UNIT 5 Flashcards

1
Q

The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching?

A) “I should position him on his abdomen with knees bent.”
B) “He will require 250 to 500 mL of enema solution.”

C) “I should wash my hands and then wear gloves.”
D) “He should retain the solution for 5 to 10 minutes.”

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The nurse is taking a health history of an 11-year-old girl with recurrent abdominal pain. Which response would lead the nurse tobsuspect irritable bowel syndrome?

A) “I always feel better after I have a bowel movement.”

B) “I don’t take any medicine right now.”

C) “The pain comes and goes.”

D) “The pain doesn’t wake me up in the middle of the night.”

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The nurse is caring for a 3-year-old girl with short bowelesyndrome as a result of trauma to the small intestine. The girl’s mother is extremely anxious and
tells the nurse she is afraid she will never learn how to care for her daughter at home. How should the nurse respond?
A) “I will help you become an expert on your daughter’s care.”

B) “You must learn how to care for your daughter at t home.”

C) “You really need the support of your husband.”

D) “There is a lot to learn and you need a positive attitude.”

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease?

A) Normal growth patterns

B) Perianal skin tags or fissures

C) Poor growth patterns

D) Abdominal tenderness

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The nurse is caring for an infant with a temporary ileostomy. As part of the plan of care, the nurse monitors for skin breakdown around the stoma. If redness occurs, what would be most appropriate to promote healing and t prevent further skin breakdown?

A) Clean the area well with a scented diaper wipe.
B) Apply a barrier/healing cream or paste on the skin.

C) Use a barrier wafer to attach the appliance.birb.com/test

D) Sanitize the area with an alcohol wipe after each diaper change.

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The nurse is caring for a 4-year-old boy who has undergone an appendectomy. The child is unwilling to use the incentive spirometer. Which
approach would be most appropriate to elicit the child’s cooperation?

“Can you cough for me please?”

“You must blow in this or you might get pneumonia.”

“If you don’t try, I will have to get the healthcare provider.”

“Can you blow this cotton ball across the tray?”

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A nurse is caring for a 14-year-old girl scheduled for . a barium swallow/upper gastrointestinal (GI) series. Before providing instructions, what would be the priority?

A) Screening the girl for pregnancy

B) Reminding her to drink plenty of fluids after the procedure C) Ordering a bowel preparation

Reminding the girl about potential light-coloredo stools

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The nurse has developed a plan of care for a 12-month-old hospitalized with dehydration as a result of rotavirus. Which intervention would the nurse include in the plan of care?

A) Encouraging consumption of fruit juice

B) Offering Kool-Aid or popsicles as tolerated

C) Encouraging milk products to boost caloric intake/test

D) Maintaining the intravenous (IV) fluid rate as ordered

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The nurse is caring for a 2-month-old with a cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after surgery and wonders if it is possible. How should the nurse respond?

A) “There is a good chance that you will be able to breastfeed almost immediately.”

“Breastfeeding is likely to be possible but check with the surgeon.”

“After the suture line heals, breastfeeding can resume.”

“We will have to wait and see what happens after the surgery

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The school nurse is working with a 10-year-old girli with/ recurrent abdominal pain. The girl’s teacher has been less than understanding about the frequent
absences and trips to the nurse’s office. How should the nurse respond?
A) “Be patient; she is trying some new medication.”

B) “The pain she is having is real.”

“The family is working toward improvement.”

“Please do not add to this family’s stress.”

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When examining the abdomen of a child, which techniquet would the nurse use last?

A) Auscultation

B) Percussion

C) Palpation

D) Inspection

A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which finding would lead the nurse to suspect that a child is experiencing
moderate dehydration?

A) Dusky extremities

B) Tenting of skin

C) Sunken fontanels

D) Hypotension

A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The nurse is determining maintenance fluid requirements for a child who weighs 25 kg. How much fluid would the child need per day?m/test

A) 1,560 mL

B) 1,600 mL

C) 1,650 mL

D) 1,700 mL

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The parents of a child diagnosed with celiac disease ask the nurse what types of food they can offer their child. What recommendation would the nurse include in the teaching plan?

A) Frozen yogurt

B) Rye bread

C) Creamed spinach

D) Fruit juice

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool’s appearance as having what quality?

Greasy

Clay-colored

Currant jelly–like

Bloody

A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The mother of a 3-week-old infant old brings her daughter in for an evaluation. During the visit, the mother tells the nurse that her baby is spitting up after feedings. Which response by the nurse would be most appropriate?

A) “We need to tell the healthcare provider about cthis.”

B) “Infants this age commonly spit up.”

C) “Your daughter might have an allergy.”

D) “Don’t worry; you’re just feeding her too much.”

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

. A group of students are reviewing information about . fluids balance and losses in children in comparison to adults. The students demonstrate a need for additional
review when they state that:

A) children have a proportionately greater amount of body water than do adults.

B) fever plays a greater role in insensible fluid losses in infants and children.

C) a higher metabolic rate plays a major role inirincreased insensible fluid losses.

D) the infant’s immature kidneys have a tendency to overconcentrate urine.

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

An 8-month-old infant is brought to the clinic for evaluation. The mother tells
the nurse that she has noticed some white patches on the infant’s tongue that look
like curdled milk after breastfeeding. The nurse suspectsboral candidiasis (thrush). Which question would the nurse use to help confirm this suspicion?

A) “Are you having breast pain when you nurseirthe baby?”

B) “Has he had any dairy problems recently?”

C) “Is he experiencing any vomiting lately?”

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The parents of a 6-week-old boy come to the clinic for evaluation because
the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. Thet mother says,
“Sometimes, it seems like it just bursts out of his mouth.” A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find?

A) Sausage-shaped mass in the upper midabdomen

B) Hard, moveable, olive-shaped mass in the right upper quadrant

C) Tenderness over the McBurney point in the right lower quadrant D) Abdominal pain in the epigastric or umbilicali regiont

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A nursing instructor is developing a class presentation about the medications used to treat peptic ulcer disease. Which drug class would the/ instructor be least likely to include in the presentation?

A) Antibiotics

B) Proton pump inhibitors

C) Histamine antagonists

D) Prokinetics

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The parents of a boy diagnosed with Hirschsprung disease are anxious and fearful of the upcoming surgery. The mother states, “I’m worried about having to care for our son’s ostomy.” Which intervention would be most helpful for the

parents?

Explaining to them about the diagnosis and surgery

Having a wound, ostomy, and continence nurse meet with them
Reinforcing that the ostomy will be temporary

Teaching them about the medications used to.slows stool output

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

. The nurse is providing care to a child with pancreatitis. When reviewing the child’s laboratory test results, what would the nurse expect to find? Select all that
apply.

A) Leukocytosis

B) Decreased C-reactive protein

C) Elevated serum amylase levels

D) Positive stool culture

E) Decreased serum lipase levels

A

A C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A child is scheduled for a lower endoscopy. What would the nurse include in the child’s plan of care in preparation for this test?

A) Explaining about the need to ingest barium

B) Establishing an intravenous access for radionuclide administration

C) Administering the prescribed bowel cleansing regimen
D) Withholding prescribed proton pump inhibitors for 5 days before

A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A group of students are reviewing information about gallbladder disease in children. The students demonstrate a need for additional review when they state:

cholesterol gallstones are more frequently found in males.

pigment stones are found primarily in the commons bile duct.

pancreatitis is a common complication of cholecystitis in children.

cholecystitis is due to chemical irritation from obstructed bile flow.

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

After teaching the parents of a child diagnosed with celiac disease about nutrition, the nurse determines that the teaching was effective when the parents identify which foods as appropriate for their child? Select all that apply.

A Wheat germ

B Peanut butter

C Carbonated drinks

D Shellfish

E Jelly

F Flavored yogurt

A

B C D E

26
Q

A group of nursing students are reviewing information about inflammatory bowel disease in preparation for a class discussion on the topic. The students
demonstrate understanding of the material when they identify which characteristics of Crohn disease? Select all that apply.

A) Distributed in a continuous fashion

B) Most common between the ages of 10 and 20.years

C) Elevated erythrocyte sedimentation rate

D
Low serum iron levels

Tenesmus

Loss of haustra within bowel

A

B C D

27
Q

After teaching the parents of a 6-year-old how to administer an enema, the nurse determines that the teaching was successful when they state that they will give how much solution to their child?

A) 100 to 200 mL

B 200 to 300 mL

C 250 to 500 mL

D 500 to 1,000 mL

A

D

28
Q

The nurse is caring for a 6-month-old with a cleft lip and palate. The mother of the child demonstrates understanding of the disorder with which statements? Select all that apply.

A) “My smoking during pregnancy didn’t have anything to do with this
disorder. Smoking primarily causes low birth weight.”

B) “I know my baby takes a lot longer to feed than most children this age.”

C) “It really worries me that my baby may have some other disorders that haven’t been detected yet.”

D) “I wonder if my baby will develop speech problems when language development begins?”

E) “Thankfully there are healthcare providers that specialize in correcting this type of disorder.”

A

B C D E

29
Q

The nurse is performing a gastrointestinal assessment on a 7-year-old boy. The parents are assisting with the history. Which assessment findings are indicative of constipation? Select all that apply.

A) “Our child only has 3 to 4 bowel movements per week.”
B) “Our child complains of pain because his bowel movements are so hard.”
C) “Our child tells us that his belly hurts a lot ofr the time.”

D) “I can tell he holds his bowel movement much of the time because of the way he stands.”

E) “I find smears of stool in his underwear almost every day.”

A

B C D E

30
Q

The nurse is preparing to administer intravenous fluids to manage a child with dehydration. The medical record indicates the child weighs 60 lb (27.2 kg). How many milliliters will initially be administered? Record your answer using two
decimal places.

A

545.45

31
Q

The nurse is caring for a child who is experiencing an acute renal transplant rejection and is to receive muromonab-CD3. What would the nurse most likely expect to assess after the first dose
is administered? A. Fever with chills, chest tightness
B. Cough, hyperkalemia
C. Photosensitivity, gastrointestinal (GI) upset
D. Urinary retention, decreased appetite

A

A

32
Q

The nurse is visually inspecting a urine specimen from a 12-year-old boy. The nurse documents gross hematuria with a specimen of which color?
A. Cloudy yellow B. Cola colored
C. Pale to almost clear urine
D. Light orange to moderately yellow colored

A

B

33
Q

The nurse is caring for a 4-year-old with a suspected urinary tract infection. What would be most appropriate to say to the child when obtaining a urine specimen from him?
A. “I will need a urine sample.”
B. “Let your mom help you tinkle in this cup.” C. “Please tinkle in this cup right now.”
D. “Please void in this cup instead of the toilet.”

A

B

34
Q

The nurse is providing postsurgical care for an infant who has undergone a hypospadias repair. Which action by the nurse would be most important to help keep the area clean while maintaining proper position of the drainage tubing?
A. Keeping the drainage tube taped in an upright position B. Administering antibiotics as ordered
C. Administering analgesics as prescribed
D. Using a double-diapering technique

A

D

35
Q

The nurse is caring for a 4-year-old girl with vulvovaginitis. After instructing the girl’s mother on how to help prevent subsequent episodes, which statement by the mother indicates a need for additional teaching?
A. “She tells me she wipes from front to back.” B. “I will make sure she changes her underwear every day.”
C. “She should avoid bubble baths.”
D. “I will help supervise her wiping after bowel movements.”

A

A

36
Q

. A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test?
A. Checking with the parents for any allergies B. Ensuring adequate hydration
C. Giving the girl an enema
D. Screening her for pregnancy

A

A

37
Q

A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication?
A. Weight loss

B. Hypotension
C. Signs of infection D. Hair loss

A

C

38
Q

The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a “freak” compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate?
A. “Let’s put you in touch with some other girls who are also having. the/ same body changes.” B. “Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it.”
C. “Your real friends do not care about your appearance and just want you to get well.” D. “You are beautiful in your own way; what matters is what is on the inside.”

A

A

39
Q

An 8-year-old girl is scheduled for a renal ultrasound. What would the nurse include in the plan of care when preparing the child for this test?
A. Withholding food and fluids after midnight B. Checking the child for allergies to shellfish
C. Ensuring the child has a full bladder
D. Informing the child she should feel no discomfort

A

D

40
Q

The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). In educating the parents, the nurse would recommend that the child avoid:
A. a liberal fluid intake. B. caffeine.
C. cranberry juice.
D. cotton underwear

A

B

41
Q

The mother of a child with end-stage renal disease asks the nurse why her son is getting an injection of erythropoietin. When responding to the mother, the nurse explains that the rationale is:
A. to treat low calcium levels. B. to stimulate growth in stature.
C. to stimulate red blood cell growth.
D. to correct acidosis

A

C

42
Q

A child is diagnosed with hemolytic-uremic syndrome (HUS). iReviewt of the child’s laboratory test results would reveal which finding?
A. Decreased blood urea nitrogen (BUN) and creatinine
B. Decreased platelets and leukocytosis C. Hypernatremia and hypokalemia
D. Respiratory acidosis and proteinuria

A

B

43
Q

. After teaching the parents of a child with a hydrocele about this condition, which statement indicates that the teaching was successful?
A. “If this gets worse and we don’t treat it, our son could become infertile.” B. “This condition should gradually go away on its own.”
C. “The surgeon is going to operate on him immediately.” D. “It’s going to be difficult putting ice packs on his scrotum.”

A

B

44
Q

The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find?
A. Hyperlipidemia B. Hypoalbuminemia
C. Decreased blood urea nitrogen (BUN) D. Hypoproteinemia

A

C

45
Q

The nurse is applying a urine bag to a 15-month-old boy to collect a urine specimen. Which action would the nurse take first?
A. Apply benzoin to the scrotal area. B. Tuck the bag downward inside the diaper.
C. Pat the perineal area dry after cleaning.
D. Apply the narrow portion of the bag on the perineal space.

A

C

46
Q

A group of students are reviewing information about renal failure in / children. The students demonstrate a need for additional teaching when they identify which agent as a potential contributor to renal failure?
A. Vancomycin B. Gentamicin
C. Co-trimoxazole
D. Amoxicillin

A

D

47
Q

A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause?
A. Klebsiella B. Escherichia coli
C. Staphylococcus aureus
D. Pseudomonas

A

B

48
Q

A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant?
A. “She’s been constipated quite a few times.”
B. “We’ve noticed that her bed is wet in the morning.”
C. “She had surgery to repair a problem with her anus.”

D. “She had a bacterial skin infection about a week ago.”

A

C

49
Q

A nurse identifies a nursing diagnosis of
Impaired urinary elimination related to infection in the urinary tract as manifested by dysuria for a preschooler. When developing the plan of care, what would be most important for the nurse
to do first? A. Develop a schedule for bladder emptying.
B. Encourage fluid intake.
C. Assess usual voiding patterns.
D. Monitor intake and output.

A

C

50
Q

While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, “Why would my daughter be more at risk than my son?” Which response by the nurse would be most accurate?om/test
A. “Girls have a smaller bladder size than boys do.” B. “A girl’s urethra is closer to the rectal opening.” C. “A girl’s urethra is longer than a boy’s urethra.”
D. “Her kidneys are less well protected.”

A

B

51
Q

A child returns from surgery in which a stoma was created in the abdominal wall to the bladder. The nurse identifies this as a:
A. vesicostomy. B. ureteral stent.
C. continent urinary diversion.
D. bladder augmentation.

A

A

52
Q

The nurse is preparing an 8-year-old girl for a cystoscopy. Which instruction would be most appropriate to give to the child?
A. “You need to make sure that you don’t go to the bathroom before the/test.” B. “You might feel some burning when you go to the bathroom afterward.” C. “I’m going to have to put a tube into your bladder to empty it.”
D. “I have to put a thick tight rubber band around your arm to get a blood specimen

A

B

53
Q
  1. The nurse is assessing a 5-year-old child’s genitourinary system. Which findings would the nurse document as normal? Select all that apply.
    A. Labial fusion
    B. Round abdomen
    C. Positive bowel sounds D. Dullness over the spleen
    E. Undescended testicles
A

B C D

54
Q

The nurse is providing instruction to the parents of a newborn boy. The parents have decided not to circumcise the child. What information should be included in the discussion? Select all answers that apply.
A. The foreskin should be pulled back for cleaning at least once per day. B. The foreskin should be pulled back gently with each diaper change.m/test C. Clean the penis gently with soap and water.
D. If the foreskin is not retractable do not force it.
E. When the foreskin is retracted, gently replace it prior to completing diapering.

A

C D E

55
Q

The nurse is caring for a client with hemolytic-uremic syndrome (HUS). The cilent is demonstrating oliguria. What does the nurse expect to find when reviewing the client’s records? A. A pattern of below-normal blood pressure
B. Higher fluid output than fluid intake C. Elevated BUN and creatinine levels
D. Increased glomerular filtration rate (GFR)

A

C

56
Q

A 15-year-old client presents to the emergency room reporting an abrupt onset of severe, sudden pain on the right side of the scrotum while playing football. The nurse notes a blue-black swelling of the affected scrotum. Which action will the nurse complete next?
A. Complete a head-to-toe assessment B. Have the client rate the pain
C. Notify the primary health care provider
D. Monitor the client’s urine output

A

C

57
Q

The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response by the client’s parent will the nurse highlight for the primary health care provider as an indicator for this condition?
A. “My child’s has recently reported urinary frequency.” B. “My child just got over a head cold with laryngitis.” C. “My child’s urine is pale yellow in color.”
D. “My child’s eyes appear sunken to me.”

A

B

58
Q

The nurse is administering an IV infusion of albumin to a child with nephrotic syndrome. What is the primary concern for the nurse when administering this medication to the child? A. Fluid overload
B. Electrolyte imbalance
C. Increased blood pressure
D. Urine output

A

A

59
Q

A child is hospitalized with acute poststreptococcal glomerulonephritis. What assessments should the nurse include in the plan of care for this child?? Select all that apply.
A. Assess level of consciousness B. Assess pain
C. Monitor blood pressure D. Auscultate lung sounds E. Inspect the urine

A

B C D E

60
Q

An infant has undergone a hypospadias repair. What intervention will the nurse teach the parents to keep the site clean and to reduce swelling?
A. “It is important to use double diapering to keep stool off the site.”
B. “The compression dressing should be changed if it becomes soiled.” /test C. “Keep the penis taped to the abdomen so stool cannot get to surgical site.” D. “You can use a gauze dressing to cover the urethral stent.”

A

A

61
Q
A