NUR 318 Focus on Child Health Exam Questions & Answers

NUR 318 Focus on Child Health Exam Questions & Answers 1. An HIV-positive woman delivers an infant. The pediatrician prescribes testing for the newborn, and the nurse prepares for which action? A. Ask the laboratory to perform virologic testing Correct B. Obtain blood from the umbilical cord to send to the laboratory C. Perform a heelstick to obtain a specimen for a Western blot assay D. Perform a fingerstick to obtain a specimen for an enzyme-linked immunosorbent assay (ELISA) accurate in infants younger than 18 months because of the persistence of maternal antibodies. Because of the potential for maternal contamination during delivery, umbilical cord blood should not be used for testing. HIV-exposed infants should undergo virologic testing within 48 hours of birth and follow-up testing, depending on the initial results. Test-Taking Strategy: Focus on the subject, newborn infant exposed to HIV. Recalling that the ELISA and Western blot assay are not accurate in an infant younger than 18 months will assist you in eliminating these options. Next eliminate the option involving cord blood, knowing that such blood could be contaminated. Review: tests for HIV in newborn Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Child Health—Infectious Diseases Giddens Concepts: Immunity, Infection HESI Concepts: Immunity, Infection Awarded 98.0 points out of 98.0 possible points. 2. A nurse providing home care instructions to a mother of a HIV-positive child discusses measures to prevent transmission of the virus. Which statement by the mother indicates a need for further instruction? A. “I won’t let my children share toothbrushes.” B. “I’ll wash up blood spills with soap and hot water and allow them to air dry.” Correct C. “I’ll wash my hands with soap and water if I touch any blood from my child.” D. “I’ll rinse bloodstained clothing with hydrogen peroxide and then wash it as usual.” Rationale: The correct method of cleaning up blood spills is to wash the area with soap and water, rinse with bleach, and let the area air dry. The remaining statements by the mother reflect correct measures to prevent transmission of the virus. Test-Taking Strategy: Focus on the subject, transmission of HIV virus. Note the strategic words “need for further instruction,” which indicates a negative event query and the need to select the incorrect statement. Recalling that blood spills must be cleaned with a 1:10 bleach/water solution will direct you to the correct option. Review: home care measures for HIV Level of Cognitive Ability: Evaluating Client Needs: Safe and Effective Care Environment Integrated Process: Teaching and Learning Content Area: Child Health—Infectious Diseases Giddens Concepts: Client Education, Infection HESI Concepts: Infection, Teaching and Learning/Patient Education Awarded 98.0 points out of 98.0 possible points. 3. A child has been in the hospital for several days for treatment of severe vomiting related to his HIV-positive status. Which assessment finding is the best indication that the child’s condition is improving? A. No lesions in the mouth and throat B. Weight increase of 1 lb (0.45 kg) over 3 days Correct C. Temperature change from 100.2° F to 99.2° F (37.3°C) D. Capillary refill slowing from 2 seconds to 3 seconds Rationale: Vomiting results in fluid volume deficit. The most accurate method of evaluating fluid volume increase (the desired outcome) is weight. A temperature decrease is not reflective of fluid volume increase. Increasing capillary refill time is indicative of a fluid volume decrease, not an increase. The absence of mouth ulcers would allow the child to drink without pain but does not reflect a fluid volume increase. Test-Taking Strategy: Note the data in the question and the strategic word best, and remember that the child is experiencing severe vomiting. Use the process of elimination and focus on the subject, an assessment finding indicating fluid volume increase. The correct option is the only one related to fluid volume. Review: child with HIV and severe vomiting Level of Cognitive Ability: Evaluating Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Child Health—Infectious Diseases Giddens Concepts: Fluid and Electrolytes, Evidence HESI Concepts: Evidence-Based Practice/Evidence, Fluids and Electrolytes Awarded 98.0 points out of 98.0 possible points. 4. A girl with systemic lupus erythematosus (SLE) wants to go to the beach with her friends on the day after their junior prom. The girl asks the nurse for guidance regarding sun exposure. The nurse should provide which information to the girl? A. She cannot be exposed to any sunlight at all B. She must bring a beach umbrella and remain under it all day C. Waterproof sunscreen with a minimum sun protection factor (SPF) of 15 is a necessity Correct D. It is all right to go to the beach as long as she wears sunglasses, a sun hat, and clothes that cover her entire body Rationale: SLE, a chronic multi-system autoimmune disease characterized by inflammation of the connective tissue, varies in severity and is marked by remissions and exacerbations. Although the origin of SLE is not known, genetic, environmental, hormonal, and immune response factors are likely responsible. These factors include exposure to sun and other UV light, stress, fatigue, viruses, bacteria, certain medications, and some food additives. Avoiding triggers that set off exacerbation is essential, so wearing appropriate sunscreen is a necessity. The sunscreen should contain an SPF higher than 15 and should be waterproof. The remaining options present incorrect information. Test-Taking Strategy: Focus on the subject, girl with SLE. Eliminate the options that are comparable or alike in that they indicate that exposure to sunlight must be avoided. Also, noting the close-ended words “cannot” and “must” will help you eliminate these options. Review: preventing exacerbation of SLE Level of Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment Integrated Process: Teaching and Learning Content Area: Safety Giddens Concepts: Client Education, Immunity HESI Concepts: Immunmity, Teaching and Learning/Patient Education Awarded 98.0 points out of 98.0 possible points. 5. A nurse is monitoring a school-age child who is being treated for dehydration. The nurse notes that the child’s urine output has been 1 mL/kg/hr over the past 3 hours and that the specific gravity of the urine is 1.020. Which is the appropriate nursing action? A. Contact the pediatrician B. Document the findings Correct C. Encourage the child to drink more fluids D. Increase the rate of flow of the intravenous (IV) solution Rationale: The appropriate nursing action is for the nurse to document the findings, because they are normal. Urine output of less than 2 to 3 mL/kg/hr in infants and toddlers, 1 to 2 mL/kg/hr in preschoolers and young school-age children, and 0.5 to 1 mL/kg/hr in school-age children or adolescents indicates dehydration. A specific gravity of the urine above 1.020 may indicate dehydration. Test-Taking Strategy: Focus on the subject, child with dehydration. Note the data in the question, and the strategic word “appropriate”. This indicates the best action by the nurse. Eliminate the options that indicate the need to implement additional treatment. Additionally, note that these options indicate increasing fluid intake. Remember also that the nurse would not increase the rate of IV fluids without a pediatrician’s prescription to do so. Review: urine output and specific gravity in school-age child Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Awarded 98.0 points out of 98.0 possible points. 6. Intravenous potassium chloride (KCL) in 0.9% sodium chloride solution has been prescribed for a child who is severely dehydrated. Before administering the solution, the nurse must take which priority action? A. Check urine output Correct B. Evaluate skin turgor C. Measure capillary refill D. Obtain the child’s blood pressure Rationale: The nurse’s priority action is to check the child’s urine output. Potassium chloride is not administered if the urine output is not adequate. If the child is anuric, potassium will be retained, causing an increased potassium level. Although skin turgor, capillary refill, and blood pressure may be checked, they are not essential assessments in this situation. Test-Taking Strategy: Focus on the subject, severely dehydrated child to receive intravenous solution of KCL. Note the strategic word“priority.” Eliminate the options that refer to clinical signs/symptoms of dehydration — skin turgor and capillary refill. Focus on what the question is asking about the administration of a particular solution. Review: IV potassium chloride Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Assessment Content Area: Intravenous Therapy Giddens Concepts: Clinical Judgment, Safety HESI Concepts: Clinical Decision-Making/Clinical Judgment, Safety Awarded 98.0 points out of 98.0 possible points. 7. A nurse is monitoring a 3-year-old with diarrhea for signs/symptoms of dehydration. The child now weighs 42 lb (19 kg), a decrease from his weight of 44 lb (20 kg) 24 hours ago. In addition to dry mucous membranes and lack of tears, what assessment finding would the nurse find? A. Decreased heart rate B. Bilateral 1+ pedal pulses Correct C. Increased blood pressure D. Urine output of 80 mL in the last 3 hours Rationale: The assessment finding the nurse would expect to find in the child with dehydration is a bilateral 1+ pedal pulse that is difficult to palpate, weak, and thready. The minimum urine output for a child is 1 mL/kg/hour. The child weighs 42 lb, or 19 kg, so 80 mL in the last 4 hours is within the minimum range. A child with dehydration will have a rapid, weak, thready pulse. Blood pressure may be decreased in moderate and severe dehydration, but it is a late sign of hypovolemia. Test-Taking Strategy: Focus on the subject, signs/symptoms of dehydration. Thinking about the pathophysiology of dehydration will direct you to the correct option. Review: child with dehydration Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Assessment Content Area: Fluids & Electrolytes Giddens Concepts: Clinical Judgment, Fluid and Electrolytes HESI Concepts: Clinical Decision-Making/Clinical Judgment, Fluid and Electrolytes Awarded 98.0 points out of 98.0 possible points. 8. A nurse is assigned to care for a child with diarrhea. Which intervention should the nurse avoid in caring for the child? A. Wearing clean gloves B. Turning the child every 2 hours C. Using protective moisture barriers D. Taking a rectal temperature every 4 hours Correct thermometer in the rectum stimulates peristalsis and may damage excoriated tissue. Gloves are worn when caring for the child. Clean gloves are sufficient; sterile gloves are not necessary in this situation. The child is turned every 2 hours to reduce pressure on irritated skin and to prevent skin breakdown. Protective moisture barriers, such as creams or ointments, are useful in protecting the skin from diarrhea stools. Test-Taking Strategy: Note the strategic word “avoid,” which indicates a negative event query and the need to select the incorrect intervention. Focusing on the child’s diagnosis and recalling that peristalsis would aggravate the condition will direct you to the correct option. Review: child with diarrhea Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Child Health—Gastrointestinal Giddens Concepts: Clinical Judgment, Elimination HESI Concepts: Clinical Decision-Making/Clinical Judgment, Elimination Awarded 98.0 points out of 98.0 possible points. 9. A nurse is providing home care instructions to the mother of a child who has undergone cleft lip repair. Which statements by the mother indicate an understanding of these instructions? Select all that apply. A. “I should put her on her stomach to sleep.” B. “I shouldn’t brush her teeth for 1 to 2 weeks.” Correct C. “I should rinse her mouth with water after feeding her.” Correct D. “I should watch for signs/symptoms of infection like drainage or fever.” Correct E. “I should never use a bulb syringe to clear secretions from her mouth.” Rationale: “I shouldn’t brush her teeth for 1 to 2 weeks,” “I should rinse her mouth with water after feeding her,” and “I should watch for signs/symptoms of infection like drainage or fever” are all accurate statements. Gentle aspiration of oral secretions may be needed to prevent respiratory complications, and bulb syringes are often sent home with the family for removal of these secretions. After cleft lip repair the child should be kept supine, on the side opposite the repair, or in an infant seat. The prone position could result in contact of the suture line with the bed linens, leading to disruption of the suture line. Test-Taking Strategy: Focus on the subject, an understanding of home care measures. Consider the safety issues related to oral surgery and positioning and wound care. Visualize each of the options to answer correctly. Review: cleft lip repair Level of Cognitive Ability: Evaluating Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Child Health—Gastrointestinal Giddens Concepts: Client Education, Safety HESI Concepts: Safety, Teaching and Learning/Patient Education Awarded 98.0 points out of 98.0 possible points. 10. A newborn is found to have esophageal atresia (EA) with tracheoesophageal fistula (TEF). In which position does the nurse immediatelyplace the infant? A. Trendelenburg B. Flat and side-lying C. Prone, with the head of the bed flat D. Supine, with the head of the bed elevated Correct Rationale: EA and TEF are congenital malformations in which the esophagus terminates before it reaches the stomach, a fistula forms an unnatural connection with the trachea, or both. Keeping the infant supine, with the head of the bed elevated, decreases the likelihood that gastric secretions will enter the lungs. Placing the child in the Trendelenburg position, flat and side-lying, or prone with the head of the bed flat is incorrect; any of these positions could result in the aspiration of gastric secretions. Test-Taking Strategy: Focus on the subject, infant with EA and TEF. Note the strategic word, “immediately” and recall the pathophysiology of this disorder. Recalling that the primary concern is aspiration of gastric secretions will direct you to the correct option. Review: infant with EA and TEF Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Child Health—Gastrointestinal Giddens Concepts: Clinical Judgment, Safety HESI Concepts: Clinical Decision-Making/Clinical Judgment, Safety Awarded 98.0 points out of 98.0 possible points. 11. A nurse is assigned to care for an infant with congenital diaphragmatic hernia (CDH). Which clinical finding supports this diagnosis? A. Presence of an anal membrane B. Failure to pass meconium stool C. Viscera located outside the abdominal cavity D. Auscultation of cardiac sounds on the right side of the chest Correct Rationale: CDH is an opening in the diaphragm through which abdominal contents herniate into the thoracic cavity during prenatal development. Clinical findings depend on the severity of the defect but may include the presence of abdominal organs in the chest (revealed by fetal ultrasonography), diminished breath sounds or an absence of such sounds on the affected side, auscultation of bowel sounds over the chest, auscultation of cardiac sounds on the right side of the chest, respiratory distress, and a scaphoid abdomen. The presence of an anal membrane and failure to pass meconium stool are findings noted in imperforate anus. The presence of viscera outside the abdominal cavity is noted in gastroschisis. Test-Taking Strategy: Focus on the subject, child with CDH. Eliminate first the options that are comparable or alike in that they are related to an imperforate anus. To select from the remaining options, focus on the name of the disorder and use your knowledge of the pathophysiology of CDH to find the correct option. Review: CDH Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Assessment Content Area: Child Health—Gastrointestinal Giddens Concepts: Clinical Judgment, Evidence HESI Concepts: Clinical Decision-Making/Clinical Judgment, Evidence-Based Practice/Evidence Awarded 98.0 points out of 98.0 possible points. 12. A nurse provides home care instructions to the mother of an infant with gastroesophageal reflux disease (GERD). Which statement by the mother indicates a need for further instruction? A. “I shouldn’t give the baby a pacifier.” Correct B. “I should thicken feedings with rice cereal.” C. “I should put the baby on her right side with her head raised.” D. “I need to give the baby small, frequent feedings and use a predigested formula.” Rationale: The use of a pacifier allows the infant to practice swallowing. Pacifier use also decreases the incidence of crying and reflux episodes and may increase clearance of reflux stomach contents. Small, frequent feedings of a predigested formula will reduce the amount of formula in the stomach, ease distension, and minimize reflux. These smaller, more frequent feedings with frequent burping are often tried as the first line of treatment. Thickened feedings tend to decrease the chances of reflux, vomiting, and aspiration. Placing the affected infant in a 30- degree head-elevated prone or right-side–lying position helps prevent reflux. Test-Taking Strategy: Focus on the subject, infant with GERD. Note the strategic words “need for further instruction.”