yr old child, the nurse should include which guideline? - CORRECT ANSWER a. A- parental control should be consistent a.i. Discipline should be a positive and necessary component of childrearing that is started in infancy & should teach socially acceptable behavior, help children protect themselves fr. danger, and channel undesireable behavior into constructive activity. Misbehavior may result fr. inconsistent rules or messages, so parental attention should be clear, reasonable, and consistent. To take the VS of a 4 month old child, which order provides the most accurate results? - CORRECT ANSWER a. A- respiratory rate, heart rate, then rectal temperature a.i. The respiratory rate should be take first in infants, since touching them or performing unpleasant procedures usually makes the cry, elevating the heart rate and making respirations difficult to count. Rectal temp is the most invasive procedure, and is most likey to precipitate crying, so should be done last A preschool-aged child who is hospitalized fy hypospadias repair is most strongly influenced by which behavior? - CORRECT ANSWER a. C- concern for his body integrity. He fears that his "insides will leak out" A child undergoing surgery to his genitalia is even more concerned about body integrity. The preschooler is quite verbal, so comprehension of the words he uses or hears may be inaccurate, while his imagination and fears may fantasize the reality All of the following interventions can be used to evaluate the effectiveness of nursing and medical interventions used to treat diarrhea. Which intervention is least useful in the nurse's evaluation of a 20 month old child? - CORRECT ANSWER a. B-assessing fontanels a.i. All of these interventions evaluate fluid status in infants (weight diapers, checking skin turgor, oserving mucous membranes for moisture checking for fluid status) The nurse assigning care for 5 yr old child w/ otitis media is concerned about the child's inceasing temperature over the past 24 hours. Which statement is accurate and should be considered when planning care for the remainder of the shift? - CORRECT ANSWER a. B- tympanic and oral temps are equally accurate a.i. A tympanic membrane sensor approximates core temps because the hypothalamus and eardrum are perfused by the same circulation. Typmpanic readings obtained using proper technique correlated moderately to strongly w/ oral temperatures in recent research studies The nurse is teaching a 12 yr old male adolescent and his family about taking injections of growth hormone for idiopathic hypopituitarism. Which adverse symptoms, commonly associated w/ growth hormone therapy, should the nurse plan to describe to the child and his family? - CORRECT ANSWER a. A- polyuria/polydipsia a.i. s/s of diabetes or hyperglycemia need to be reported. Those receiving growth hormone should be monitored to detect elevated blood sugars and glucose intolerance at 8am the unlicensed assistive personnel (UAP) informed the charge nurse that a female adolescent client w/ acute glomerulonephritis has a BP of 210/110. The 4am BP reading was 170/88. The client reports to the UAP that she is upset because her boyfriend did not visit last night. What action should the nurse take first? - CORRECT ANSWER a. -Administer PRN prescription of nifedipine (Procardia) sublingually a.i. Sublingual procardia lowers blood pressure very quickly, and this should be done first A 12-month-old is admitted w/ a respiratory infection and possible pneumonia. He is placed in a tent w/ oxygen. Which nursing intervention has the greatest priority for this infant? - CORRECT ANSWER a. C- a patent airway has the highest priority. Humidification will liquefy the nasal secretions thereby increasing the amount of secretions and making having a bulb syringe the highest priority The nurse is assigning care for a 4 yr old child w/ otitis media and is concerned about the child's increasing temperature over the past 24 hours. When planning care for this child it is important for the nurse to consider that - CORRECT ANSWER a. B- a tympanic measurement of temperature will provide the most accurate reading a.i. A tympanic membrane sensor is an excellent site because botht he eardrum and hypothalamus (temperature-regulating center) are perfused by the same circulation. The sensor is unaffected by cerumen and the presence of suppurative or unsuppurative otitis media does not effect measurement. RULE OF THUMB: for managementsterile procedures should be assigned to licensed personnel. Management skill will tested on the NCLEX. An RN is not required to do: rectal temp A three month old boy weighing 10 lbs 15 oz an axillary temp of 98.8. The nurse determines the daily caloric need for this child is approximately - CORRECT ANSWER a.600 calories per day. C- 10lbs 15oz = 10.9. Convert lbs by dividing 2.2; 10.9/2.2=4.59kg, rounded to 5kg. An infant requires 108 calories/kg/day (108 x 5=540 calories/day.) However this infant requires 10% more calories because he has one degree temperature elevation. 10% of 540 and 540 + 54= 594. This infant will require approx 600 calories/day. The nurse is teaching the parents of a 5 yr old w. cystic fibrosis about respiratory treatment. Which statement indicates to the nruse that the parents understand? - CORRECT ANSWER a. C- administer aerosol therapy followed by a postural drainage before meals. a.i. Postrural drainage for a child w/ cystic fibrosis is most effective when performed after nebulization and before meals or at least 1 hour after eating to prevent nausea & vomiting. Postural drainage uses gravity to promote mucous removal after nebulization (which open airways).. Pulmonary toileting or respiratory treatment should be given 3-4 times daily, not esisodically A 4- yr old boy was admitted to the emergency room w/ fractured right ulna and a short arm cast is applied. When preparing the parents to take the child home, which discharge instruction has the highest priority? - CORRECT ANSWER a. A- call the healthcare provider immediately if his nailbeds appear blue. a.i. A- Cyanosis indicates impaired circulation to fingers and should be reported immediately. Although the actions described may be indicated, they are implemented rather excessively & might tend to frighten the parents. It is not necessary to check the child's ability to move his fingers hourly for 2 days. A 3 week old newborn is brought to the clinic for a follow up after a home birth. The mother reports that her child bottle feeds for 5 min only and falls asleep. The nurse auscultates a loud murmur characteristic of a ventricular septal defect (VSD), and finds the newborn is acyanotic w/ respiratory rate of 64 breaths per min. What instruction should the nurse provide the mother to ensure the infant is receiving adequate intake? (Select all that apply) - CORRECT ANSWER A- Monitor the infant's weight and # of wet diapers per day B- Increase the infant's intake per feeding by 1-2 ounces per week d. allow the infant to rest and reefed on demand or every 2 hrs E. use a softer nipple or increase the size of the nipple opening Rationale: Correct responses are A,B,D, E. neonates who have VSD may fatigue quickly during feeding and ingest inadequate amounts. They should be monitored for weight gain and at least 6 wet diapers per day. A one month old should ingest 2-4 ounces of formula per feeding and progress to about 30 ounces per day by 4 months of age. Due to fatigue, the infant should rest, but feed at least every 2 hours to ensure adequate intake. A softer (preemie) nipple or a larger slit in the nipple helps to reduce the sucking effort and energy expenditure, thus allowing the infant to ingest more w/ less effort. Antibiotoic prophylaxis is recommended for infants w/ VSDs, but should not be mixed in a bottle of formula because it is difficult to ensure tha the total dose is consumed During routine screening at a school clinic, an otoscope examination of a child's ear reveals a tympanic membrane that is pearly gray, slightly bulging, and not movable. What action should the nurse take next? - CORRECT ANSWER a. B- Ask the child if he/she has had cold, runny nose, or any ear pain lately. a.i. More information is needed to interpret these finding, the tympanic membrane is normally pearly gray, not bulging, and moves when the client blows against resistance or a small puff of air is blown into the ear canal. Since this child's findings are not completely normal, further assessment of hx and related s/s is indicated for accurate interpretation of the finding. Which behavior should the nurse expect a two-year-old child to exhibit? - CORRECT ANSWER a. C- display possessiveness of toys a.i. Two year old children are egocentric and unable to share w/ other children and behaviors of a preschooler. The nurse is teaching a mother to give 4ml of a liquid antibiotic to a 10 month old infant. Which statement by the parent indicates a need for further teaching? - CORRECT ANSWER a. B- using a teaspoon will help me measure this correctly a.i. The prescribed medication is 4ml dosage and is measured w/ the most accuracy using a syringe, so if the parent uses teaspoon which is equiavelnt to 5ml, further teaching is indicated A 3 yr old client w/ sickle cell anemia is admitted to the ER w/ abdominial pain. The nurse palapates an enlarged liver, and x ray reveals an enlarged spleen, and a CBC reveals anemia. These findings indicate which type of crisis? - CORRECT ANSWER a. B- sequestration this support a sequestration crisis where blood pools in the spleen, and is characterized by abdominal pain anemia A 14 yr old female client tells the nurse that she is concerned about the acne she has recently developed/ Which recommendation should the nurse provide? - CORRECT ANSWER a. C- wash the hair and skin frequently w/ soap and hot water a.i. Washing the hair & skin w/ soap & hot water removes oil debris fr. the skin and helps prevent & treat acne. Oily skin especially bothersome during adolescence when hormones cause enlargement of sebaceous glands and increased glandular secretions which predispose the teenager to acne is contraindicated. Cosmetics "medicated" or not should be used sparingly to avoid further blocking sebaceous gland ducts. Might be indicated at a later time, if healthcare recommendations are not successful. An 18 month old is admitted to the hospital w/ possible Hirschsprung's disease. When obtaining a nursing hx the nurse asks about bowel habits. What description of the disease? - CORRECT ANSWER a. D- Ribbon-like and brown a.i. Hirschsprung's disease is a mechanical obstruction caused by inadequate motility in a part of the intestines. The condition results fr. failure of ganglion cells to migrate craniocaudally along the GI tract during gestation. The lack of peristalsis in the affected bowel segment causes constripation and smaller diameter, brown colored stools When planning the care for a child who has had a cleft lip repair, the nurse knows that crying should be minimized because it - CORRECT ANSWER a. D- prevention of stress on the lip suture line is essential for optimum healing and the cosmetic appearance of a cleft lip repair. Although crying causes (increased salvation, leads to vomiting, stresses the suture line) these conditions do not create a problem for the child w/ a cleft lip repair A 15 yr old girl tells the school nurse that all of her friends have started their periods and she feels abnormal because she has not. Which response is best for the nurse provide? - CORRECT ANSWER a. C- explain that menarche varies and occurs between the ages of 12-18 years As part of the physical assessment of children, the nurse observes and palpates the fontanels. Which child's fontanel finding should be reported to the healthcare provider? - CORRECT ANSWER a. A- a 6 moth old w/ failure to thrive that has a closed anterior fontanel a.i. @ 6 months of age the anterior fontanel should be open, and it should not be closed until approx 18 months A 2 yr old child w/ gastro-esophageal reflux has developed a fear of eating. What instruction should the nurse include in the parent's teaching plan? - CORRECT ANSWER a. D- a 2- year old child is comforted by consistency The nurse is assessing a 2 year old. What behavior indicates that the child's language development is within normal limits? - CORRECT ANSWER a. D- half of a child's speech is understandable a.i. Between approximately 15 & 24 months of age, a child's speech is only ½ understandable What preoperative nursing intervention should be included in the plan of care for an infant w/ pyloric stenosis? - CORRECT ANSWER a. D- observe for projectile vomiting a.i. Projectile vomiting, which contributes to metabolic alkalosis is the classic sign of pyloric stenosis When evaluating the effectiveness of interventions to improve the nutritional status of an infant w/ gastro-esphageal reflux, which intervention is most important for the nurse to implement? - CORRECT ANSWER a. A- record weight daily a.i. The most definitive measure of improved nutrition is an infant is obtaining the child's daily weight Which finding in a 19 yr old female client should trigger further assessment by the nurse? - CORRECT ANSWER a. A- menstruation has not occurred a.i. Menstruation is an expected secondary sex characteristic that occurs with pubescence and typically occurs by age 18, so A should prompt further investigation to determine the cause of this primary amenorrhea. Children receive tetanus as part of the DPT childhood immunization series, and a booster is not typically given until age 16. A 6 month old boy and his mother are at healthcare provider's office for a well-baby check up and routine immunizations. The healthcare provider recommends to the mother that the child receive an influenza vaccine. What medications should the nurse plan to administer today? - CORRECT ANSWER a. B- all the immunizations w/ the influenza vaccine given at a separate site fr. any other injection a.i. At 6 months of age, the routine immunizations should HEP B, DTaP, Hib, PCV (pneumococcal) , IPV (inactivated poliovirus) and influenza. The influenza vaccine should be given at a separate site fr. any other injection. A nurse who is working in the Poison Control Center receives several telephone calls from parents whose children have ingested possible poisons. The nurse should recommend inducing vomiting for which child? - CORRECT ANSWER 16-month old who drank 2 ounces of acetaminophen (Tylenol) elixir. Two contraindications to live virus immunization - CORRECT ANSWER Immunocompromised child or a child in a household with an immunocompromised indiviudal Three classic s/s of measles - CORRECT ANSWER 1.Photophobia 2. Confluent rash that begins on the face and spreads downward 3. Koplik spots on the buccal mucosa List the s/s of iron deficiency - CORRECT ANSWER Anemia; pale conjunctiva; pale skin color; atrophy of papillae on tongue, brittle, ridged, or spoon-shaped nails; and thyroid edema Identify food sources of vitamin A - CORRECT ANSWER Liver, sweet potatoes, carrots, spinach, peaches, and apricots What disease occurs with vitamin C defiency? - CORRECT ANSWER Scurvy What measurements reflects present nutrional status? - CORRECT ANSWER weight, skinfold thickness, and arm circumference List the s/s of dehyration in an infant - CORRECT ANSWER Poor skin turgor, absence of tears, dry mucous membranes, weight loss, depressed fontanel, and a decreased urinary output List the lab findings that can be expected in a dehydrated child - CORRECT ANSWER Loss of bicarb/decreased serum pH, loss of sodium (hyponatremia), loss of potassium (hypokalemia), elevated Hct, and elveated BUN How should burns in chilren be assessed? - CORRECT ANSWER By using the Lund-Browder chart, which takes into account the changing proportions of the child's body How can the nurse best evaluate the adequacy of fluid replacement in children? - CORRECT ANSWER By monitoring the urine output How should a parent be instructed to childproof a house? - CORRECT ANSWER By being taught to lock all cabinents, to safely store all toxic household items in locked cabinents, and to examine the house from the child's point of view What interventions should the nurse perform first in caring for a child who has ingested a poison? - CORRECT ANSWER Assessment of the child's respiratory, cardiac, and neurologic status What early signs should the nurse assess for if lead poisoning is suspected? - CORRECT ANSWER Anemia, acute cramping, abdnominal pain, vomiting, constipation, anorexia, lethargy, hyperactivity, aggression, impulsiveness, decreased interest to play, irritability, short attention span. Describe the purpose of bronchodilators - CORRECT ANSWER To reverse bronchospasms What are the physical assessment findings for a child with asthma? - CORRECT ANSWER Expiratory wheezing, rales, tight-cough, and signs of altered blood gases What nutrional support should be provided for a child with cystic fibrosis? - CORRECT ANSWER Pancreatic enzyme replacement, fat-soluble vitamins, and a moderate- to-low carbohydrate, high-protein, moderate-to-high-fat diet Why is genetic counseling important for the family of a child with cystic fibrosis? - CORRECT ANSWER Because the diesease is autosomal recessive in its genetic pattern List seven signs of respiratory distress in a pediatric client - CORRECT ANSWER Restlessness, tachycardia, tachypnea, diaphoresis, flaring nostrils, retractions, and grunting Describe the care of a child in a mist tent? - CORRECT ANSWER Monitor child's temperature; keep tent edges tucked in clothing dry; assess respiratorty status; look at child inside tent What position does a child with epiglottitis assume? - CORRECT ANSWER Upright sitting with chin out and tongue protruding ("tripod position"). Why are IV fluids importnat for a child with an increased respiratory rate? - CORRECT ANSWER The child is at risk for dehydration and acid-base imbalances What is the msot common postoperative complication following a tonsillectomy? Describe the s/s of this complication - CORRECT ANSWER hemorrhage; frequent swallowing, vomiting fresh blood, and clearing throat Children with chronic otitis media are at risk for developing what problem? - CORRECT ANSWER Hearing loss What are the physical features of a child with down syndrome? - CORRECT ANSWER Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes Describe scissoring? - CORRECT ANSWER A common characteristic of spastic cerbral palsy in infants; legs are extended and crossed over each other, feet are plantarflexed What are two nursing priorities for a newborn with myelomeningocele? - CORRECT ANSWER Prevention of infection of the sac and monitoring for hydrocephalus (measure head circumference; check fontanel; assess neurologic functioning). List the s/s of increased ICP in an older child? - CORRECT ANSWER Irritability, change in LOC, motor dysfunction, headache, vomiting, unequal pupul response, and seizures What teaching should parents of a newly shunted child recive? - CORRECT ANSWER Information about s/s of infection and increased ICP, understanding that shunt should not be pumped and that child will need revisions with growth; guidance concerning growth and development State the three main goals in providing nursing care for a child experiencing a seizure? - CORRECT ANSWER Maintain patent airway, protect from injury, and observe carefully What are the side effects of Dilantin? - CORRECT ANSWER Gingival, hyperplasia, dermatitis, ataxia, GI distress Descbrine the s/s of a child with meningitis. - CORRECT ANSWER Fever, irritability, vomiting, neck stiffness, opisthotonos, positve Kernig's sign, positive Brudzinski sign; infant may not show classic signs even though very ill What antibodies are usually prescribed for bacterial meningitis? - CORRECT ANSWER Ampicillin, penicillin, or chloramphenicol How is a child usually positioned after brain tumor surgery? - CORRECT ANSWER Flat or on either side Descrbine the mechanism of inheritence of Duchenne muscular dystrophy. - CORRECT ANSWER Duchenne muscular dystrophy is inherited as an X-linked recessive trait. What is the Gowers sign? - CORRECT ANSWER Gowers sign is an indicator of muscular dystrophy; to stand, the child has to walk hands up legs Describe the function of an osmotic diuretic - CORRECT ANSWER Osmotic diuertics remove water from the CNS to reduce cerebral edema What interventions increase ICP? - CORRECT ANSWER Suctioning, positioning, and turning. Differentiate between a right-to-left and left-to-righ shunt in cardiac disease - CORRECT ANSWER A right-to-left shunt bypasses the lungs and delivers unoxygenated blood to the systemic circulation, causing cyanosis. A left-to-right shunt moves oxygenated blood back through the pulmonary circulation List the four defects associated with tetralogy of Fallot. - CORRECT ANSWER VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy List the common signs of cardiac problems in an infant - CORRECT ANSWER Poor feeding, poor weight gain, respiratory distress and infections, edema, and cyanosis What are the two objectives in treating congestive heart failure? - CORRECT ANSWER Reuce the workload of the heart, and increase cardiac output Describe nursing interventions to reduce the workload of the heart - CORRECT ANSWER Give small frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutra thermal enviroment. Organize activites to disturb child only as indicated What position would best relieve the child experiencing a tet spell? - CORRECT ANSWER Knee-chese position or squatting What are common signs of digoxin toxicity? - CORRECT ANSWER Diarrhea, fatigue, weakness, nausea, and vomiting; the nurse should check for bradycardia prior to administration List five risks in cardiac catherization. - CORRECT ANSWER Arrhythmia, bleeding, perforation, phlebitis, and obstruction of the arterial entry site. What cardiac complications are associated with rhematic fever? - CORRECT ANSWER Aortic valve stenosis and mitral valve stenosis What medications are used to treat rheumatic fever? - CORRECT ANSWER Penicillin, erythromycin, and aspirin Describe feeding techniques for a child with cleft lip or palate - CORRECT ANSWER Use lamb's nipple or prosthesis. Feed child upright, with frequent bubbling List the s/s of esophageal atresia with TEF: - CORRECT ANSWER Chiking, coughing, cyanosis, and excess salivation. What nursing actions are initiated for the newborn with suspected esophageal atresia with TEF? - CORRECT ANSWER Maintain NPO immediately, and suction secretions Describe the postoperative nursing care for an infant with pyloric stenosis - CORRECT ANSWER Maintain IV hydration, and provide small, frequent oral feedings of glucose or elctrolyte solutions or both within 4-6hours. Gradually increase to full-strength formula. Position infant on right side in semi-Fowler position after feeding. Describe why a barium enema is used to treat intussusception. - CORRECT ANSWER It reduces the telescoping of the intestine through hydrostatic pressure without surgical intervention. Describe the preoperative nursing care for a child with Hurschsprung disease? - CORRECT ANSWER Check VS and take axillary temp. Provide bowel cleasning program, and teach about colostomy. What care is needed for a child with a temporary colostomy? - CORRECT ANSWER Family needs education about skin care and appliances. Referral to an enterostomal therapist is appropriate. What are the signs of anorectal malformation? - CORRECT ANSWER A newborn who does not pass meconium within 24 hrs; meconium appearing through a fistula or in the urine; an unusual-appearing anal dimple What are the priorites for a child undergoing abdominal surgery? - CORRECT ANSWER Maintain fluid balance (I&O, nasogastric suction, monitor electrolytes); monitor VS; care for rains, if present; assess bowel function; prevent infection of incisional area and other postop complications, and support child and family with teaching Describe the information families should be given when a child is receiving oral iron preparations. - CORRECT ANSWER Give on an empty stomach and with Vitamin C. Use straws to avoid discoloring teeth. Tarry stool are normal. Increase dietary sources of iron List dietary sources of iron - CORRECT ANSWER Meat, green leafy veggies, fish, liver, whole grains, legumes What is the genetic transmission patter of hemophilia? - CORRECT ANSWER It is an X-linked recessive chromosomal disorder transmitted by the mother and expressed in male children Describe the sequence of events in the vaso-occlusive crisis in sickle cell anemia - CORRECT ANSWER A vaso-occlusive crisis is caused by the clumping of red blood cells, which blocks small blood vessels; therefore, the cells cannot get through the capillaries, causing pain and tissue and organ ischemia. Lowered oxygen tension affects HgbS, which causes sickling of the cells Explain why hydration is a priority in treating sickle cell disease - CORRECT ANSWER Hydration promots hemodilution and circulation of the red cells through the blood vessels What should families and clients do to avoid tirggering sickling episodes? - CORRECT ANSWER Keep child well hydrated. Avoid known sources of infection. Avoid high altitudes. Avoid strenuous exercise Nursing interventions and medical treatments for a child with leukemia are based on what three phsyiologic problems? - CORRECT ANSWER Anemia (decreased erythrocytes), infection (neutropenia), bleeding thrombocytopenia (decreased platelets) How is congenital hypothyroidism diagnosed? - CORRECT ANSWER Newborn screening revealing a low T4 and a high TSH What are the symptoms of congenital hypothyroidism in early infancy? - CORRECT ANSWER Larg, protruding tongue, coarse hair, lethargy, sleepiness, and constipation What are the outcomes of untreated congenital hypothyroidism? - CORRECT ANSWER Mental retardation and growth failure What are the metabolic effects of PKU? - CORRECT ANSWER CNS damage, mental retardation, and decreased melanin List food high in phenylalanine content - CORRECT ANSWER Meat, milk, dairy products, and eggs What are the three classic signs of diabetes? - CORRECT ANSWER Polydipsia, polyphagia, and polyuria The signs of hypoglycemia? - CORRECT ANSWER tremors, sweating, headache, hunger, nausea, lethargy, confusion, slurred speech, anxiety, tingling around moth, nightmares The signs of hyperglycemia? - CORRECT ANSWER Polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, and syncope Describe the nursing care of a child with keotacidosis - CORRECT ANSWER Provide care for an unconscious child, administer regular insulin IV in normal saline, monitor blood gas values, and maintain strict I&O Describe developmental factors that would impact the school-age child with diabetes - CORRECT ANSWER need to be like peers; assuming responsibility for own carel modification of diet; snacks and exercise in school What is the relationship between hypoglycemia and exercise? - CORRECT ANSWER during exercise insulin uptake is increased and the risk for hypoglycemia occurs List normal findings in nerovascular assessment - CORRECT ANSWER Warm extremity, brisk capillary refill, free movement, normal sensation of the affected extremity, and equal pulses What is compartment syndrome - CORRECT ANSWER Damage to nerves and vasculature of an extremity due to compression What are the s/s of compartment syndrome - CORRECT ANSWER Abnormal neurovascular assessmentl cold extremity, severe pain, inability to move the extremity, and poor capillary refill Why are fractures of the epiphyseal plate a special concern? - CORRECT ANSWER Fractures of the epiphyseal plate (growth plate) may affect the growth of the limb. How is skeletal tracion applied? - CORRECT ANSWER Skeletal traction is maintained by pins or wires applied to the distal fragment of the fracture. What discharge instructions should be included concerning a child with a spica cast? - CORRECT ANSWER Check child's circulation. Keep cast dry. Do not place anything under cast. Prevent cast soilage during toileting or diapering. What are the s/s of congenital dislocated hip in infants? - CORRECT ANSWER Unequal skin folds of the buttocks. Ortolani sign, limited abduction of the affected hip, and unequal leg lengths How would the nurse conduct a scoliosis screening? - CORRECT ANSWER Ask the child to bend forward from the hips, with arms hanging free. Examine the child for a curve in the spin, a rib hump, and hip asymmetry What instructions should a child with scoliosis receive about the Milwaukee brace? - CORRECT ANSWER The child should be instructed to wear the brace 23 hours per day; wear a T shirt under brace; check skin for irritation; perform back and abdominal exercises What care is indicated for a child with juvenile rheumatoid arthritis? - CORRECT ANSWER Prescribed exercise to maintain mobility; splinting of affected joints; and tea ching about medication management and side effects of drugs which growth and development characteristic should the nurse consider when monitoring the effects of a topical medication for an infant? - CORRECT ANSWER A thin statum corneum that increases topical absorption. Infants have a thin outer skin layer (stratum corneum) so the nurse should monitor the infant for a prompt onset and response to to the application of topical medication. A, C, and D are unrelated to topical med admin. a child with hemophilia A - CORRECT ANSWER apply pressure and ice for bleeding while elevating and resting the extremity. Hemophilia, a blood disorder, causes joint bleeding which is treated with rest, ice, compression adn elevation (RICE).