PEDS practice capstone final questions and answers 2024.docx

  A nurse is teaching the mother of a child who has cystic fibrosis and has a prescription for pancreatic enzymes three times per day. Which of the following statements indicates that the mother understands the teaching? "My child will take the enzymes to improve her metabolism." "My child will take the enzymes following meals." "My child will take the enzymes to help digest the fat in foods." "My child will take the enzymes 2 hours before meals." - Correct Answers: "My child will take the enzymes to help digest the fat in foods." MY ANSWER Pancreatic enzymes help the body to digest fat in foods. take pancreatic enzymes immediately before meals. A nurse is providing teaching to the parents of a child who has streptococcal pharyngitis about ways to prevent disease transmission. Which of the following responses by the parent indicate an understanding of the teaching? "We'll continue to encourage him to drink lots of fluids." "We'll take his temperature every 4 hours." "We'll give him Tylenol for the pain." "We'll discard his toothbrush and buy another." - Correct Answers: "We'll discard his toothbrush and buy another." MY ANSWER Children who have positive throat cultures for streptococcal infection should replace their toothbrush after they have been taking antibiotics for 24 hr. Using a contaminated toothbrush can re-introduce the bacteria and spread it to others if others handle the toothbrush. A nurse in an emergency department is caring for an infant who has a 2day history of vomiting and elevated temperature. Which of the following should the nurse recognize as the most reliable indicator of fluid loss? Body weight Skin integrity Blood pressure Respiratory rate - Correct Answers: Body weight MY ANSWER Body weight is the most reliable indicator of fluid loss for infants and young children. A nurse is providing teaching to a school aged child who has a new diagnosis of type one diabetes mellitus. Which of the following statements by the child indicates an understanding of the teaching? "My morning blood glucose should be between 90 and 130." "I should eat a snack half an hour before playing soccer." "I should not take my regular insulin when I am sick." "I can store unopened bottles of insulin in the freezer." - Correct Answers: "I should eat a snack half an hour before playing soccer." MY ANSWER Exercise lowers blood glucose levels. The child should eat a snack half an hour prior to physical activity. If the exercise is prolonged, the child might require a snack during the activity. A nurse is planning care for an infant who has spinal bifida and has to undergo surgical closure of the myelomeningocele SAC? Which of the following interventions should the nurse include in the plan of care? Maintain the infant in the supine position. Initiate contact precautions. Provide a latex-free environment. Limit visitors to immediate family members. - Correct Answers: Provide a latex-free environment. MY ANSWER Children who have spina bifida have a very high risk for developing a latex allergy, which can be life-threatening. The specific cause is unknown. However, because the incidence of latex allergy increases with repeated exposure to latex products, it is critical for the nurse to eliminate every possible exposure to supplies and equipment that contain latex. A nurse in an Ed is caring for a child who is experiencing an acute asthma attack. which of the following medication should the nurse expect to administer first? Fluticasone Budesonide Montelukast Albuterol - Correct Answers: Albuterol MY ANSWER Albuterol is considered a "rescue" medication due to its rapid onset of action. Asthma is a chronic inflammatory disorder of the airways. Asthmatic episodes are associated with airflow limitation or reversible obstruction. Albuterol is a beta2 adrenergic agonist used for the treatment of acute exacerbations of asthma by promoting bronchodilation and suppressing histamine release in the lungs. This medication can be given by inhalation, orally, or as a parenteral preparation. The inhaled medication has a more rapid onset of action than the oral form and also reduces the risk for the adverse effects of irritability, tremor, nervousness, and insomnia. A nurse is preparing to administer a vaccine to a 4year old child. Which of the following vaccines should the nurse administer? Haemophilus influenza type b (Hib) Hepatitis B (HepB) Varicella (VAR) Meningococcal (MCV4) - Correct Answers: Varicella (VAR) MY ANSWER The child should have received the first dose between 12 to 15 months of age. The child should then receive a second dose between 4 and 6 years of age. A nurse is teaching new parents the proper way to use an infant safety seat. Which of the following should indicate to the nurse a need for further teaching? "I will dress my baby in a one piece outfit so I can use the harness to secure her in the car seat." "My baby will be able to watch me drive while sitting in the back seat." "I will place the infant safety seat in the middle of the back seat, away from the windows." "We will need to go by the weight and height of the child when deciding to change to a booster seat." - Correct Answers: "My baby will be able to watch me drive while sitting in the back seat." MY ANSWER The safest area for a car seat is in the back seat. Infants should travel in a rear-facing position for the best protection from airbags and neck and head injury. While in a rear-facing position, the back of the car seat supports the infant's weak neck muscles, soft fontanels, and spine in the event of a frontal motor vehicle crash. A nurse is administering ear drops to a toddler and pulls the auricle down and back. The mother asks why are you pulling the ear that way? Which of the following explanation should the nurse provide? "This technique opens the ear canal, allowing medication to reach the inner ear region." "When this technique is used, the toddler experiences less pain." "This is the safest and easiest way to administer this medication." "When this technique is used, the medication will not run out of the ear." - Correct Answers: "This technique opens the ear canal, allowing medication to reach the inner ear region." MY ANSWER For children younger than 3 years old, the auricle should be pulled down and back to fully open the ear canal. This technique allows the correct dose of medication to enter the ear. a nurses caring for a child who ingested kerosene. Which of the following assessment is the nurse's priority? Respiratory rate Burns of the mouth Bowel sounds Visual acuity - Correct Answers: Respiratory rate MY ANSWER Using the airway, breathing, circulation approach to client care, the nurse should prioritize assessing the client's respiratory rate. Small amounts of kerosene can enter the lungs and damage them directly, causing a severe aspiration pneumonia. Because the pneumonia is caused by chemical irritation rather than bacteria, antibiotics aren't useful for prevention or treatment. Breathing becomes rapid and gasping, and vomiting and persistent coughing can follow. In severe cases, brain damage can occur. A nurse is caring for a child on the oncology unit. The child's parents are asking the nurse about the cancer diagnosis. Which of the following information should the nurse provide the parents about the most common malignant renal and intra-abdominal tumor of childhood? Ewing sarcoma Osteosarcoma Neuroblastoma Wilms' tumor - Correct Answers: Wilms' tumor MY ANSWER Wilms' tumor, or nephroblastoma, is the most common malignant renal and intra-abdominal tumor of childhood. A nurse is caring for a group of adolescents. Which of the following findings should be reported to the provider immediately? A who is client 1 day postoperative and has a temperature of 37.5° C (99.5° F) A client who has a burn injury to an estimated 5% his leg and is crying A client's blood pressure changes from 112/60 mm Hg to 90/54 mm Hg when standing A client who has an ankle fracture reports a pain level increase from 3 to 5 after initial ambulation - Correct Answers: A client's blood pressure changes from 112/60 mm Hg to 90/54 mm Hg when standing Vital sign ranges for adolescents are similar to those for adults. A drop in the systolic blood pressure of more than 20 mm Hg or a drop in the diastolic of more than 10 mm Hg after standing is considered to be orthostatic hypotension. One of the most common causes of orthostatic hypotension is hypovolemia. The client likely will feel lightheaded and dizzy. This finding should be reported to the provider. A nurse receives a call from a parent of a child who has von Willebrand disease and has having a Nosebleed. Which of the following instructions should the nurse give to the parent? "Place your child in a sitting position with her head tilted back." "Apply ice at the base of the nose for 5 min and then check for bleeding." "Place your child in a supine position with a pillow under her back." "Have your child sit with her head tilted forward and hold pressure on her nose for 10 minutes." - Correct Answers: "Have your child sit with her head tilted forward and hold pressure on her nose for 10 minutes." The nurse should instruct the parent to have the child sit up with her head tilted forward to reduce the risk of aspiration. The parent should apply pressure with the thumb and forefinger to the child's nose for 10 min and then check for further bleeding. A nurse is providing health promotion teaching to an adolescent. Which of the following information should the nurse include in this teaching? "Share piercing needles only with close friends you trust." "Limit your caloric intake to avoid becoming overweight." "Your need for sleep will increase during periods of growth." "Tanning beds are much safer then lying in the sun." - Correct Answers: "Your need for sleep will increase during periods of growth." MY ANSWER The nurse should inform the adolescent that sleep needs increase during growth spurts. Adequate sleep and rest during the adolescent period is important for optimal health. 11-month-old infant reportedly fell down a flight of stairs from the porch to the sidewalk. CT scan shows small subdural hematoma. Admit for close observation. Which of the following actions should the nurse take? (Select all that apply.) Encourage the guardian to feed the infant. Palpate fontanel level. Assess pupillary reaction to light. Stabilize the infant's spine. Evaluate for the presence of a Babinski reflex. Measure the infant's head circumference. - Correct Answers: Palpate fontanel level. Assess pupillary reaction to light. Measure the infant's head circumference. Measure the infant's head circumference is correct. Manifestations of an increasing subdural hematoma can include an increase in the infant's head circumference as blood collects between the dura and arachnoid membranes that cover the brain. Assess pupillary reaction to light is correct. An increase in intercranial pressure due to acute hemorrhage can cause neurological changes in pupillary reaction to light. Pupil responses to light can be unresponsive, unequal, or slow. Palpate fontanel level is correct. Manifestations of an increasing subdural hematoma can include bulging of the anterior fontanel as blood collects between the dura and arachnoid membranes that cover the brain. A nurse is caring for a child who has suspected appendicitis. Which of the following provider prescriptions should the nurse clarify? Maintain NPO status. Monitor oral temperature every 4 hr. Medicate the client for pain every 4 hr as needed. Administer sodium biphosphate/sodium phosphate. - Correct Answers: Administer sodium biphosphate/sodium phosphate. Enemas and laxatives are contraindicated because they increase the volume in the bowel and can cause the inflamed appendix to rupture, increasing the risk for peritonitis. A nurse is caring for a 12 month old toddler who is hospitalized and confined to a room with contact precautions in place. Which of the following toys should the nurse recommend in order to meet the developmental needs of the client? Large building blocks Hanging crib toys Modeling clay Crayons and a coloring book - Correct Answers: Large building blocks Large building blocks are age-appropriate toys for a 12-month-old toddler. A nurse is assessing a 3 month old infant. Which of the following findings should the nurse report to the provider? Inability to raise head when in prone position. Inability to sit without support. Inability to pick up an object with her fingers. Inability to bring an object to her mouth. - Correct Answers: Inability to raise head when in prone position A 3-month-old infant should be able to raise her head and shoulders from prone position; therefore, the nurse should report this finding to the provider. A nurse is caring for a toddler who has acute laryngotracheobronchitis and has been placed in a cool mist tent. Which of the following findings indicates that the treatment has been effective? Barking cough Improved hydration Decreased stridor Decreased temperature - Correct Answers: Decreased stridor Laryngotracheobronchitis, or croup, is a condition caused by an infection of the upper airway (larynx, trachea, and bronchus) and is characterized by a barking cough. Edema and obstruction in the upper airways cause the characteristic cough and stridor (noisy breathing). The direct purpose of a cool mist tent is to humidify the inspired air, which decreases respiratory effort. A nurse reports an incident of suspected child abuse. One of the parents of the child becomes upset and demands to know their reason for the nurse's action. Which of the following responses by the nurse is appropriate? "As a nurse, I am required by law to report suspected child abuse." "I am unable to discuss this, but I can contact my supervisor to speak with you." "The provider will be coming to explain the situation." "I reported the incident to my supervisor who decided to contact the authorities." - Correct Answers: "As a nurse, I am required by law to report suspected child abuse." A nurse is required by law to report suspected child abuse. Therefore, this is a truthful, non-accusatory response. A nurse is planning care for an adolescent who is postop following scoliosis repair with Harrington rod instrumentation. Which of the following interventions should the nurse include in the plan of care? Keep the head of the bed at a 30° angle. Reposition the client by log rolling every 4 hr. Place the client in protective isolation. Initiate the use of a PCA pump for pain control. - Correct Answers: Initiate the use of a PCA pump for pain control. The nurse should initiate the use of a PCA pump for an adolescent who is postoperative following scoliosis repair. The PCA pump allows the client to control the delivery of pain medications. the nurse should plan to maintain the client in a supine position to prevent bending of the spine. A nurse is caring for a child who has rheumatic fever. When obtaining the child's medical history from the parent the nurse should recognize the significance of which of the following data as a possible source of the child's infection? classmate who has fifth disease A sibling who had a sore throat 3 weeks ago The father who had gastritis 2 weeks ago A neighbor's child who has chickenpox - Correct Answers: A sibling who had a sore throat 3 weeks ago MY ANSWER Rheumatic fever typically develops 2 to 6 weeks after an untreated or ineffectively treated streptococcal infection of the respiratory tract. If the sibling had a respiratory infection, it is likely the client also has a streptococcal respiratory infection. A nurse is caring for a 4year old child who has croup and wet the bed overnight period when the parents visit the next day the nurse explained the situation and one of the parents say she never watched the bed at home. I am so embarrassed. Which of the following responses should the nurse make? "It is expected for children who are hospitalized to regress. The toileting skills will return when your child is feeling better." "I know this can really be embarrassing. I have kids myself, so I understand, and it doesn't bother me." "Your child did not seem upset, so I wouldn't worry about it if I were you." "Why does it bother you that your child has wet the bed?" - Correct Answers: "It is expected for children who are hospitalized to regress. The toileting skills will return when your child is feeling better." A recently learned skill, such as toilet training, is often temporarily lost due to the stress of hospitalization. The nurse should reassure the parents that regression is an expected behavior in children who are hospitalized and that her child will regain bladder control when she is feeling better. A nurse is caring for an adolescent who has spina bifida and is paralyzed from the waist down. Which of the following statements by the client should indicate to the nurse a need for further teaching? "I only need to catheterize myself twice every day." "I carry a water bottle with me because I drink a lot of water." "I use a suppository every night to have a bowel movement." "I do wheelchair exercises while watching TV." - Correct Answers: "I only need to catheterize myself twice every day." The client has paralysis from the level of the defect down. In the majority of cases, this condition affects bladder and bowel continence. Catheterization should be performed every 4 hr. Infrequent emptying of the bladder can result in stasis and urinary tract infections. A nurse is caring for a child who has influenza. The nurse should identify that which of the following statements by the parent indicates the child has an increased risk for Reye syndrome? "I give my child ibuprofen when his muscles are aching." "I am encouraging my child to drink grapefruit juice." "I give my child aspirin to reduce his fever." "I am leaving a humidifier on in my child's room when he naps." - Correct Answers: "I give my child aspirin to reduce his fever." The administration of aspirin for fever associated with a viral illness increases the child's risk for Reye syndrome. Reye syndrome is a metabolic encephalopathy with manifestations of cerebral edema and fatty changes in the liver. A nurse is assessing adolescent who has an exacerbation of Graves' disease. Which of the following findings should the nurse expect? Weight gain Bradycardia Lethargy Heat intolerance - Correct Answers: Heat intolerance An exacerbation of Graves' disease can cause heat intolerance due to an increased metabolic rate, which leads to warm flushed moist skin and extreme diaphoresis. A nurse is planning care for a 10 month old infant who is 8 hour postoperative following cleft palate repair period which of the following interventions should the nurse include in the infants plan of care? Feed the infant with a spoon for 48 hr. Apply and release elbow restraints every hour. Keep the infant supine. Suction the mouth with an oral suction tube. - Correct Answers: Apply and release elbow restraints every hour. It is essential to apply elbow restraints after surgery to keep the infant from placing her hands in and around her mouth. The nurse should remove them periodically to inspect the skin and allow the infant to exercise her arms. The nurse should avoid feeding the infant with a spoon to prevent trauma to the surgical site. Keeping the infant upright in an infant seat helps with drainage of secretions. The nurse should suction the infant's nose and mouth with a bulb syringe as needed to maintain a patent airway, but should not place hard objects, such as an oral suction tube, in the infant's mouth to avoid trauma. A home health nurse is teaching a child's parents about endotracheal suctioning. Which of the following information should the nurse include in the teaching? Apply suction when inserting the catheter. Apply suction for less than 10 seconds. Set the suction pressure to 110 mm Hg. Allow the child to rest for 10 to 15 seconds after each suctioning attempt. - Correct Answers: Apply suction for less than 10 seconds. Prolonged suctioning can cause damage to tissues and induce hypoxia. Hypoxia can interfere with stages of respiration, cellular absorption, and blood transport. The nurse should instruct the parents to give the child 30 to 60 seconds to rest after each suctioning attempt to allow oxygen saturation to return to baseline. set the suction pressure between 60 and 100 mm Hg. The nurse should instruct the parents to apply suction when withdrawing the catheter and not when inserting it. A nurse is providing discharge instructions to a parent and his school aged child who has juvenile idiopathic arthritis. Which of the following instructions should the nurse include? Encourage the child to take a 45 min nap daily. Allow the child to stay at home on days when her joints are painful. Apply cool compresses for 20 min every hour. Administer prednisone on an alternate-day schedule. - Correct Answers: Administer prednisone on an alternate-day schedule. Prednisone is an effective anti-inflammatory agent that can have serious adverse effects. Taking prednisone on an alternate-day schedule can help maintain joint mobility and minimize adverse effects. a school nurse is assessing a child who has been stung by a bee. The child's hand is swelling of the nurse notes that the child has allergies to insect stings. Which of the following findings should the nurse expect if the child develops anaphylaxis? Bradycardia Nausea Hypertension Urticaria Stridor - Correct Answers: Nausea. Urticaria Stridor A common gastrointestinal response to excessive histamine release is nausea. Urticaria is correct. A common skin manifestation of excessive histamine release is hives, also known as urticaria. Stridor is correct. A serious, life-threatening response to excessive histamine release is airway narrowing, which presents as dyspnea and stridor. A nurse is caring for a child who has an exacerbation of cystic fibrosis. Which of the following laboratory findings should the nurse report to the provider immediately? Blood glucose 140 mg/dL Oxygen saturation 85% RBC 3.2 million/uL Serum sodium 156 mEq/L - Correct Answers: Oxygen saturation 85% The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning - having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. Therefore, the nurse should report this finding to the provider immediately. A nurse is teaching the parents of a child who has rheumatic fever which of the following statements by a parent indicates understanding of the teaching? "My child may take aspirin for his joint pain." "My child will need a blood transfusion prior to discharge." "I will need to wear a gown when in my child's room." "I will apply lotion to my child's peeling hands." - Correct Answers: "My child may take aspirin for his joint pain." Children who have rheumatic fever might take salicylates (aspirin) to control the inflammatory process that occurs in the joints. A nurse is caring for a child who has cystic fibrosis and a pulmonary infection. Which of the following findings is the nurses priority? Blood streaking of the sputum Dry mucous membranes Constipation Inability to clear secretions - Correct Answers: Inability to clear secretions The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning - having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority-setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. Therefore, the inability to clear secretions is the priority-finding because the child has a compromised airway and the nurse must act in a manner that ensures transportation of oxygen to the body's cells. A nurse is reviewing the medical record of a 2 month old infant who has rotavirus. The nurse notes a hemoglobin level of 12 and a hematocrit of 51%. Which of the following statements by the nurse indicated understanding of the laboratory values? "The infant might be dehydrated." "The infant might be anemic." "The infant might have received too much fluid." "The infant might have leukemia." - Correct Answers: "The infant might be dehydrated." An increased hematocrit level indicates dehydration. Hematocrit levels rise when blood volume is decreased during dehydration.