NUR 0416 Pediatrics final exam review – 75 Questions with Correct Answers Provided

Pediatrics final exam review – 75 questions 1. Who is at greater risk for sepsis? Newborns Ch. 15 Pg. 503 - Children less than 3 months with rectal temp greater than 38 degrees are at risk for sepsis and should be seen by doctor. Book: A neonate should be evaluated by a physician if which signs and symptoms are present? c. Rectal temperature above 38°C The nurse is caring for a neonate who is suspected of having sepsis. Which assessment findings would the nurse interpret as most indicative of sepsis? Hypothermia 2. What age group has a high incidence of infectious disease? a. The physiologic immaturity of an infant's body systems increases the risk for infection b. Infants and young children are more susceptible to infection due to their immature immune system 3. Hypo- and hyper- thyroidism- s/s (which one is not a symptom) Ch. 26 Pg. 1029 Hyperthyroidism Hypothyroidism • Nervousness/anxiety • Tiredness/fatigue • Diarrhea • Constipation • Heat intolerance • Cold intolerance • Weight loss • Weight gain • Smooth, velvety skin • Dry, thick skin; edema of face, eyes, and hands • Decreased growth Q: What finding would the nurse expect to assess in a child with hypothyroidism? Weight Gain Q: The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess? It is difficult to keep the child awake 4. SATA- R/F for immune disorders (3/5 choices) The parents of a 7-month-old child with an infection ask the nurse about how to treat their child's fever. After providing teaching, the parents voice understanding with which statements? Select all that apply. A)"Unless my child develops a fever over 102.2°F , I don't need to make an appointment with the physician." C)"I can use acetaminophen to help with the symptoms of the infection but it won't get rid of the infection." D) "Even though people get frightened, fevers are not a bad thing during an infection unless it gets too high." 5. Myasthenia gravis- what to do with the crisis Ch. 25 Pg. 995 - Autoimmune disease inherited as a congenital disease. - Myasthenia crisis is a medical emergency with symptoms including sudden respiratory distress, dysphagia, dysarthria, ptosis, diplopia, tachycardia, anxiety, and rapidly increasing weakness. - Management: anticholinesterase meds (pyridostigmine). If weakness is not controlled, additional meds adm would be corticosteroids and immunosuppressant. Google - Choking can occur. Respiratory can be affected leading to intubation and mechanical ventilation. Q: The client is experiencing a myasthenic crisis. Which of the following is a priority action of the following ordered actions? Insert NG tube Q: The client diagnosed with MG is admitted to the emergency department with a sudden exacerbation of motor weakness. Which assessment data indicate the client is experiencing a myasthenic crisis? The client's symptoms improve when administering on a cholinesterase inhibitor. 6. HIV+ mother- what diagnostic test are you going to do? Ch. 25 Pg. 982 - PCR test- positive in infected infants 1mo. - ELISA- positive in infants with infected mother because of received antibodies - CD4 counts are low in HIV infection Book: A 4-month-old infant born to an HIV-infected mother is going into foster care because the mother is too ill to care for the child. The foster mother wants to know if the infant is also infected. What is the best response by the nurse? d. “The PCR test is positive; this indicates HIV infection, which may or may not progress to AIDS.” 7. Child in ER with pulse at 48- what indication are you going to give - Atropine (anticholinergic): sinus bradycardia - Dopamine (inotropic): bradycardia - Epinephrine (vasopressor, inotropic): bradycardia 8. Asthma- dust in the air provokes attacks Ch. 18 - Air pollution, allergens, family history, and viral infections might all play a role in asthma Asthma in infants is usually triggered by: viral infection 9. Child who fell off a swing- what are you going to check after assessing ABC? The patient hit his head- LOC Q: A child has fallen off of a swing at the playground and her father states that she became groggy. After assessing a child's airway, breathing, and circulation (ABCs), what would the nurse do next? Assess level of consciousness 10. SATA- different respiratory infection in upper airway (2/5 choices) SEE HANDOUT Ch. 29 - Burns - Croup - Epiglottitis - Foreign-body aspiration - Reflux - Strangulation or near strangulation - Tracheomalacia - Vascular ring A group of students are reviewing information about respiratory arrest in children. The students demonstrate understanding of this information when they identify what common causes of respiratory arrest involving the upper airway? Select all that apply. A) Croup, D) Epiglottitis 11. Near drowning patient, 3 y/o – highest priority Ch. 29 Pg. 543 - Near drowning is when the child has suffered a submersion injury and has survived for at least 24 hours. - Assessment begins with resuscitative measures. Gain info about submersion. Chronic neurologic damage occurs in many cases related to hypoxia. The parents bring their 3-year-old son to the emergency department after he ingested some of his mother's medicine. Which assessment would be of critical importance for this child?A)Assessing mental status and skin moisture and color A 3-year-old girl had a near-drowning incident when she fell into a wading pool. Which intervention would be of the highest priority? Suctioning the upper airway to ensure airway patency 12. SATA- 17 y/o with anorexia nervosa- what test are you going to do (2/5 choices) Ch.28 Pg. 1107 - Electrolytes and electrocardiogram o severe electrolyte disturbances and cardiac arrhythmias often occur. 13. Myelomeningocele with neurogenic bladder- how to explain the neurogenic bladder to the patients - Neurogenic bladder refers to the failure of the bladder to either store urine or empty itself of urine. Children with neurogenic bladder have loss of control over voiding. - Teaching should include positioning, preventing infection, feeding, promoting urinary elimination through clean intermittent catheterization, preventing latex allergy, and identifying the signs and symptoms of complications such as increased ICP The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. What information would the nurse include? Soaking the catheter in a vinegar and water solution to sterilize 14. Nursing diagnosis for a patient with spica cast Ch.22 Pg. 863 Risk for impaired skin integrity related to immobility, casting, traction, use of braces or adaptive devices The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis? Risk for impaired skin integrity due to cast and location 15. What should a 6 month child do? The question is if the child has a problem how are you identified there is a problem a. child cannot sit with assistance at 6 months of age b. infant crosses eyes most of the time at age 6 months. c. infant does not laugh or squeal by 6 months of age 16. Nephrotic syndrome- lab results that the nurse expect to see (3) Ch. 21 Pg. 778 - Urine dipstick for proteinuria - Serum protein and albumin levels with be low (hypoproteinuria & hypoalbuminemia) - Serum cholesterol and triglyceride levels are elevated (hyperlipidemia) - BUN and creatinine may become elevated The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find? C) Decreased blood urea nitrogen (BUN) 17. Hemolytic uremic syndrome- patient with oliguria – what is expected in the lab results? Ch. 21 Pg. 781 - Elevated BUN and creatinine - Moderate to severe anemia (with the presence of Burr cells, schistocytes, spherocytes, or helmet cells), mild to severe thrombocytopenia - Increased reticulocyte count - Increased bilirubin and lactic dehydrogenase (LDH) levels - Negative Coombs test (except in cases of Streptococcus pneumoniae infection) - Leukocytosis with left shift - Hyponatremia - Hyperkalemia - Hyperphosphatemia - Metabolic acidosis A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding? Decreased platelets and leukocytosis 18. Patient with nocturnal enuresis- additional teaching if you heard the parents say what? (pick the worst one) Ch. 21 Pg. 776 - Nocturnal enuresis: nighttime bedwetting - Teach the family that the child is not lazy, nor does he or she wet the bed intentionally - Teach parents to limit fluid intake after dinner and ensure that the child voids just before going to bed - Teach the parents to use bed pads and to make the bed with two sets of sheets and pads to decrease the workload in the middle of the night 19. Dosage calculation- mg/dose 20. Psoriasis- what do you see Ch. 23 Pg. 886 - Inspect the skin for erythematous papules that coalesce to form plaques, most frequently found on the scalp, elbows, genital area, and knees (Fig. 23.16). Facial plaques may also occur and are more common in children than adults. The plaques have a silvery or yellow-white scale and sharply demarcated borders. Layers of scale may be present, which, when removed, result in pinpoint bleeding (referred to as the Auspitz sign). Plaques on the scalp may result in alopecia. Examine the palms and soles, noting fissures and scaling. Skin biopsy, though rarely needed for diagnosis, will show hyperplastic epidermis, with thinning of the papillary dermis. A teenage girl with psoriasis tells the nurse that she is so embarrassed by the plaque on her skin that she doesn't want to go to school. What is the best response by the nurse? B) "It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis." 21. What do you tell the parents not to do with eczema? Ch. 23 Pg. 882 - Avoid clothing made of synthetic fabrics or wool. Avoid triggers known to exacerbate atopic dermatitis. Avoid tight clothing and heat. Prevent scratching. The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? "After bathing, I need to rub his skin everywhere to make sure he is completely dry." 22. HIV+ mother- she is wondering if the baby is getting the disease- how should you respond? - Diagnosing AIDS in neonates is difficult because all neonates of women with HIV receive maternal antibodies and therefore initially test positive for HIV antibodies. However, not all such neonates actually are infected. The newborn of an HIV-positive mother has a 25% to 30% chance of developing HIV Q: A client who has tested positive for the human immunodeficiency virus (HIV) delivers a girl. When she asks whether her baby has acquired immunodeficiency syndrome (AIDS), how should the nurse respond? "She may have acquired HIV in utero, but we won't know for sure until she's older." 23. Expected assessment in an infant with hip dysplasia CH. 22 PG. 832 - Assessment techniques for developmental dysplasia of the hip. (A) Assess for asymmetry of thigh and gluteal folds. (B) Assess for unequal knee height related to femur shortening. (C) Note limitation in hip abduction. (D) Positive Trendelenburg sign: note pelvis/hip drops when leg is raised. (E) Feel for “clunk” when adduction and depression of femur dislocates hip (Barlow test). Assess for “clunk” when the dislocated hip is abducted and relocated (Ortolani sign). The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which finding would help confirm this diagnosis? B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers. 24. Nursing diagnosis for a patient with myelomeningocele after repaired