NRSG 4502 PEDS FINAL EXAM TEST BANK QUESTIONS AND ANSWERS

NRSG 4502 PEDS FINAL EXAM TEST BANK QUESTIONS AND ANSWERS MORBIDITY/MORTALITY STATISTICS: The clinic nurse is reviewing statistics on infant mortality for the United States versus other countries. Compared with other countries that have a population of at least 25 million, the nurse makes which determination? -The United States is ranked last among 27 countries. Which is the leading cause of death in infants younger than 1 year in the United States? -congenital anomalies What is the major cause of death for children older than 1 year in the United States? -Unintentional injuries In addition to injuries, what are the leading causes of death in adolescents ages 15 to 19 years? -Suicide and homicide The nurse is planning a teaching session to adolescents about deaths by unintentional injuries. Which should the nurse include in the session with regard to deaths caused by injuries? -more deaths occur in males What do mortality statistics describe? -the number of individuals who have died over a specific period The nurse should assess which age group for suicide ideation since suicide in which age group is the third leading cause of death? -late school age and adolescents Parents of a hospitalized toddler ask the nurse, what is meant by family-centered care? The nurse should respond with which statement? -Family-centered care recognizes that the family is the constant in a child’s life The school nurse is evaluating the number of school-age children classified as obese. The nurse recognizes that the percentile of body mass index that classifies a child as obese is greater than which? -95th percentile The school nurse is explaining to older school children that obesity increases the risk for which disorders? (Select all that apply.) -hypertension, dyslipidemia, and altered glucose metabolism COMPLICATIONS OF JAUNDICE What is an infant with severe jaundice at risk for developing? -encephalopathy When should the nurse expect breastfeeding-associated jaundice to first appear in a normal infant? -2-4 days Which intervention may decrease the incidence of physiologic jaundice in a healthy full-term infant? -institute early and frequent feedings What is an important nursing intervention for a full-term infant receiving phototherapy? -observing for signs of dehydration When should the nurse expect jaundice to be present in a full-term infant with hemolytic disease? -within 24 hours after birth The nurse is caring for an infant who will be discharged on home phototherapy. What instructions should the nurse include in the discharge teaching to the parents? -Make a follow-up visit with the health care provider within 2 or 3 days after your infant has been on phototherapy IMMUNIZATIONS Pertussis vaccination should begin at which age? -2 months A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. What should the nurse explain? -A topical anesthetic can be applied before injections are given. A 4-month-old infant comes to the clinic for a well-infant checkup. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations should include which? -DTaP and IPV can be safely given Which serious reaction should the nurse be alert for when administering vaccines? -allergic reaction Which muscle is contraindicated for the administration of immunizations in infants and young children? -dorsogluteal The nurse is administering the first hepatitis A vaccine to an 18-month-old child. When should the child return to the clinic for the second dose of hepatitis A vaccination? -after 6 months The nurse is preparing to administer a measles, mumps, rubella, and varicella (MMRV) vaccine. Which is a contraindication associated with administering this vaccine? -the child has a disorder that causes a deficient immune system The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine? (Select all that apply.) -the hepatitis B vaccination series should be begun at birth -an unimmunized 10-year-old child should receive 3 doses administered 4 weeks apart The nurse is planning to administer immunizations to a 6-month-old infant. Which interventions should the nurse implement to minimize local reactions from the vaccines? (Select all that apply.) -select a needle length of 1 inch -inject the vaccine into the vastus lateralis The clinic nurse is administering influenza vaccinations. Which children should not receive the live attenuated influenza vaccine (LAIV)? (Select all that apply.) -a child with asthma -a child with diabetes -a child with cancer receiving chemo What immunization should not be given to a child receiving chemotherapy for cancer? -MMR A parent of a hospitalized child on chemotherapy asks the nurse if a sibling of the hospitalized child should receive the varicella vaccination. The nurse should give which response? -the sibling can get a Varicella vaccination COMMUNICATION STYLE (only Q’s that were not totally common sense included) Which is considered a block to effective communication? -using clichs Which is the single most important factor to consider when communicating with children? -child’s developmental level Because children younger than 5 years are egocentric, the nurse should do which when communicating with them? -focus communication on the child The nurse’s approach when introducing hospital equipment to a preschooler who seems afraid should be based on which principle? -child may think equipment is alive When the nurse interviews an adolescent, which is especially important? -allow an opportunity to express feelings The nurse understands that blocks to therapeutic communication include what? (Select all that apply.) -socializing -using clichs -defending a situation RESPIRATORY DISTRESS IN INFANTS Which is a central factor responsible for respiratory distress syndrome in a newborn? -deficient surfactant production A preterm infant of 33 weeks of gestation is admitted to the neonatal intensive care unit. Approximately 2 hours after birth, the neonate begins having difficulty breathing, with grunting, tachypnea, and nasal flaring. What should the nurse recognize? -further evaluation is needed The nurse is caring for a preterm neonate who requires mechanical ventilation for treatment of respiratory distress syndrome. Because of the mechanical ventilation, the nurse should recognize an increased risk of what? -pneumothorax What are possible premature infant complications from oxygen therapy and mechanical ventilation? -bronchopulmonary dysplasia and retinopathy of prematurity A preterm infant with respiratory distress syndrome is receiving inhaled nitric oxide (NO). What is the reason for administering the inhaled nitric oxide? -to reduce pulmonary vasoconstriction and pulmonary hypertension The nurse is caring for a neonate with respiratory distress syndrome. The infant has an endotracheal tube. What should nursing considerations related to suctioning include? -suctioning should not be carried out routinely The health care provider has prescribed surfactant, beractant (Survanta), to be administered to an infant with respiratory distress syndrome (RDS). The nurse understands that the beractant will be administered by which route? -via the ET tube NURSING INTERVENTIONS FOR PAIN REDUCTION What describes nonpharmacologic techniques for pain management? -they may reduce pain perception Which nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain? -oral sucrose and nonnutritive sucking The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurse’s response should be based on which characteristic about preterm infant’s pain? -they perceive and react to pain in much the same manner as children and adults A preterm infant has just been admitted to the neonatal intensive care unit. The infant’s parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. What should the nurse’s explanation be? -pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates The nurse is teaching the parents of a child with recurrent headaches methods to modify behavior patterns that increase the risk of headache. Which statement by the parents indicates understanding the teaching? -we will respond matter-of-factly to requests for special attention NEPHROTIC SYNDROME What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome? -reduced serum albumin What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)? -minimize excretion of urinary protein A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child? -minimize risk of infection The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need? -restricting fluids A child is admitted for minimal change nephrotic syndrome (MCNS). The nurse recognizes that the child’s prognosis is related to what factor? -response to steroid therapy The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching? -I should not add additional salt to any of my child’s meals What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema? -elevate the scrotum with a rolled washcloth What do the clinical manifestations of minimal change nephrotic syndrome include? -massive proteinuria, hypoalbuminemia, and edema For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs? -diuresis occurs as urinary protein excretion diminishes A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone. The nurse realizes further teaching is required if the parents state what? -we understand our child will not be able to attend school, so we will arrange for home schooling The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what? -2 to 3 years What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply.) -no salt added at the table -restriction of foods high in sodium NURSING INTERVENTIONS FOR IV THERAPY The nurse is caring for a child receiving a continuous intravenous (IV) low-dose infusion of morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to do which first? -administer naloxone (Narcan) The nurse is planning pain control for a child. Which is the advantage of administering pain medication by the intravenous (IV) bolus route? -provides most rapid onset of effect, usually in about 5 minutes When caring for a child with an intravenous (IV) infusion, what is an appropriate nursing action? -check the insertion site frequently for signs of infiltration The nurse determines that a child’s intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action? -end the infusion and notify the practitioner CYSTIC FIBROSIS Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF? -mechanical obstruction caused by increased viscosity of mucous gland secretions What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (CF)? -Meconium ileus What tests aid in the diagnosis of cystic fibrosis (CF)? -sweat test, stool for fat, chest radiography A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? -before chest physiotherapy (CPT) A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (DNase). What statement about DNase is true? -may cause voice alterations The parent of a child with cystic fibrosis (CF) calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these signs and symptoms are suggestive of what condition? -pneumothorax Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be included in the plan of care? -pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal A child is in the hospital for cystic fibrosis. What health care providers prescription should the nurse clarify before implementing? -pancreatic enzymes every 6 hours In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind? -diet should be high in calories, proteins, and unrestricted fats A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative of cystic fibrosis (CF)? -greater than 60 mEq/L A school-age child with cystic fibrosis takes four enzyme capsules with meals. The child is having four or five bowel movements per day. The nurse’s action in regard to the pancreatic enzymes is based on the knowledge that the dosage is what? -needs to be increased to decrease the number of bowel movements per day RESPIRATORY INFECTIONS Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of respiratory infections? -they are safer Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which information? -do not use for more than 3 days