1 | P a g e ATI PN PEDIATRICS PROCTORED EXAM 4 NEWEST V ERSIONS | WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED RATIONALES ANSWERS | 2024(NEWEST) ALREADY GRADED A+ PKU will causes _____ __ ______if left untreated Mental Retardation rationale: Phenylketonuria (PKU) is a recessive hereditary defect of metabolism that, if untreated, causes severe mental retardation. It is not related to congenital heart defects, increased intracranial pressu re, or to a strangulated intestine. In working with the child or family of a child with a congenital disorder, the most effective nursing intervention for this child or family would be for the nurse to Use reflective listening and offer nonjudgmental suppo rt rationale: Families are naturally apprehensive and find it difficult not to overprotect a child who is ill. They often increase the child's anxiety and cause fear in the child about participating in normal activities. Children are rather sensible about finding their own limitations and usually limit their activities to their capacity if they are not made unduly apprehensive. Some families can adjust well and provide guidance and security for the sick child. Others may become confused and frightened and show hostility, disinterest, or neglect; these families need guidance and counseling. The nurse has a great responsibility to support the family. The nurse's primary goal is to reduce anxiety in the child and family. This goal may be accomplished through op en communication and ongoing contact. Following birth the newborn's independent circulatory system is established. If there is an abnormal opening between the chambers in the heart, which of the following cardiac defects may occur? Ventricular septal defec t Explanation: A ventricular septal defect is the most common intracardiac defect. It consists of an abnormal opening in the septum between the two ventricles. One of the clinical manifestations seen in the child with hydrocephalus is which of the followi ng? An extremely large and rapidly growing head An excessively large head at birth is suggestive of hydrocephalus. Rapid head growth with widening cranial sutures is also strongly suggestive and may be the first manifestation of this condition 2 | P a g e The nurse i s caring for a newborn of a substance abusing mother who is withdrawing from alcohol. Which of the following would the nurse likely see in this newborn? Newborn is hyperactive and irritable The newborn that is withdrawing from alcohol typically is hyperac tive, irritable, has trouble sleeping, and may have tremors or seizures. Characteristics of FAS include low birth weight, and small height and head circumference. This newborn is prone to respiratory difficulties, hypoglycemia, hypocalcemia, and hyperbilir ubinemia. A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which of the following disorders? Spina bifida ratio nale: Spina bifida is a failure of the posterior laminae of the vertebrae to close, leaving an opening through which the spinal meninges and spinal cord may protrude. Hydrocephalus is a condition characterized by excess cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity. Cleft palate is a result of failure of the primary and secondary palates to fuse. Esophageal atresia is the absence of a normal opening or abnormal closure of the esophagus. You care for a child b orn with a tracheoesophageal fistula. Which finding during pregnancy would have caused you to suspect this might be present? Hydramnios Rationale: Because a fetus swallows amniotic fluid, when there is an obstruction of the esophagus, amniotic fluid accum ulates, leading to hydramnios. Four weeks before the birth of her already large child, the physician has told the pregnant woman that if the baby gets bigger and his lungs are ready, the physician would like to perform a cesarean to deliver the baby. The w oman asks the nurse what the downside is to having a cesarean rather than a vaginal delivery. What is an appropriate response by the nurse? "As the baby passes through the birth canal some of the excess fluid is expelled from the lungs, if that doesn't hap pen there's a higher risk of respiratory distress." Rationale: Transient tachypnea of the newborn (TTN) involves the development of mild respiratory distress in a newborn. TTN results from a delay in absorption of fetal lung fluid after birth. As the fetu s passes through the birth canal during delivery, some of the fluid is expelled as the thoracic area is compressed. TTN is commonly seen in newborns born by cesarean delivery. It typically occurs after birth with the greatest degree of distress occurring a pproximately 36 hours after birth. TTN commonly disappears spontaneously around the third day A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episode s of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings? 3 | P a g e esophageal atresia Rationale: Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be given until the newborn has been examined. An infant with hydrocephalus is scheduled to have a ventriculoperitoneal shunt inserted. Immediately following the procedure, which nursing action would best prevent decompression from excessive CSF flow? Keeping the head of the infant level with the body Rationale: Keeping the infant's head fairly even with the rest of the body prevents gravity from moving more fluid into the shunt than necessary The nurse who is caring for newborn Andrew notices that although he has seemed healthy at 18 hours of age, Andrew's abdomen is now distended. By 24 hours he has passed no stool. The nurse will Inform the physician of the findings In some newborns, a shallow opening may occur in the anus with the rectum ending in a blind pouch some distance higher. Thus, being able to pass a thermometer into the rectum does not guarantee that the rectoanal canal is normal. More reliable presumptive evidence is obtained by watching carefully for the first meconium stool. Abdominal distention also occurs. If the newborn does not pass a stool within the first 24 hou rs, the physician should be notified. Definitive diagnosis is made by radiographic studies. In some newborns, a colostomy is performed and extensive abdominoperineal resection is delayed until 3 -5 months of age or later. A pre -term newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and increased head circumference. These signs indicate the newborn most likely has which of the following complications? intraventricular hemorrhage (IVH) Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full (or bulging) fontanelle, cyanosis, and increased head circumference. A newborn is diagnosed with congenital hypothyroidism prior to discharge from the hospital. What medication does the nurse anticipate administering to the newborn? Levothyroxine rationale: The thyroid hormone must be replaced as soon as the diagnosis is made. Levothyroxine sodium, a synthetic thyroid hormone replacement, is the drug most commonly used. Over the course of an eight hour shift of postop erative care for a child who has had ventriculoatrial shunt placement, the nurse notes that the child's cry has become increasingly shrill and the child has 4 | P a g e projectile vomiting. The nurse would notify the physician immediately because of the possibility th at the child might be experiencing increased intracranial pressure Symptoms of increased intracranial pressure (IICP) may include irritability, restlessness, personality change, high -pitched cry, ataxia, projectile vomiting, failure to thrive, seizures, s evere headache, changes in level of consciousness, and papilledema. At least every 2 -4 hours, the nurse should monitor the newborn's level of consciousness, check the pupils for equality and reaction, monitor the neurologic status, and observe for a shrill cry, lethargy, or irritability. When examining a newborn for developmental hip dysplasia, which of the following motions would the newborn's hip be unable to accomplish? abduction rationale: Infants with shallow acetabulums are unable to abduct their hi ps. It would be best to place an infant with a myelomeningocele in which position prior to surgery? on the stomach (prone) Placing the infant prone prevents direct trauma to the lesion and reduces the chance that feces will contaminate the lesion. The nur se is caring for a newborn with retinopathy of prematurity (ROP). Which of the following is the best explanation of this disorder? The infant has a degenerative disease of the retina Retinopathy of prematurity (ROP) is a form of retinopathy (degenerative disease of the retina) commonly associated with the preterm newborn. The immature liver in the preterm infant cannot manage all the bilirubin produced by hemolysis (destruction of red blood cells with the release of hemoglobin), making the infant prone to jaundice and high blood bilirubin levels. Intraventricular hemorrhage (IVH) is a complication of preterm birth in which there is bleeding into the brain's ventricles. In hyaline membrane disease, the premature infant's lungs are deficient in surfactant and thus collapse after each breath, greatly increasing the work of breathing. When planning preoperative care for a newborn with a cleft lip and palate, a major need for which you would plan interventions is Nutrition An infant with a cleft lip is unable to suck effectively, so obtaining adequate nutrition is a major concern.
