Exam 1
While examining a 2-year-old child, the nurse in charge sees that the anterior fontanel is open. The nurse should:
A. Notify the physician
B. Chart this as an expected finding
C. Look for signs of abuse
D. Ask family about a history of neuro problems
A. Notify the physician
*Anterior fontanel does stay open longer than the posterior one, however should be closed by 18mo so this is an abnormal finding
A child with suspected rheumatic fever is admitted to the pediatric unit. When obtaining the child’s history, the nurse considers which information to be most important?
A. Fever that started 3 days ago
B. Lack of interest in food
C. A recent episode of pharyngitis
D. Vomiting for the past 2 days
C. A recent episode of pharyngitis
* this should make the nurse consider strep which is the main cause of RF
The nurse is evaluating a female child with acute poststreptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement?
A. Increased urine output
B. Increased appetite
C. Improved energy level
D. Decreased diarrhea
A. Increased urine output
*Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute poststreptococcal glomerulonephritis (APSGN) is improving
A child is diagnosed with Wilms’ tumor. During assessment, the nurse expects to detect:
A. Hematuria
B. Nausea and Vomiting
C. Flank pain
D. Painless abdominal mass
D. Painless abdominal mass
*The most common sign of Wilms’ tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth
When developing a plan of care for a male adolescent, the nurse considers the child’s psychosocial needs. During adolescence, psychosocial development focuses on:
A. Becoming industrious
B. Establishing an identity
C. Achieving intimacy
D. Developing initiative
B. Establishing an identity
*According to Erikson, the primary psychosocial task during adolescence is to establish a personal identity confusion. The adolescent attempts to establish a group identity by seeking acceptance and approval from peers, and strives to attain a personal identity by becoming more independent from the family. Becoming industrious is the developmental task of the school-age child, achieving intimacy is the task of the young adult, and developing initiative is the task of the preschooler.
A nurse is caring for a child diagnosed with coarctation of aorta. While assessing him, the nurse would expect to find which of the following?
A. The child squats often while playing
B. The child experiences several cyanotic episodes a day
C. Absent or diminished femoral pulses
D. Chest pain
C. Absent or diminished femoral pulses
What is the typical bolus fluid rate for a pediatric client experiencing dehydration?
A. 20ml/kg
B. 30ml/kg
C. 40ml/kg
D. 50ml/kg
A. 20ml/kg
A child who is diagnosed with diabetes mellitus type 1 displays symptoms of pallor, diaphoresis, and confusion; which of the following actions should the nurse instruct the parents?
A. Provide a simple sugar like honey
B. Provide a complex carbohydrate like milk
C. Contact healthcare provider before doing anything.
D. Call an ambulance ASAP
A. Provide a simple sugar like honey
*Immediate action is important. Therefore, providing little sugar temporarily corrects low serum glucose levels. A simple sugar is preferred because it is converted to glucose more quickly than a complex sugar. A child with hyperglycemia needs fluid to prevent dehydration. B: Because complex sugars, such as milk, are absorbed more slowly, they do not provide an immediate response. C: Contacting the healthcare provider wastes valuable time during which emergency measures could be started to raise the child's glucose level. Ambulance may not be necessary depending on how the child responds to the simple sugar
When developing a plan care for a hospitalized child, the nurse knows that children in which age group are most likely to view illness as a punishment for misdeeds?
A. Toddler
B. Preschool
C. School-age
D. Adolescence
B. Preschool
*Magical Thinking
An appropriate intervention for a child with a heart disease in order to decrease cardiac demands and minimize cardiac workload includes which of the following?
A. Feeding the child over prolonged periods of time to avoid exhaustion
B. Allowing the child to have their way at all times to minimize conflict and stress
C. Scheduling care to allow for uninterrupted periods of rest
D. Encouraging activity to build endurance
C. Scheduling care to allow for uninterrupted periods of rest
The nurse answers a call light and finds a frightened mother whose child, the patient, is having a seizure. Which of these actions should the nurse take?
A. Help the mother restrain the child to prevent injury
B. Insert an oral airway to maintain patency
C. Tell the mother to remain calm with the child while the nurse leaves to go grab PRN seizure meds
D. Clear the area and position the client safely to prevent injury
D. Clear the area and position the client safely to prevent injury
*prevention of injury is important during acute seizure episodes. We never restrain clients, insert anything into their mouths, and we should not leave the kid unattended. If anything we can call out for assistance and have someone else bring the meds to us.
A nurse admits a child with suspected type 1 DM; which question should the nurse ask the parents that would further support this diagnosis?
A. Does your child complain of a headache ever?
B. Does your child experience any issues with nocturia?
C. How much candy and sweets does your child ingest on a daily basis?
D. Has the child had any changes in bowel function?
B. Does your child experience any issues with nocturia?
*Bedwetting in children who have previously stayed dry at night is often an early sign of diabetes that supports the symptom of polyuria.
During a well-baby visit, a mother asks the nurse when she should start giving her infant solid foods. The nurse should instruct her to introduce which solid food first?
A. Applesauce
B. Mashed bananas
C. Rice cereal
D. Yogurt
C. Rice cereal
* Easy to digest with relatively minimal allergic reactions seen
A nurse is providing education to a family of a child who was diagnosed with asthma. Which of the following statements indicate a need for further home care teaching?
A. My child needs more fluids to thin out his thick secretions
B. We will make sure he avoids exercise to prevent attacks
C. We will have him take the short acting beta (albuterol) at the first indication of an attack
D. We need to try to identify triggers for his attacks
B. We will make sure he avoids exercise to prevent attacks
*Children with asthma should be encouraged to exercise as tolerated, but they should maintain consistent amounts and be cautious of overdoing it. Exercise is healthy so we don't want to discourage it. Child just may need to take inhaler prior to working out.
A 13 yo female patient has had a lumbar puncture to examine the CSF to determine if bacterial infection exists. The best position to keep her in after the procedure is:
A. legs drawn into chest (fetal position)
B. Supine for several hours after
C. High Fowlers to promote optimal lung expansion
D. Lateral position
B. Supine for several hours after
*prevents spinal headache that occurs from leakage of CSF through puncture site. Allows clots to form and seal site off.
A nurse is planning a client education program for sickle cell disease (SCD); what topic should be included in the plan of care?
A. Intense aerobic exercise to improve oxygenation and endurance
B. Fluid restrictions to prevent fluid volume overload complications
C. High iron, high protein diet
D. Proper handwashing and avoidance of of people who are sick
D. Proper handwashing and avoidance of of people who are sick
*Infection is a huge trigger for Sickle Cell Crisis
A nurse should expect a 3-year-old child to be able perform which action?
A. Tie shoes
B. Ride a tricycle
C. Jump Rope
D. Roller Skate
B. Ride a tricycle
*other answer options are too mature for a 3yo
Which of the following instructions should a nurse include in a teaching plan for the parents of a child with otitis media?
A. Placing the child in the supine position to bottle-feed
B. Giving prescribed amoxicillin (Amoxil) on an empty stomach
C. Cleaning the inside of the ear canals with cotton swabs
D. Avoiding contact with people who have upper respiratory tract infections
D. Avoiding contact with people who have upper respiratory tract infections
*Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection. A: A bottle-fed child should be fed in an upright position because feeding the child in the supine position may actually precipitate otitis by allowing the formula to pool in the pharyngeal cavity. B: Amoxicillin, when prescribed, should be given with food to prevent stomach upset. C: Cotton swabs can cause injuries such as tympanic perforation. They may be used to clean the outer ear, but they should never be inserted into the ear canal.
Reye's syndrome is a rare and severe illness affecting children and teenagers. Its development has been linked with the use of aspirin and which of the following?
A. Meningitis
B. Encephalits
C. Strep Throat
D. Varicella
D. Varicella
* Reye's syndrome has been linked with the ingestion of aspirin in children with viral infections like varicella
Which of the following tests is most effective in diagnosing hemophilia?
A. CBC
B. PTT
C. Platelet count
D. Iron level
B. PTT
*This is most specific to this disease