PAEDIATRIC Flashcards
1
Q
A nurse is counselling the family of a child with AIDS. What is the most important concern the nurse should discuss with the parents?
A/ Risk for injury
B/ Susceptibility of infection
C/ Inadequate nutritional intake
D/ Altered growth and development
A
B/ Infection
Rationale:
Children with AIDS have a dysfunction of the immune system and are susceptible to opportunistic infections. Although adequate nutrition can be a problem for kids with AIDS, infection poses a greater threat. Altered growth is not as significant as infection.
2
Q
An 8 year old child who is experiencing a sickle cell pain episode is admitted to the child health unit. What is the appropriate nursing care during this acute period?
A/ Limiting Fluids until the crisis ends
B/ Administering Prescribed Analgesics
C/ Applying cold compresses to painful joints
D/ Performing range-of-motion exercises of affected joints to stimulate blood flow.
A
B/ Pain meds
Rationale:
Severe pain is associated with sickle cell crisis and should be controlled through analgesics. Hydration is important to promote hemodilution, improve circulation and prevent more sickling. Cold will constrict vessels and make the situation worse. Warmth is preferred. ROM exercises would increase swelling and pain. Bad call… Pain tx is number one with sickle.
3
Q
What teaching must the nurse emphasize to the family when preparing a school-aged child with persistent asthma for discharge?
A/ A cold, dry environment is desirable
B/ Limits should not be placed on their behaviour
C/ The health problem is gone when symptoms subside
D/ Medications should be used even when the child is asymptomatic
A
D/
Rationale:
Children with asthma must continue to take their meds to keep them asymptomatic. Some environmental moisture is needed for asthmatics, and limits should always be placed of any adolescent behaviour regardless of illness or not.
tx includes: Inhaled corticosteroids, Long-acting Beta2-agonists, and leukotriene modifiers.
4
Q
A school nurse is teaching a group of teachers’ aides about the cause of lead poisoning in children. What should be considered in terms of prevention?
A/ Lead poisoning is known to be caused by ingestion of foods high in fat
B/ Lead poisoning is known to be caused by passive or inattentive parenting
C/ Environmental factors are involved because lead is available for ingestion and inhalation
D/ Increasing milk intake will counteract the adverse affects of lead ingestion
A
C/ Environmental factors through inhalation and ingestion
Rationale:
Caused by lead in the environment. Unless fat has been exposed to lead, it is not a factor. Parenting roles are neither a factor too.Milk does not counteract the effects of lead.
5
Q
A 5 year-old child is admitted to the paediatric unit complaining of colicky abdominal pain with guarding, nausea, anorexia, and a low-grade fever. Palpation of the right lower quadrant of the abdomen elicits pain. What is the likely diagnosis for this patient?
A/ Ulcerative Colitis
B/ Acute Appendicitis
C/ Hirschsprung Disease
D/ Hookworm Infestation
A
B/ Acute Appendicitis
Rationale:
Classic signs of appendicitis. Kid would have diarrhea if ulcerative colitis. Hirschsprung disease is manifested by constipation, and manifestations of hookworm infestations are: anemia, malnutrition, and popular eruptions.
6
Q
What is the most important thing for a nurse to teach parents of a child with Duchenne Muscular Dystrophy to do for their school-aged-child?
A/ Maintain high caloric diet
B/ Institute seizure precautions
C/ Restrict the use of larger muscles
D/ Perform range of motion exercises
A
D/ ROM exercises
Rationale:
ROMs are essential to help achieve primary objectives of maintaining optimal muscle function for as long as possible and preventing the development of contractures. High caloric diet would make them fat, which would push them to a wheel-chair faster than you can say “fat guy in a little coat”. Seizures have nothing to do with duchenne, and restricting large muscles could result is disuse atrophy and contractures.
7
Q
A school nurse informs the mother of an 11-year old girl that her daughter has been giving her lunch to her friends and buying cookies and cola a lunch. The mother asks the nurse how to best solve the problem, and the nurse responds BEST by saying:
A/ “Give her enough money to buy a proper lunch”
B/ “Withhold her allowance until she promises to eat her lunch”
C/ “Explain to her child how important a nutritious lunch is for her health”
D/ “Have her help you plan nutritious meals that include her favourite foods”
E/ “Lace all your cookies at home with fish oil, and your cola with bacon grease; thus, rendering her love of sweets obsolete and ensuring she will never eat poorly again”
A
D/ Develop meal plan together.
Rationale:
Involving the kid will give the child a sense of achievement and encourage her to eat the foods that are enjoyed and nutritious for her. Other options do not promote adherence or healthy behaviour. Punishment will cause rebellion. Lacing foods would work, but it is frowned upon by many paediatric institutions.
8
Q
What is the priority nursing intervention for a young infant who has an IV in place after undergoing abdominal surgery?
A/ Administering oral Fluids
B/ Limiting Handling by parents
C/ Weighing diapers after each void to ensure proper In and out
D/ Maintaining patency of IV infusion
A
D/ Patency of IV
Rationale:
It is imperative to monitor IV site and tubing for patency to avoid obstruction or infiltration. Oral fluids are not administered after abdominal surgery until peristalsis has returned. The is no reason to limit parent handling under these circumstances. Although it is important to measure in and out, IV maintenance is priority.
9
Q
An infant with the diagnosis of heart failure is being given Furosemide BID. Which lab values should the nurse report to the primary care physician?
A/ Na+ 140 mmol/L
B/ Ca+ 1.2mmol/L
C/ Cl 102 mmol/L
D/ K+ 3.0mmol/L
A
D/ Potassium
Rationale:
Furosemide is a potassium-sparing loop diuretic, making K+ something that should be checked often. Normal K+ concentration of infants if 3.5-5.0mmol/L in infants. Other values are in normal ranges.
10
Q
A 2-week old infant is admitted with a tentative diagnosis of a VSD (ventricular septal defect). The parents report that their baby has had a hard time feeding since coming home after birth. What should the nurse consider before responding?
A/ Feeding problems often occur in neonates
B/ Inadequate suckling is not significant in the absence of cyanosis
C/ Ineffective suckling and swallowing may be indications of a heart defect
D/ Many neonates retain mucus, and this can interfere with feeding for several weeks.
A
C/ Indication of heart defect
Rationale:
Compromised heart function causes decreased cardiac output; which often results in cyanosis and fatigue from ineffective suckling and swallowing. When feeding issues persist in a neonate, it generally is an indication of some pathology. Inadequate suckling is NEVER insignificant! Newborns become free from mucus around 24-48 hours post birth.
11
Q
A 5-month-old infant is brought to the paediatric clinic for a routine monthly exam. What assessment finding alerts the nurse to notify the primary HCP?
A/ HR of 100bpm
B/ BP of 75/48 mm Hg
C/ Respiratory rate of 70/min
D/ Temp 37.5C
A
C/ Resp of 70/min
Rationale:
Average resp rate of infants is 35/min. Tachypnea requires further investigation. All other vitals are in normal range.
If the child was anxious or scared, their HR would infants and so would their BP
12
Q
The neonate has a protruding tongue and a crease that traverses the entire width of each palm. The nurse recognizes that these findings are characteristic of what congenital condition? A/ Hypothyroidism B/ Down Syndrome C/ Turner Syndrome D/ Fetal Alcohol Syndrome
A
B/ Down Syndrome
Dysmorphic features that are characteristic of Down Syndrome include:
Protruding tongue
Simian creases across the palms
Turner Syndrome is characterized by a webbed neck and peripheral edema, children with FAS have dysmorphic features, but are different from downs.
13
Q
An infant with a congenital Heart defect is being given gavage feedings. The parents ask the nurse why this is necessary. What is the best response from the nurse?
A/ It limits the chance of vomiting
B/ It allows the feeding to be administered rapidly
C/ The energy that would have been expended on sucking is preserved
D/ The quantity of nutritional liquid can be better regulated than with a bottle.
A
C/ Energy conservation
Gavage feeding is preferred for weak infants, those with respiratory distress or ineffective sucking-swallowing coordination. It conserves energy and reduces the workload of the heart.
Feeding an infant is NOT desirable as it could lead to aspiration. Gavage may reduce emesis, but it is not typically indicated if baby is vomiting. Amount given CAN be regulated through bottle feeding.
14
Q
While teaching a parents' group about acute otitis media, the nurse includes the fact that among infants and children, acute otitis media is an infection commonly caused by: A/ A virus B/ Bacteria C/ A fungus D/ Rickettsia
A
B/ Bacteria
15
Q
What is the priority nursing intervention for a 6-month-old infant with bronchiolitis?
A/ Discouraging parental visits to conserve energy
B/ Monitoring skin colour, anterior fontanel, and vitals
C/ Wearing gown, cap, mask, and gloves while rendering care
D/ Promoting stimulating activities to meet developmental needs
A
B/ Monitor!
Constant assessments are VITAL in determining the infant’s oxygenation and hydration status and responses to the disease process.
16
Q
The parents of an infant recently diagnosed with cystic fibrosis ask a nurse what causes the foul-smelling, frothy shit. What is the best response by the nurse? A/ Undigested Fats B/ Sodium and Chloride C/ Partially digested Carbohydrates D/ Lipase, Trypsin, and amylase release
A
A/ Undigested fats
Due to lack of pancreatic enzyme lipase, fats remain unabsorbed and are excreted in excessive amounts in the stool.
17
Q
A 4-month-old is on nothing-by-mouth status prior to surgery. What should the nurse do when the baby starts crying? A/ Offer a pacifier B/ Provide baby rattle C/ Hang mobile over crib D/ Wrap a soft blanket around baby
A
A/ Pacifier
Sucking a pacifier provides comfort to infants through oral gratification. Rattles would stimulate the infant further, along with a mobile. Blankets would provide tactile stimulation but would not stimulate their mouth.
18
Q
During the assessment of a hospitalized infant, the nurse notes dry mucous membranes, the absence of tears when the infant cries, and poor skin turgor. Which parameter should help the nurse further evaluate these findings?
A/ Daily serum electrolytes
B/ Respiratory rate and rhythm
C/ Intake and output over past 24 hours
D/ Alterations in heart sounds since admission
A
C/ In and outs
Infant is showing signs of severe dehydration. In and out determines how much fluid the baby is getting and expelling. Checking the others would be the result of severe dehydration.
19
Q
A nurse in the clinic is taking the health history of a 16 year old girl. When the nurse asks questions regarding her sexual activity, she begins to perspire and hyperventilate. As her anxiety increases, she indicates that she feels dizzy, SOB, and that her heart is racing. What condition can the nurse identify? A/ Metabolic acidosis B/ Respiratory Acidosis C/ Pulmonary Hypertension D/ Hyperventilation syndrome
A
D/ Hyperventilation syndrome
Hyperventilation syndrome is respiratory alkalosis that happens with deep and rapid breathing. Clinical findings are related to increased pH and lowered bicarb and O2 levels.
20
Q
A nurse is completing the discharge protocol for a 14 year old patient with osteomyelitis. The nurse teaches the parents how and when to administer the IV antibiotics at home. The schedule for admission is QID. When should they administer the meds? A/ 8am, 12, pm, 4pm, 8pm B/ 8am, 4pm, 12am, 4am C/ 10am, 2pm, 10pm, 2am D/ 6am, 12pm, 6pm, 12am
A
D/
Iv antibiotics should be administered 6 hours apart from one another when QID. This ensures the constant blood level of the drug is maintained.
21
Q
A 15 year old with Type I diabetes has a history of non-compliance with therapy. What must the nurse consider about the teen's developmental stage before starting a counselling program? A/ They usually deny their illness B/ They have a need for attention C/ The struggle for identity is typical D/ Regression is associated with illness
A
C/ identity struggle
Striving to attain identity and independence are tasks of the adolescent, and rebellion against established norms may be exhibited.
22
Q
What is the most appropriate nursing intervention for a child with sickle cell anemia?
A/ Teaching the family who to limit sickling crisis
B/ Preparing the child for occasional blood transfusions
C/ Educating the family about prophylactic medications
D/ Expelling to the child how excess oxygen causes sickling.
A
A/ Most important goal of sickle cell is learning how to prevent crisis’. This is done by hydration, promoting oxygenation, and avoiding strenuous exercise.
Transfusion are more of a common occurrence, and there are Ø prophylactic meds for sickle cell crisis. Excess oxygen does NOT cause sickling, but a depletion.
23
Q
An adolescent boy comes to the school nurse complaining of a 2 day hx of low grade fever, exhaustion, and lack of energy and a lack of appetite. He has missed two days of school in the previous week. Which assessment should the nurse use to identify the possible origin of the problem?
A/ Eliciting the Kernig sign
B/ Eliciting the Brudzinski sign
C/ Checking for lymphadenopathy
D/ Checking the pupillary response to light and accommodation.
A
C/ Lymphadenopathy
Infectious mononucleosis is viral and common in people between 15-30 years. Signs and symptoms include fever, fatigue, swollen glands, enlargement of the liver and spleen.
Pupillary response to light and accommodation is checked as part of a neuro assessment and is not indicated. The Kernig Sign (asking the child to Straighten a leg bent at a 90 degree angle) and the Brudzinski Sign (asking child who is supine to bend his head and try to put his chin on his chest) are parts of exams to identify meningitis.
24
Q
A nurse in a paediatric clinic is testing a 4 year old with recurrent otitis media for signs of hearing loss. The mother asks what can be done is there is a hearing loss. The nurse responds that the most common tx is: A/ Myringotomy B/ Adenoidectomy C/ Neomycin ear drops D/ Systemic steroid therapy
A
A/ Myringotomy
Myringotomy is a surgical incision to permit drainage of infected middle ear fluid and thus improve hearing.
Removal of adenoids with not releave pressure from inflamed ear. Antibiotics are administered systemically, not locally if needed. Steroids are not prescribed.
25
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A child with acute lymphoid leukemia is started on chemotherapy protocol that includes prednisone. What side effects of this medication does the nurse anticipate?
A/ Alopecia
B/ Anorexia
C/ Weight loss
D/ Mood changes
```
D/ Mood changes
Euphoria and mood swings may result from steroidal therapy. Alopecia and anorexia are not symptoms of steroids. The patient can experience an increase in appetite which can lead to weight gain, NOT weight loss.
26
A nurse is caring for a 4 year old child who was just diagnosed with cystic fibrosis. The child has been passing loose, bulky, foul-smelling stools and is in the third percentile for weight, What is the best explanation of the growth failure?
A/ Impaired digestion and absorption because of the lack of pancreatic enzymes
B/ Dyspnea and SOB, which cause anorexia and disinterest in food
C/ Increased bowel motility and diarrhea which leads to inadequate absorption of nutrients
D/ Pulmonary obstruction, which causes an oxygen deficit and inadequate tissue nourishment
A/ Lack of enzymes
Lack of trypsin, amylase, and lipase that typically aids in fat digestion and absorption. This leads to the wasting of tissues and the failure to thrive. Kids with CF are recommended to eat 150%-200% of the regular caloric intake for their age.
27
A child undergoes tonsillectomy and adenoidectomy for numerous recurrent respiratory tract infections. After the surgery, the nurse should teach the parents to:
A/ Offer ice chips
B/ Encourage the intake of ice cream
C/ Keep the child in supine position
D/ Gargle with diluted mouthwash solution
E/ Do a Darth Vader impression with their raspy voice.
A/ Offer ice chips
Ice soothes and promotes vasoconstriction. Milk products like ice cream will coat the mouth, making the child feel the urge to clean their throat and could precipitate bleeding. Supine promotes edema and does not allow the oral secretions to drain from the mouth. Mouthwash is not indicated.
28
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A nurse is obtaining the health hx from the mother os a preschooler with Reye Syndrome. The nurse should ask the mother if the child has recently had:
A/ Rubella
B/ Chickenpox
C/ Rheumatic Fever
D/ Bacterial Meningitis
```
B/ Chickenpox
Children with Reye's syndrome (which is viral) are among those recently recovering from Chicken pox. Reye Syndrome Does not occur post-rubella, and Rheumatic fever is a streptococcal infection.
29
After Several days of bedrest, a preschool-aged boy with the diagnosis of liver laceration becomes demanding and will not listen to nurses. The child was found in the playroom twice on the previous shift. How can the nurse best meet the needs of this child?
A/ tell the child why remaining in bed will enhance recovery
B/ Have a television set moved into the kid's room ASAP
C/ Place soft restraints on the child when family cannot be present.
D/ Move the child into a room with another preschooler with whom he can play with.
D/ Make friends.
Preschoolers are social individuals who enjoy the company of others and become bored when isolated. They will not understand complex explanations of cause and effect (A). Although TV provides a distraction, encouragement of peer contact is preferred.
30
```
A pre-school aged child admitted with Reye syndrome will most likely be placed...
A/ In an isolation room
B/ On a presurgical Unit
C/ On a paediatric Floor
D/ In the ICU
```
D/ ICU
A child with Reye Syndrome is critically ill and needs the constant supervision that is available in an ICU. Reye Syndrome is not contagious, Surgery is needed. A general paediatric unit does not offer the continued assessment and intensive interventions that are needed for a child with Reye syndrome.
31
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A nurse is caring for a preschooler who is being prepared for surgery. What does the nurse expect to have the most influence on the Child's response to hospitalization?
A/ Fear of separation
B/ Fear of Bodily harm
C/ Belief in death's finality
D/ Belief in the supernatural
```
B/ Fear of bodily harm
Fear of mutilation is typical at this age because they have vague views of body boundaries. Toddlers are more likely to fear separation than preschoolers, and preschoolers do not see death as final, nor do they have developed supernatural beliefs.
32
A 4 year old child who barely survived a near-drowning incident is in critical condition in the paediatric ICU. Suddenly the child opens her eyes and smiles, prompting the parents to say "Look! I think she is getting better now!" What is the best response from the nurse?
A/ "You're right, that's a very good sign"
B/ "Try to have your child hold your hand"
C/ "We're doing everything we can to provide recovery"
D/ "Sometimes they smile right before they die"
C/
The nurse needs to emphasize that they are doing everything they can to promote recovery without providing false hope.
33
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While examining a newborn, the nurse brushes his finger upward on the infant's sole. The newborn responds by fanning their toes outward. Which reflex is the nurse using?
A/ Rooting
B/ Moro
C/ Plantar Grasp
D/ Babinski
```
D/ Babinski
34
An 18 month old toddler stepped on a rusty nail and is brought to the ER a week later. The nurse determines the family lives in a rural area and that the child has never received healthcare. The child shows signs of generalized tetanus, including neck and jaw stiffness and facial muscle spasms. What does the nurse conclude with these clinical findings?
A/ Bacterial infection of the upper respiratory tissues progressing to sepsis and death
B/ Neuropathy caused by allergic reaction to the presence of the invading organism
C/ Localized edema of the upper trunk and neck tissues resulting in the obstruction of their airway
D/ Painful muscle rigidity caused by exposure of the nervous system to the exotoxin of the causative organism
D/ Exotoxin
Tetanus is characterized by trismus (difficulty opening mouth). Stiffness of the facial and neck muscles progressing to larygospasm, generalized rigidity, opisthotonos, and respiratory arrest. Tetanus is NOT bacterial, but is an exotoxin that affects the CNS.
35
```
After a 4 year old child undergoes craniotomy the nurse performs a neurological assessment that includes level of consciousness, pupillary activity, and reflex activity. What should the nurse include in this assessment?
A/ B/P
B/ Motor Function
C/ Rectal Temp
D/ Head Circumference
```
D/ Head size
Motor function is part of a neurological assessment and provides insight into cerebral function. Blood pressure and temp are not a direct measure of neurological status. A change in head circumference is the result of increased cranial pressure and is NOT expected in a 4 year old whose cranial bones are fused.
36
A nurse is Teaching dietary management to the parents of a toddler who is undergoing chelation therapy to treat lead poisoning. What should be included in the dietary care plan?
A/ Maintaining a low sodium diet
B/ Ensuring adequate fluid intake
C/ Avoiding refined sugar and flour
D/ Offering high-calorie, low protein diet
B/ Fluid intake
Hydration is needed because the lead complexes released during chelation therapy are excreted by the kidneys. There is no basis for restricting salt, or refined sugar and flour.
37
A nurse is teaching the mother of a toddler with celiac disease the specific foods allowed on the Gluten-free diet. What information is important for the nurse to help the mother understand.
A/ Corn flour is NOT included in the diet
B/ Labels of prepared foods must be read carefully
C/ Caloric intake is increased to compensate for deficiency of proteins
D/ The gluten-free diet is discontinued when the affected child starts kindergarten
B/ Labels of prepared foods must be read carefully.
Foods can always have hidden gluten and labels should be read carefully. Rice and corn are virtually gluten free. The diet may remain for the rest of the child's life.
38
A 3-year-old ingests a substance that may be poisonous. The parent calls a neighbour who is a nurse and asks what they should do. What is the best response from the nurse?
A/ Administer syrup of ipecac
B/ Call Poison control
C/ Take the child to the emergency department
D/ Give the child bread dipped in milk to absorb the poison.
B/ Call poison control
They have the most up-to-date information and how to treat the poisoning. They will advise whether to go to the Emerge or what to do. administration of ipecac is no longer recommended by the American Academy of Paediatrics.
39
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A nurse is planning for the discharge of a child with sickle-cell vaso-occulsive crisis. What is the most important information for the nurse to emphasize?
A/ High Calorie Diet
B/ Rigorious Exercise regimen
C/ An increased intake of fluids
D/ Increase of hours spent sleeping
```
C/ Intake of fluids
Dehydration promotes sickling of cells. Increasing fluids reduces sickling crisis'. Exercise decreases oxygenation and may cause sickling. Increase in time spent sleeping is not needed.
40
The parents of a 2 year-old boy are watching the nurse administer the Denver II developmental Screening test to their son. They ask, "Why did you make him draw on paper? We don't let him draw much at home." What is the best response?
A/ "I should have asked you about drawing first"
B/ "These drawings help us determine his intelligence"
C/ "It lets us test his ability to perform tasks requiring his hands"
D/ "Why in the hell would you not allow your bastard son to draw? Like seriously, you guys are straight up negligent".
C/ hand testing
The test is used to determine the presence of a child's development who appears to be behind the norm.
41
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While reviewing the admission of a child, the nurses determines that the 2 year old has not received their MMR vaccine. At what age should the child receive their vaccine?
A/ 2 months
B/ 4 months
C/ 6 months
D/ 12 months
```
D/ 12 months
42
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A nurse is teahcing the parents of a toddler whose been recently diagnosed with hemophilia. What area of the body should the nurse inform the parents about the increased risk of bleeding?
A/ Brain
B/ Joints
C/ Kidneys
D/ Abdomen
```
B/ Joints
Their constant movement and weight-bearing makes them susceptible. Bleeding may occur in the other areas, but are less likely.
43
A 2-year-old is brought to the ER with fever, drooling, and agitation. The child is not coughing and is sitting upright and leaning forward. Which nursing intervention is a priority?
A/ IV fluids and antibiotics
B/ Immediate removal of the parents from the room to keep the child calm
C/ Maintenance of the child in a prone position during transportation to radiology
D/ Procurement of a crash cart and Emergency airway management tools to be kept on hand during examination of the throat.
D/
Because the possibility of airway obstruction by the epiglottis, a crash cart and emergency airway management tools should be close at hand during examination. IV fluids and antibiotics should be started, but it is not 1st priority. The child must stay seated to help promote comfort of breathing.
44
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A child is admitted to the paediatric unit with severe dehydration. Which IV access site should the nurse use to provide fluids?
A/ Foot vein
B/ Scalp Vein
C/ Hand Vein
D/ Arm Vein
```
C/ Hand vein
The hand is the appropriate site for the child. The foot is appropriate for an infant, as too the scalp.
45
A 2-year-old boy living on a farm is found to have Ascaris Lumbriocoides (roundworm) infection. The nurse teaches the mother of these parasites. What statement indicates that the mother needs more teaching?
A/ The rest of my family won't need medicine
B/ My little boy won't be able to play in the fields until he gets older.
C/ We are going to have to wash everyone's bedding in soapy water everyday
D/ We are going to have to make sure vegatables are well cooked before me eat them
C/ You do not need to wash the sheets everyday. Because it is not transmitted from person to person, the family does not need medication.
46
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What clinical finding should a nurse suspect that a toddler with a rash has rubella? Select all that apply.
A/ Conjunctivitis
B/ Nuchal rigidity
C/ Low-grade fever
D/ Lymphadenopathy
E/ Koplik Spots in the mouth
```
C/ Fever
D/ Lymphadenopathy
Rubella is characterized by: Low fever, malaise, sneezing, and coughing with swollen lymph nodes, especially in the posterior cervical and periauricular nodes.
Conjunctivitis occurs with the measles, Nuchal rigidity occurs with meningitis and encephalitis. Koplik spots are present with measles.
47
A toddler receives a gastrostomy tube feeding q4h. What is the priority nursing intervention for the child?
A/ Opening the tube 1 hour prior to feeding
B/ Keeping the child lying flat during feeding
C/ Flushing the tubing with normal saline after the feeding
D/ Positioning the child on their right side after feeding.
D/ Right sided positioning
This facilitates digestion because the pyloric sphincter is on the right side and gravity aids in emptying the stomach, The feeding may be started immediately after the tubing is opened. Keeping the kid flat could lead to aspiration. Water is used to flush, not NS.
48
After teaching the parents of a child the cause of ringworm of the scalp (tinea capis), which statement by the parents demonstrates effective teaching?
A/ "It results from overexposure to the sun"
B/ "It is caused by the infestation of a mite"
C/ "It is a fungal infection of the scalp"
D/ "It is an allergic reaction"
C/ Caused by the fungus of the dermatophyte group of the species.
Mites would only produce bites on the skin
All other answers are stupid.
49
A parent asks the nurse how to care for a child with chickenpox. The nurses best response includes:
SELECT ALL THAT APPLY
```
A/ Use OTC aspirin to treat the fever
B/ Encourage oatmeal baths
C/ Keep fingernails short
D/ Avoid overheating
E/ Do not return to school until all lesions have crusted over
```
B/ Encourage oatmeal baths
C/ Keep fingernails short
D/ Avoid overheating
E/ Do not return to school until all lesions have crusted over
Oatmeal baths with soothe itching
Short fingernails reduces trauma to the skin and decreases risk for infections
Overheating is associated with increased itching
Once crusted over, they are safe to return to school
Giving a child Aspirin could lead to Reye's Syndrome if they have chickenpox. It leads to swelling of the Liver and the Brain
50
A mother has heard that mononucleosis is spreading at their children's school. She asks the nurse what she can do to prevent the infection from reaching her kids. The best response includes:
A/ Take no precautionary methods
B/ Sterilize the children's eating utensil's before they are reused
C/ Wash their linens separately in hot water
D/ Encourage her children to use hand sanitizer frequently
A/ Don't do anything
Transmission is typically done through intimate encounters including kissing. It can also be transmitted by sharing drinks and food.
Sterilization will not prevent anything, nor will washing their sheets.
Hand sanitizer has no effect.
51
A 17-year-old whore states to the clinic nurse that she thinks she has gonorrhea. She states that before she gets tested, she wants assurances that the nurse will not tell her parents and that no one will know. What is the MOST appropriate response by the nurse?
A/ Because you are underage, we have to tell your parents and gain their consent in order to treat you
B/ We can treat you without parental consent, but they have the right to review your medical records
C/ We can treat you without parental consent, however if you test positive, we will need to inform the public health department
D/ We can treat you without parental consent, and we will keep this confidential for your safety
C/ Treatment without consent, but Public Health department must know that you're a slut.
Medical records cannot be accessed without client consent
Certain STIs must be reported by law.
Notification of her partner will also take place, but methods vary depending on laws.
52
A 13 month-old has a seizure 3 weeks after the administration of the chickenpox vaccine. The nurse should
A/ Recognize the events are unrelated
B/ Report the event through an immunization surveillance team
C/ Explain to the parents that this is a rare but acceptable risk
D/ Refer the child to a neurologist
B/ Report to immunization surveillance team
53
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After a tonsillectomy and adenoidectomy, which finding would the nurse suspect an early hemorrhage in a 5-year-old child?
A/ Drooling of Bright red secretions
B/ Pulse rate of 95 bpm
C/ Vomiting of 25mL of dark brown emesis
D/ BP of 95/56
```
A/ Drooling of bright red
Because of the discomfort after surgery, child avoid swallowing and therefore drool. If the drool is bright red it indicates active bleeding. They may also be swallowing frequently to clear their throat and this may too be a sign of hemorrhage.
Pulse is normal, so too is BP
Vomiting is not uncommon after surgery, and dark brown may the residual blood that is partially digested. It is actually a normal finding. IF the emesis was bright red, then it would be hemorrhaging
54
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A adolescent female is prescribed Amoxicillin for otitis media infection. The nurse should teach of the inherent risks of taking this medication alongside:
A/ OTC antihistamines
B/ Oral Contraceptives
C/ Multiple Vitamins
D/ Ibuprofen
```
B/ Oral Contraceptives
Amoxicillin reduces the effectiveness of oral contraceptives and therefore the client should be instructed to use other methods of contraception to avoid pregnancy.
Other answers have no effect
55
```
An 11-year-old is admitted to the hospital for treatment of an asthma attack. Which finding indicates immediate intervention is required?
A/ Thin-copious mucous secretions
B/ Productive cough
C/ Intercostal retractions
D/ Respiratory rate of 20 breath/min
```
C/ Intercostal retractions
indicates an increase in respiratory efforts which is a sign of respiratory distress.
Secretions would be thick, and coughing would be non-productive.
All other symptoms are signs of improvement.
56
A teen with chest pain goes to the school nurse. The nurse determines that the teen has a history of asthma but has been asymptomatic for years. What should the nurse do next?
A/ Call their parents
B/ Have the teen lie down for 30 minutes
C/ Obtain a peak flow reading
D/ Have the teen take 2 puffs from their prescribed short-acting bronchodilator
C/ Peak flow reading
Complaints of Chest pain in teens is rarely cardiac, so initial assumption should be respiratory. Especially since chest pain can be related to Asthma.
A peak flow reading would be able to evaluate their respiratory status. (Measures the ability to push air out of your lungs)
Calling their parents is an appropriate response, however it should be done after the assessment.
Lying down may also be a viable option, but is not priority
Using their Bronchodilator may not be the best choice if they haven't used it in years.
57
A child with cystic fibrosis does not like taking their pancreatic enzyme supplement with their meals and their parents do not like forcing him to do so. The nurse explains that the most important reason for the child to take the supplement is because:
A/ They will become dehydrated if it is not taken with meals and snacks
B/ They need these pancreatic enzymes to help their digestive system absorb fats, carbohydrates and proteins
C/ They need the pancreatic enzymes to help them liquify their mucous and keep their lungs clear
D/ They will experience severe diarrhea if they do not take the supplement
B/ Help digest fats, sugars and proteins
These pancreatic enzymes help to digest nutrients and prevent fatty, foul, and voluminous stools due to improper digestion. This can in turn lead to malnutrition and poor development.
Dehydration is not an issue with CF
The enzyme has no effect on the viscosity of mucous
Diarrhea is not caused by missing the enzyme.
58
A teen with Cystic Fibrosis has been admitted to the hospital with laboured respirations, fatigue, malnutrition, and failure to thrive. This the latest of several admissions, so which is the most important action of the nurse?
A/ Placing the client on bedrest and obtaining a script for blood gas analysis
B/ Implementing a high-calorie. high-protein, low-fat, vitamin enriched diet and pancreatic granules
C/ Applying an oximeter and initiating respiratory therapy
D/ Inserting an IV and starting antibiotic therapy
C/ Pulse oximeter and respiratory therapy
Clients with CF often die from respiratory problems. The mucous in their lungs is often tenacious and hard to expel, leading to lung infections and interference with oxygen exchange.
They require respiratory therapy to help correct respiratory issues associated with CF
Other options are correct, however not as important initially.
59
A child with cystic fibrosis is receiving Gentamicin therapy. What nursing action is most important?
A/ Monitoring intake and output
B/ Obtaining daily weights
C/ Monitoring the client for signs of constipation
D/ Obtaining stool samples for hemoccult testing
A/ Intake and output
In and out is crucial when a patient is on an amnioglycoside like Gentamicin as a decrease in urinary output is an early sign of renal damage due to the toxicity of the drug.
Weight monitoring is not indicated when receiving an amnioglycoside.
Constipation and bleeding are not side effects of this medication
60
```
The mother of a 3-year-old child arrives at the clinic and tells the nurse that her child has been scratching the skin continuously and has developed a rash. The nurse suspects scabies after assessing the child's skin due to the presence of:
A/ Fine Grayish-red line
B/ Purple-Coloured lesions
C/ Thick, Honey-Coloured crusts
D/ Clusters of fluid-filled sacs
```
A/ Scabies
Parasitic skin disorder where the parasite appears as burrow or fine, grayish-red, threadlike lines. They may be hard to see is they are obscurred by scratches and inflammation.
Purple-coloured lesions are indicative of various disorders
Thick honey-coloured crusts are characteristic of Impetigo or secondary infection to eczema
Clusters of fluid-filled vesicles are indicative of Herpesvirus infection
61
```
The nurse is monitoring a 3-year-old for signs of increased Intracranial pressure following a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP?
A/ Vomiting
B/ Bulging Anterior Fontanel
C/ Increasing Head circumference
D/ Complaints of a frontal headache
```
A/ Vomiting
The brain, although well protected, is highly susceptible to pressure that may accumulate within it's enclosure. Vomiting is an early sign of increased ICP and can become excessive as pressure builds up and stimulates the medulla in the brainstem which houses the vomiting centre.
Their fontanels are fused...
62
```
A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. The nurse understands that which diagnostic study should confirm this diagnosis?
A/ Platelet count
B/ Lumbar Puncture
C/ Bone Marrow Biopsy
D/ WBC count
```
C/ Bone Marrow biopsy
Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test is mircoscopic examination of bone marrow obtained by bone marrow aspirate and biopsy.
Lumbar puncture is done to look for blast cells in the spinal fluid that indicate CNS disease
The WBC and Platelet count could be high or low or even normal and is not indicative.
63
```
The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?
A/ Incessant Crying
B/ Coughing at night time
C/ Choking with feedings
D/ Severe projectile Vomiting
```
C/ Choking
Esophageal atresia and tracheoesophageal fistula causes choking during feeding because the esophagus terminates before it reaches the stomach, ending in a blind pouch with a fistula that forms a connect to the treachea. ANy child that experiences the "3 C's" during feeding (coughing, Choking, unexplained cyanosis) should be suspected of a tracheoesophageal fistula
64
The nurse provides feeding instructions to a parent of an infant diagnosed with
gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis?
A/ Provide less frequent and larger feedings
B/ Burp the infant less frequently during feedings
C/ Thin the feedings by adding water to the formula
D/ Thicken the feedings by adding rice cereal to the formula
D/ Thicken
Smaller more frequent feedings with often burping is prescribed. Thickened feedings may reduce episodes of emesis.
65
```
The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the mother about the child’s symptoms?
A/ Watery Diarrhea
B/ Projectile Emesis
C/ Increased Urinary Output
D/ Vomiting large amounts of bile
```
B/ Projectile BARFING
```
In pyloric stenosis, hypertrophy of the circular muscles of the pyloris causes narrowing of the pyloric canal. Clinical manifestations include:
Projectile vomiting
Irritability
Hunger
Crying
Constipation
Signs of dehydration
Decreased urinary out output
```
66
The nurse is preparing to care for a child with a diagnosis of intussusception (IN-TUH-SUS-SEP-TION). The nurse reviews the child’s record and expects to note which symptom of this disorder documented?
A/ Water Diarrhea
B/ Ribbon-like Stool
C/ Profuse Projectile Vomiting
D/ Bright Red blood and mucous in their stool
D/ Bloody mucousy stool
Intussusception is the telescoping of one part of the bowel into another and results in the obstruction of intestinal contents.
Severe abdominal pain that is crampy and intermittent, with the possibility of vomiting possible; however NOT projectile.
Bright red blood and mucous is present in the stool and are described as currant jelly-like stool.
67
```
The mother of a 6-year-old child arrives at a clinic because the child has been experiencing scratchy, red, and swollen eyes. The nurse notes a discharge from the eyes and sends a culture to the laboratory for analysis. Chlamydial conjunctivitis is diagnosed. On the basis of this diagnosis, the nurse determines that which requires further investigation?
A/ Possible ocular trauma
B/ Possible Sexual abuse
C/ Presence of a severe allergy
D/ Presence of a respiratory infection
```
B/ Sexual abuse
Conjunctivitis is an inflammation of the conjunctiva, specifically, chlamydial conjunctivitis in a child who is not sexually active should signal to investigate for sexual abuse.
Other options could be the causative factors for conjunctivitis, but not a Chlamydial conjunctivitis.
68
```
The nurse is reviewing the laboratory results for a child scheduled for tonsillectomy. The nurse determines that which laboratory value is most significant to review?
A/ Creatinine Level
B/ Prothrombin Time
C/ Sedimentation Rate
D/ BUN Level
```
B/ pTT
Because the tonsillar area is highly vascularized, postoperative bleeding is a concern. pTT, partial thromblastin time, platelet, hemoglobin and hematocrit, WBC and urinalysis are performed postoperatively.
The other options do not signify post-op bleeding
69
After a tonsillectomy, the nurse reviews the health care provider’s (HCP’s) postoperative prescriptions. Which prescription should the nurse question?
A/ Monitor for bleeding
B/ Suction every two hours
C/ Give no milk or milk products
D/ Give clear, cool liquids when awake and alert
B/ Suction
Suction equipment should be available, but should not be done unless there is an airway obstruction because of the risk to trauma at the surgical site.
Milk and milk products should be avoided at first as they coat the mouth and throat causing the client to want to clear their throat which is contraindicated.
Clear cool liquids are encouraged, and you ALWAYS check for bleeding post operatively.
70
A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care?
SELECT ALL THAT APPLY
A/ Provide a soft diet
B/ Position the child on their left side
C/ Administer antihistamine BID
D/ Irrigate the right ear with normal saline q8h
E/ Administer Motrin for fever every 4 hours as prescribed and needed
F/ Instruct parents about the need to provide antibiotics for the full dose of therapy
A/ Soft food
E/ Motrin
F/ Antibiotic compliance
The child will likely have a fever and pain, loss of appetite and possible ear drainage.
Control the Fever with Motrin and position them on their affected side to allow drainage of fluid from the ear. Do not lay them on unaffected side (B).
Soft diet will relieve pain of chewing.
Antibiotics should be followed until the end of therapy NOT the end of treatment, to avoid rebound infection or antibiotic resistance.
The ear should not be irrigated as it can worsen their symptoms.
Antihistamines are not indicated with otitis media.
71
```
A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition?
A/ Warm dry skin
B/ Decreased Wheezing
C/ HR of 90bpm
D/ Respirations of 18 breaths/min
```
B/ Wheezing
Although it could be interpreted as a positive sign, it may also indicate their inability to move air. A "silent chest" is an ominous sign during asthma. Increased wheezing might actually indicate their condition is improving
Warm-dry skin indicates improvement as they are normally diaphoretic during exacerbation.
Pulse and respiratory rate is normal for this age.
72
```
On assessment of a child diagnosed with Acute-stage Kawasaki Disease, the nurse expects to note which clinical manifestation of the acute stage of the disease?
A/ Cracked Lips
B/ Normal Appearance
C/ Conjunctival Hyperemia
D/ Desquamation of the skin
```
C/ Conjunctival Hyperemia
Kawaskai Disease is an acute inflammatory illness, where in the acute stage the child will have a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of cervical nodes.
All other symptoms represent the sub-acute stage.
73
The parents of a 3-week old healthy newborn asks the nurse why their baby occasionally goes crossed-eyed. The best response from the nurse would be:
A/ An eye patch may be required to correct their vision
B/ Your child will likely need a ophthalmology consult
C/ It is normal to have some eye crossing during the newborn period
D/ Surgery may be needed to correct their vision
C/ Normal
During the first few months of life their eyes may wander and appear to be crossing one another. As ocular muscles mature around 2-3 months, this should disappear.
No intervention needed
74
```
A parent brings their 4-month0-old in for a visit and states their infant is not progressing normally. What assessment would the nurse find to determine if developmental delays are occurring at 4 months?
A/ No interest in peekaboo games
B/ Does not turn from front to back
C/ Does not babble
D/ Sits unsupported
```
C/ Does not Babble
Babies tend to babble around the end of 3 months. The lack of speech should be investigated further to assess for language delays.
Infants typically do not play peekaboo until 7 months and the ability to roll over occurs around 5 months of age.
75
The nurse assess a 6-month-old infant for vaccine readiness. Which finding would most likely indicate the need to delay administering the Diphtheria, Tetanus, and pertussis vaccine?
A/ Family history of SIDS
B/ Fever of 38.5 following 4-month-vaccinations
C/ Acute bilateral otitis media
D/ Living with family member who is immune suppressed.
C/ Ear Infection
Vaccination in the presence of a moderate-severe infection with or without a fever increases the risk of injury and decreases the chance of mounting a reasonable immunity.
No evidence links Vaccines and SIDS
A fever may be expected up to 48 hours after a vaccine and warrants to special attention.
This vaccine is not a live vaccine and therefore no special precautions are warranted for immunocompromised or suppressed family members.
76
```
To assess the development of a 1-month-old, the nurse asks the parent is the baby can:
A/ Smile and laugh out loud
B/ Roll from back to side
C/ Hold a rattle briefly
D/ Lift their head from a prone position
```
D/ Lift their head from prone position.
A healthy full-term baby should be able to do this since birth.
Smiling and laughing is expected around 2-3 months.
Rolling from back to front and holding a rattle is expected around 4 months
77
Which infant MOST needs a referral for developmental and gross motor delay?
A/ 2 months old who does not roll over
B/ 4 month old who cannot sit without support
C/ 6 month old who does not crawl
D/ 9 month old who does not stand while holding on
D/ Cannot stand
More than 90% of 9 month olds are expected to stand while holding onto an object.
78
Which of the following is at the greatest risk for SIDS?
A/ 3 month old infant
B/ 2 year old with apnea lasting up to 5 seconds
C/ Firstborn child whose parents are in their 40s
D/ 6 month old who has had 2 bouts of pneumonia
A/ 3 month old
Highest incidence is around 2-3 months of age (90% before 6 months)
Apnea lasting longer than 20 seconds has been associated with SIDS. But at 2 years is less likely.
Parental age and recent pneumonia infection has no links to SIDS.
79
A 3-year-old is brought to the ER in her parent's arms. The child's mouth is open, and she is drooling and lethargic. The mother states that she became ill suddenly 2 hours ago. What should the nurse do first?
A/ Draw blood cultures for a CBC
B/ Start an IV line
C/ Inspect the throat with a tongue blade
D/ Maintain the child in an undisturbed and upright position.
D/ Keep the child still and calm. Maintain position
They are in severe respiratory distress with the potential for complete airway obstruction. Disturbing them may occlude their airway by irritating their epiglottis, especially through a tongue blade.
Although the child may be intubated or undergo a tracheotomy, initially they must be kept calm and in their current position with minimal disruption.
Any attempt to examine the child, provide an IV, or restrain them could obstruct their airway.
80
```
A 21 month old recently diagnosed with croup now has a respiratory rate of 48 breaths per min, heart rate of 120 bpm, and a temp of 38.2 degrees. The nurse is having difficulty calming the child; what should the nurse do next?
A/ Administer Tylenol
B/ Call the HCP immediately
C/ Allow the toddler to continue to cry
D/ Offer clear fluids every few minutes
```
B/ Call the HCP
The normal respiration rate for a child of this age is 25-30 breaths per minute, at 48 breaths per minute, this child is experiencing respiratory distress, especially since they cannot calm down. The HCP should be notified immediately!
Tylenol is not always indicated unless the fever is 38.6 or greater
Continuation of their crying will only worsen their respiratory distress
Clear fluids would do nothing help in this scenario.
81
```
The nurse observes an 18 month old who has been admitted with a respiratory tract infection who is seen drooling while sitting forward with an open mouth and protruding tongue. The nurse should first:
A/ Position them supine
B/ Call the rapid response team
C/ Suction their airway
D/ Administer Oxygen
```
B/ Rapid response team
The nurse should suspect epiglottitis in any young child with a respiratory tract infection and is presenting in this position. Epiglottitis is a medical emergency, and the rapid response team should be notified to secure their airway.
While waiting for the team, the child should remain upright to facilitate breathing; complete obstruction could occur if supine or prone or becomes agitated - therefore avoid procedures that could cause agitation or inflammation of the epiglotis such as suctioning and oxygen therapy.
82
A charge nurse is making up plans for a group of children on a paeds unit. Thenurse should most avoid assigning the same nurse to care for a 2-year-old with RSV and:
A/ an 18-month-old with RSV
B/ A 9-year-old 8 hours post-appendectomy
C/ A 1-year-old with a heart defect
D/ A 6-year-old with sickle cell crisis
C/ Heart defect
RSV can be spread by direct and indirect contact, so private rooms are preferred. If it is not an option, the nurse should understand that RSV possess the greatest threat to children under 2 years of age; especially if they have other chronic problems such as heart defects.
Pairing two RSV clients together would be the ideal choice if private rooms are unavailable.
83
A nurse is determining which child is at the highest priority to be seen in the ER. Which of the following is at the highest priority for the nurse?
A/ 6-year-old with a fever of 40.0 degrees, muffled voice, no spontaneous cough, and drooling
B/ 3-year-old with a fever of 37.8 degrees, barky cough, and mild intercostal retractions
C/ 4-year-old with a fever of 38.3 degrees, hoarse cough, inspiratory stridor and restlessness
D/ 13-year-old with a fever of 40 degrees, chills and a cough with yellowish sputum
A/ DROOLING
This child is showing signs and symptoms of epiglottitis, which is a medical emergency!
B and C are showing signs of croup, which symptoms often diminish when they are exposed to the cool night air. If symptoms do not improve, they may require a dose of dexamethasone
The 13-year-old is showing signs of Bronchitis.
84
```
A child with Cystic fibrosis is admitted to the unit. What type of diet should the nurse expect for this kid?
A/ High fat, High carbohydrate diet
B/ High calorie, High protein diet
C/ High calorie, High carbohydrate diet
D/ High carbohydrate, high protein diet
```
B/ High calorie and Protein
This type of diet is needed to ensure adequate growth. Some kids with CF required twice the normal allowance of calories due to their poor ability to digest fats.
85
The nurse is caring for a child who just underwent cardiac catheterization 2 hours prior. The nurse finds the dressing and surrounding bedding saturated with blood, the nurse should first:
A/ Assess vital signs
B/ Reinforce the dressing
C/ Apply pressure just above the catheter insertion site
D/ Notify the HCP
C/ DIRECT PRESSURE
Direct pressure is the first step to control bleeding. This should be done while another person notifies the HCP immediately.
Vital signs will not stop the patient from bleeding out.
The dressing can be reinforced with other bandages after the bleeding has been contained.
86
Discharge information is to be provided for the parents of a 3-month-old with a heart defect who is to receive digoxin. What information should the nurse provide?
SELECT ALL THAT APPLY
A/ Give medication at regular intervals
B/ Mix the medication with a small volume of breast milk or formula
C/ Repeat the dose one time if the child vomits immediately after administration
D/ Notify the HCP of poor feeding or vomiting
E/ Make up any missed doses as soon as realized
F/ Notify the HCP if more than two consecutive doses are missed
A/ Give medication at regular intervals
D/ Notify the HCP of poor feeding or vomiting
F/ Notify the HCP if more than two consecutive doses are missed
Digoxin should be taken at regular intervals (roughly 12 hours).
Vomiting and poor feeding may be signs of toxicity.
If two or more doses are missed, contact the HCP to ensure therapeutic drug levels.
Do not mix with food or water to ensure client received entire dose if refusal occurs
Taking the dose at alternative times or adding a missed dose with screw with serum levels.
87
Which of the following signs and symptoms would lead the nurse to believe the infant suffers from Tetralogy of Fallot?
SELECT ALL THAT APPLY
```
A/ Murmur
B/ History of Squatting
C/ Bounding pulses
D/ Cyanosis
E/ Faint pulse
F/ Tachypnea
```
A/ Murmur
B/ History of Squatting
D/ Cyanosis
F/ Tachypnea
```
TOF is a heart condition with 4 defects:
Pulmonic Stenosis
Right Ventricular Hypertrophy
VSD
Overriding aorta (Positioned over the VSD)
```
A systolic murmur, cyanosis, and tachypnea are signature signs... in toddlers, TOF can also manifest in squatting (knee to chest position). They assume this pose to reduce the amount of blood returning to heart.
88
Which intervention is the greatest priority for the nurse to perform on a child with congestive heart failure caused by pulmonary stenosis?
A/ Educating the family about the signs of infection
B/ Administering Enoxaparin to improve left ventricular contractility
C/ Assessing heart rate and blood pressure q2h
D/ Administering furosemide to decreases systemic congestion
D/ Furosemide therapy
Pulmonary stenosis can cause right-sided heart failure, resulting in venous congestion. As the valve becoming more and more narrow, it leads to right ventricular hypertrophy and venous pressure build up as blood cannot properly return to the heart. Removing accumulated fluid is the primary goal of therapy, and it is done through diuretics like furosemide.
Enoxaparin is an anticoagulant and would not help increase left-sided ventricular contractility
It is important to complete regular assessments, but it will not improve their situation... only monitor it.
89
A nurse is planning care for a 12-year-old with Rheumatic fever. The nurse should teach the parents to:
A/ Observe the child closely
B/ Allow them to participate in activities that will not tire him
C/ Provide adequate rest periods between activities
D/ Encourage someone to be with the child 24 hours of the day
C/ Adequate rest between activities.
This will decrease the client's cardiac workload.
Their condition does not warrant close observation or 24 hour supervision unless cardiac complications develop or carditis occurs.
90
```
Which initial finding indicates the development of carditis in a child with Rheumatic fever?
A/ Heart Murmur
B/ Hypotension
C/ Irregular pulse
D/ Anterior Chest wall pain
```
A/ Murmur
```
In Rheumatic fever, the connective tissues of the heart become inflamed, leading to carditis. Common signs of carditis are:
Heart murmurs
Tachycardia at rest
Cardiac enlargement
Changes in electrical conductivity
```
Hypotension and chest pain are not usually associated with carditis, and an irregular pulse is uncommon with carditis.
91
```
For a 2 year old with Kawasaki Disease, what should be the priority intervention?
A/ Taking vital signs q6h
B/ Monitoring in and out q1h
C/ Minimizing skin discomfort
D/ Providing passive ROM exercises
```
B/ In and out
In the initial stages of Kawasaki Disease, the child is at increased risk of congestive heart failure. So the nurse should assess the signs of CHF, which would indicate respiratory distress and decreased output
Vitals would be done more frequently than q6h
Skin discomfort is important, it is not the priority.
Passive ROM would be done if they develop arthritis.
92
A child with Kawasaki Disease is receiving low dose ASA. The mother calls the clinic and states that her child has been exposed to influenza. Which recommendations should the nurse make?
SELECT ALL THAT APPLY
```
A/ Increase fluid intake
B/ Stop the ASA
C/ Keep the child home from school
D/ Watch for fever
E/ Weigh the child daily
```
B/ Stop the ASA
D/ Watch for fever
ASA needs to be stopped due to the risk of Reye's Syndrome
Watch for signs and symptoms of influenza
Increasing fluid intake and weighing the child is not needed as they may not even have the flu. Keeping them home is unwarranted too as they are asymptomatic and may not even be sick.
Tell the mother to calm her tits and stop helicoptering her kids.
93
What is the most appropriate method for collecting blood from a toddler with Hemophilia A?
A/ Use finger punctures for lab draws
B/ Prepare to administer platelets
C/ Apply heat to the extremity before venipuncture
D/ Schedule all labs to be done at the same time
D/ All labs at the same time
Minimizes the amount of trauma and risk of bleeding.
Finger punctures tend to hurt more and run a greater risk of bleeding.
Platelet counts are typically normal in Hemophilia
Heat would cause vasodilation and increase the risk of bleeding.
94
The nurse is teaching the parents of a child with sickle cell anemia how to avoid sickling crisis. The nurse should include which instruction?
A/ Exercise in cool temperatures
B/ Drink at least 2 quarts of fluids per day
C/ Avoid contact sports
D/ Take anti-inflammatory drugs before exercising
B/ Fluid intake increase
Hydration prevents cell stasis in small vessels and reduces the odds of sickling.
Clients should avoid exercising in cold temperatures or swimming in cold water
Contact sports are not recommended but only because the risk associated with bleeding as they do not cause sickling.
Anti-inflammatory medications will not prevent sickling before exercise
95
```
The nurse reviews the record of a child who is suspected to have glomerulonephritis and expects to note which finding that is associated with this diagnosis?
A/ Hypotension
B/ Brown-coloured Urine
C/ Low urine specific gravity
D/ Low BUN
```
B/ Brown piss
Glomerulonephritis is inflammatory injury to the glomerulus. Gross hematuria is the classic symptom. Hypertension is also common, NOT hypotension.
BUN may be elevated, not decreased, along with a higher Urine specific gravity.
96
```
The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome?
A/ Hypertension
B/ Generalized Edema
C/ Increased Urinary Output
D/ Frank, bright red blood in the urine
```
B/ Generalized Edema
Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
Blood pressure if likely to be normal or slightly hypotensive.
Urine may appear frothy, with a decrease in output.
The main component to Nephrotic syndrome is edema.
97
```
The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure?
A/ Restrict Fluids
B/ Care for the arteriovenous fistula
C/ Encourage foods high in potassium
D/ Administer analgesics as prescribed
```
A/ Restrict Fluids
hemolytic-uremic syndrome if believed to be associated with bacterial toxins, chemicals and viruses that result in acute kidney injury in children. Kids may have acquired hemolytic anemia, thrombocytopenia, renal injury and CNS symptoms. IF they are on peritoneal dialysis for anuria, they should be restricted of fluids as they are not passing urine.
Pain is not associated.
Potassium should be restricted under anuric situations.
Peritoneal dialysis does not require a arteriovenous fistula.
98
The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan?
A/ “Caution should be used when straddling the infant on a hip.”
B/ “Vital signs should be taken daily to check for bladder infection.”
C/ “Catheterization will be necessary when the infant does not void.”
D/ “Circumcision has been delayed to save tissue for surgical repair.”
D/ Delayed circumcision
Hypspadias is a congenital defect involving abnormal opening of the urethra on the penis. Orifice in hypospadias is located below the glans penis on the ventral surface. Circumcision would eliminate tissues used for repair.
A, B, and C are unrelated to situation
99
The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention?
A/ Cover the bladder with petroleum jelly gauze.
B/ Cover the bladder with a non adhering plastic wrap.
C/ Apply sterile distilled water dressings over the bladder mucosa.
D/ Keep the bladder tissue dry by covering it with dry sterile gauze.
B/ Plastic wrap
In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The use of petroleum jelly gauze should be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucosa when removed.
100
The nurse understands that which information collected during the assessment of a child recently diagnosed with glomerulonephritis is most often associated with the diagnosis?
A/ Child fell off a bike onto the handlebars
B/ Nausea and vomiting for the last 24 hours
C/ Urticaria and itching for 1 week before diagnosis
D/ Streptococcal throat infection 2 weeks before diagnosis
D/ Strep throat infection
Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks.
101
```
The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe?
A/ Pallor
B/ Edema
C/ Anorexia
D/ Proteinuria
E/ Weight Loss
F/ Decreased Serum lipids
```
A/ Pallor
B/ Edema
C/ Anorexia
D/ Proteinuria
Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.
102
The parents of a child recently diagnosed with cerebral palsy ask the nurse about the disorder. The nurse bases the response on the understanding that cerebral palsy is which type of condition?
A/ An infectious disease of the central nervous system
B/ An inflammation of the brain as a result of a viral illness
C/ A congenital condition that results in moderate to severe retardation
D/ A chronic disability characterized by impaired muscle movement and posture
D/ Chronic disability
Cerebral palsy is a chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system.
103
The nurse notes documentation that a child with meningitis is exhibiting a positive Kernig’s sign. Which observation is characteristic of this sign?
A/ The child complains of muscle and joint pain.
B/ Petechial and purpuric rashes are noted on the child’s trunk.
C/ Neck flexion causes adduction and flexion movements of the lower extremities.
D/ The child is not able to extend the leg when the thigh is flexed anteriorly at the hip.
D/ The child is not able to extend the leg when the thigh is flexed anteriorly at the hip.
Meningitis is an infectious process of the central nervous system caused by bacteria and viruses. The inability to extend the leg when the thigh is flexed anteriorly at the hip is a positive Kernig’s sign, noted in meningitis.
104
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A mother arrives at an emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected, and the nurse checks the child’s airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP?
A/ Nausea
B/ Irritability
C/ Headache
D/ Bradycardia
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D/ Bradycardia
Head injury is the pathological result of any mechanical force to the skull, scalp, meninges, or brain. A head injury can cause bleeding in the brain and result in increased intracranial pressure (ICP). In a child, early signs include a slight change in level of consciousness, headache, nausea, vomiting, visual disturbances (diplopia), seizures. Late signs of increased ICP include a significant decrease in level of consciousness, bradycardia, decreased motor and sensory responses, alterations in pupil size and reactivity, posturing, Cheyne-Stokes respirations, and coma.
105
The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing?
A/ Flaccid paralysis of all extremities
B/ Adduction of the arms at the shoulders
C/ Rigid extension and pronation of the arms and legs
D/ Abnormal flexion of the upper extremities and extension and adduction of the lower
extremities
C/ Rigid extension and pronation of the arms and legs. Somewhat outwards extension and flexion
Decerebrate (extension) posturing is characterized by the rigid extension and pronation of the arms and legs. Option 1 is incorrect. Options 2 and 4 describe decorticate (flexion) posturing.
106
A child is diagnosed with Reye’s syndrome. The nurse develops a nursing care plan for the child and should include which intervention in the plan?
A/ Assessing hearing loss
B/ Monitoring urine output
C/ Changing body position every 2 hours
D/ Providing a quiet atmosphere with dimmed lighting
D/ Quiet environment
Reye’s syndrome is an acute encephalopathy that follows a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver. In Reye’s syndrome, supportive care is directed toward monitoring and managing cerebral edema. Decreasing stimuli in the environment by providing a quiet environment with dimmed lighting would decrease the stress on the cerebral tissue and neuron responses. Hearing loss and urine output are not affected. Changing the body position every 2 hours would not affect the cerebral edema directly.
107
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The nurse develops a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child’s bedside?
A/ Emergency cart
B/ Tracheotomy set
C/ Padded tongue blade
D/ Suctioning equipment and oxygen
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D/ Suctioning equipment and oxygen
A seizure results from the excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. Because increased oral secretions and apnea can occur during and after the seizure, oxygen and suctioning equipment are placed at the bedside. A tracheotomy is not performed during a seizure. No object, including a padded tongue blade, is placed into the child’s mouth during a seizure. An emergency cart would not be left at the bedside, but would be available in the treatment room or nearby on the nursing unit.
108
An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period?
A/ Test the urine for protein.
B/ Reposition the infant frequently.
C/ Provide a stimulating environment.
D/ Assess blood pressure every 15 minutes.
B/ Reposition the infant frequently.
Hydrocephalus occurs as a result of an imbalance of cerebrospinal fluid absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased intracranial pressure. In infants with hydrocephalus, the head grows at an abnormal rate, and if the infant is not repositioned frequently, pressure ulcers can occur on the back and side of the head.
109
The nurse is developing a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? SELECT ALL THAT APPLY
A/ Time the seizure.
B/ Restrain the child.
C/ Stay with the child.
D/ Place the child in a prone position.
E/ Move furniture away from the child.
F/ Insert a padded tongue blade in the child’s mouth.
A/ Time it
C/ Stay with
E/ Move furniture
During a seizure, the child is placed on his or her side in a lateral position. Positioning on the side prevents aspiration because saliva drains out the corner of the child’s mouth. The child is not restrained because this could cause injury to the child. The nurse would loosen clothing around the child’s neck and ensure a patent airway. Nothing is placed into the child’s mouth during a seizure because this action may cause injury to the child’s mouth, gums, or teeth. The nurse would stay with the child to reduce the risk of injury and allow for observation and timing of the seizure.
