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Exam (elaborations)

HEALTH J73J74J7 PEDS Ati A

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HEALTH J73J74J7 PEDS Ati A

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  • April 1, 2021
  • 9
  • 2020/2021
  • Exam (elaborations)
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1. A nurse is assisting the provider with a developmental assessment of a toddler. Which of the
following behaviors should the nurse recognize as an expected finding?
a. Stands on one foot for several seconds.
b. Standing on one foot for several seconds is an expected behavior for a toddler.
2. A nurse is contributing to the plan of care for a child who has sickle cell anemia and is
experiencing a vaso occlusive crisis. Which of the following is the priority intervention for
the nurse to recommend to include in the plan?
a. Promote oxygen utilization.
b. The priority action the nurse should take when using the airway, breathing,
circulation (ABC) approach to client care is promoting oxygen utilization to
prevent further sickling of the red blood cells and promote adequate oxygenation
of the tissue.
3. A nurse is reinforcing teaching about home safety with the parent of a toddler. Which of
the following parent statements indicates an understanding of the teaching?
a. "I will place a screen in front of the replace."
b. The nurse should instruct the parent to place a screen in front of a replace or




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other heating appliances to prevent burns.




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4. A nurse is reinforcing teaching regarding the immunization schedule of a newborn.




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Which of the following statements made by the parent should the nurse recognize as an




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understanding of the newborn's immunization schedule?




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a. "My baby will receive his next immunization when he is 2 months old."
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b. Newborns should receive the next scheduled immunization 2 months after birth.
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5. A nurse is preparing to administer the measles, mumps, and rubella (MMR) vaccine to a
preschooler. The nurse should recognize which of the following statements by the parent
as a contraindication to receiving the immunization?
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a. “My child received an immunoglobulin last month."
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b. The nurse should identify that a preschooler who received an immunoglobulin
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less than 1 month ago should not receive the MMR vaccine on this day. The
nurse should instruct the parent to reschedule the immunization after 3 months
have elapsed, since the child received passive immunity via administration of an
immunoglobulin.
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6. A nurse is reinforcing teaching with the parents of a child who has cystic fibrosis and is
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taking pancrelipase as a pancreatic enzyme replacement. The nurse should plan to
inform the child's parents that the therapeutic effects of this medication can be evaluated
by which of the following?
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a. Amount and consistency of stools.
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b. Recording the amount and consistency of the child's stools will help determine
the effectiveness of pancrelipase, which is taken to decrease the bulk of feces.

7. A nurse is reinforcing teaching with the parent of a child who has hemophilia and is
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experiencing acute hemarthrosis. Which of the following instructions should the nurse
include in the teaching?
a. Keep the affected joints immobilized.
b. The nurse should reinforce with the parent to keep the child's affected joints
elevated and immobilized to minimize bleeding. After the acute episode, the child
should begin active range-of-motion exercises.
8. A nurse has just received change-of-shift report for four children in a pediatric unit.

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, Which of the following children should the nurse collect data from the first?
a. A child who has a fever and nuchal rigidity
b. A client who has a fever and nuchal rigidity is unstable. This finding indicates
bacterial meningitis, which requires urgent data collection and intervention to
reduce complications for the child and prevent further spread of the infection.
Therefore, the nurse should collect data from this child first.
9. A nurse is assisting with scoliosis screenings for a group of school-age children. The
nurse should place the students in which of the following positions during the screening?
a. Befinding forward with back parallel to the floor
b. The nurse should observe for asymmetry and prominence of the rib cage by
having the students bend forward with the back parallel to the floor.

10. A nurse in a pediatric clinic is observing for an anaphylactic reaction after administering
an IM antibiotic to a child 5 min ago. Which of the following manifestations should the
nurse expect to observe the first?
a. Hives.




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b. The nurse should observe for hives first because this is an early manifestation of




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an anaphylactic reaction.




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11. A nurse is monitoring a preschooler following an abdominal CT scan with contrast dye.




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The nurse should identify which of the following as an indication that the preschooler




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experienced an allergic reaction to the contrast dye?
a. Urticaria.
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b. The nurse should monitor the child for an allergic reaction to the contrast dye.
Manifestations of the allergic reaction include hives, itching, pushing of the skin,
and possible anaphylaxis.
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12. A nurse is reinforcing teaching with the parents of a 7-year-old female child about
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behavioral expectations. Which of the following behaviors should the nurse include in the
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teaching?
a. Spends a lot of time by herself.
b. Spending time alone is an expected characteristic of a 7-year-old female child.
When they do spend time with others, children in this age group prefer to
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socialize with children of the same sex and age.
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13. A nurse is assisting with the care of an infant who has spina bida and recently had a
ventriculoperitoneal shunt placed for hydrocephalus. Which of the following findings
should the nurse identify as an indication of increased intracranial pressure?
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a. High-pitched cry.
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b. The nurse should identify that a high-pitched cry is an indication of increased
intracranial pressure.
14. A nurse is collecting data from a child who has iron deficiency anemia. Which of the
following data signifies that adherence to ferrous sulfate therapy has occurred?
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a. Green, tarry stools.
b. Green, tarry stools are an expected outcome of ferrous sulfate therapy.
Therefore, this is an indication of adherence to the prescribed medication
regimen.
15. A nurse is collecting data from a 12-month-old infant during a well-child visit. The nurse
should identify which of the following findings as a deviation from expected growth and
development?

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