Kidney Disorders
Dr. Jones prescribes corticosteroids for a child with nephritic syndrome. What is the primary purpose of administering corticosteroids to this child?
C. To decrease proteinuria
The primary purpose of administering corticosteroids to a child with nephritic syndrome is to decrease proteinuria. It helps relieve the inflammation in the kidney and promotes healing. The proteinuria usually ranges in the sub nephrotic range (less than 3.5 g/day), but it can go up to the nephrotic range. A 24-hours urinary protein assay is required if the attendant nephrotic syndrome is suspected.
Clay is an 8-year-old boy diagnosed with heart failure. Which of the following shows that he is strictly following the directed therapeutic regimen?
C. Normal weight for age
Adequate weight for height demonstrates adequate nutritional intake and lack of edema. Symptoms of heart failure include those due to excess fluid accumulation (dyspnea, orthopnea, edema, pain from hepatic congestion, and abdominal distention from ascites)
Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely?
At I week to 1 year of age, peaking at 2 to 4 months
SIDS can occur any time between 1 week and 1 year of age. The incidence peaks at 2 to 4 months of age. Sudden infant death syndrome (SIDS) is the abrupt and unexplained death of an infant less than 1-year old. Despite a thorough investigation (a careful review of clinical history, death scene investigation, and a complete autopsy), a cause for the patient’s demise is not identified.
Veronica’s parents were told that their daughter needs ribavirin (Virazole). This drug is used to treat which of the following?
C. Respiratory syncytial virus (RSV)
Ribavirin is an antiviral medication used for treating RSV infection and for children with RSV who are compromised (such as children with bronchopulmonary dysplasia or heart disease). There is a single antiviral medication approved for use against RSV in the United States,
Tiffany is diagnosed with increased intracranial pressure (ICP); which of the following if stated by her parents would indicate a need for Nurse Charlie to reexplain the purpose for elevating the head of the bed at a 10 to 20-degree angle?
B. Increase intrathoracic pressure
Head elevation decreases, not increases, intrathoracic pressure. In most patients with intracranial hypertension, head and trunk elevation up to 30 degrees is useful in helping to decrease ICP
The nurse is aware that the following laboratory values support a diagnosis of pyelonephritis?
C. Pyuria
Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. A urinary specimen should be obtained for a urinalysis.
Which of the following is most likely associated with a cerebrovascular accident (CVA) resulting from congenital heart disease?
A. Polycythemia
The child with congenital heart disease develops polycythemia resulting from an inadequate mechanism to compensate for decreased oxygen saturation. Secondary erythrocytosis of cyanotic congenital heart disease (CCHD) is pathologically different from primary erythrocytosis of polycythemia vera (PV).
Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would Nurse Nica expect to assess?
C. Chest pain
Older children with pneumococcal pneumonia may complain of chest pain. Physical findings also vary from patient to patient and mainly depend on the severity of lung consolidation, the type of organism, the extent of the infection, host factors, and the existence or nonexistence of pleural effusion.
Archie who weighs 44 lb has been given an order for amoxicillin 500 mg b.i.d. The drug text notes that the daily dose of amoxicillin is 50 mg/kg/day in two divided doses. What dose in milligrams is safest for this child?
C. 500 mg
First, calculate the child’s weight in kg: 44/2.2 = 20 kg. Then calculate the appropriate daily dose according to the drug text: 50 mg/kg/day = 50 mg x 20 kg = 1,000 mg/day. the abbreviation b.i.d. means twice daily; therefore 1,000 divided by 2 equals 500 mg.
Nurse Oliver is attending to a child with Cushing’s syndrome. Which of the following nursing interventions would be most necessary?
B. Handling the child carefully to prevent bruising.
The nurse should handle the child carefully because Cushing’s syndrome causes capillary fragility, resulting in easy bruising and calcium excretion, resulting in osteoporosis.
Nurse Chole is evaluating a female child with acute post-streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement?
A. Increased urine output
Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving
Bryce is a child diagnosed with coarctation of aorta. While assessing him, Nurse Zach would expect to find which of the following?
B. Absent or diminished femoral pulses
Absent or diminished femoral pulse is a classic characteristic of coarctation of the aorta. In patients with neonatal coarctation evolving while the patent ductus arteriosus is closing, the lower extremity saturation can be low as perfusion to the lower body can be maintained by ductal patency.
Beta-adrenergic agonists such as albuterol are given to Reggie, a child with asthma. Such drugs are administered primarily to do which of the following?
A. Dilate the bronchioles
Beta-adrenergic agonists, such as albuterol, are highly effective bronchodilators and are used to dilate the narrow airways associated with asthma.
Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions?
C. Epiglottitis
Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis. By the early 1990s, the use of the Hib conjugate vaccine caused a 99% drop in infections caused by Hib.
Which type of diabetes mellitus (DM) most likely results from heterogenous risk factors, making it preventable?
B. Type 2
Type 2 DM is a complex disorder of various causes with social, behavioral, and environmental risk factors.
Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and takes steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following?
D. Ketone bodies from fat metabolism.
Inability to use glucose causes lipolysis, fatty acid oxidation, and release of ketones, resulting in metabolic acidosis and coma
Appropriate intervention is vital for many children with heart disease in order to go on to live active, full lives. Which of the following outlines an effective nursing intervention to decrease cardiac demands and minimize cardiac workload?
C. Scheduling care to provide for uninterrupted rest periods
Organizing nursing care to provide for uninterrupted periods of sleep reduces cardiac demand. Allow for rest periods between care; disturb only when necessary for care and procedures. This promotes rest and conserves energy.
The Andrews family has been taking good care of their youngest, Archie, who was diagnosed with asthma. Which of the following statements indicate a need for further home care teaching?
B. “We’ll make sure that he avoids exercise to prevent attacks.”
Additional teaching is needed if the family states that the child with asthma should avoid exercise to prevent attacks.
A nurse prepares to administer a 3ml injection via intramuscular injection to a 5-year-old child. The nurse selects which site to administer the medication?
C. Ventrogluteal
Intramuscular injection sites are chosen based on the child’s age and muscle development. The ventrogluteal muscle is the ideal choice to administer 0.5ml-3ml amount of injection on a 3-12-year-old child.
Nurse Bennet is a community nurse practicing primary prevention for psychiatric disorders in children. On which of the following risk factors would he focus?
B. Family history of mental illness
Abnormal genes and family history of mental illness have been implicated in many psychiatric disorders occurring in children and adolescents.
Nurse Christine is planning a client education program for sickle cell disease (SCD) in children. Which of the following interventions would be included in the care plan?
A. Health teaching to help reduce sickling crisis.
Prevention is one of the principal goals of therapeutic management because there is no cure for sickle cell disease. Consequently, health education to help lessen the sickling crisis is key.
Arrange these parts of the conduction system of the heart in the correct order as an action potential would pass through them.
Purkinje fibers
Atrioventricular bundle
R and L bundle of His
SA node
AV node
1. The SA node is the natural pacemaker of the heart.
2. The electrical stimulus from the SA node eventually reaches the AV node and is delayed briefly so that the contracting atria have enough time to pump all the blood into the ventricles.
3. Once the atria are empty of blood the valves between the atria and ventricles close.
4. At this point, the atria begin to refill and the electrical stimulus passes through the AV node and Bundle of His into the Bundle branches and Purkinje fibers.
An unconscious child is brought to the emergency room due to Tylenol poisoning. Which of the following is the most appropriate nursing action?
B. Gastric lavage with activated charcoal.
In an unconscious child with Tylenol poisoning, the priority intervention is to administer gastric lavage with activated charcoal to decrease the absorption of Tylenol
A 1-year-old child is diagnosed with scabies. Which of the following medicines is expected to be prescribed?
A. Permethrin
Permethrin and Lindane are used against scabies, but lindane is contraindicated for children below two years old because of the risk of seizures and neurotoxicity.
Sunshine, age 13, 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:
C. Supine for several hours, to prevent a headache.
Lying flat keeps the patient from having a “spinal headache.”