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Evolve: Pediatric exam.
A 3-week-old newborn is brought to the clinic for follow-up after a home birth. The mother reports that her child bottle feeds for 5 minutes only and then falls asleep. The nurse auscultates a loud murmur characteristic of a ventricular septal defect (VSD), and finds the newborn is acyanotic with a respiratory rate of 64 breaths per minute. What instruction should the nurse provide the mother to ensure the infant is receiving adequate intake? (Select all that apply.) - CORRECT ANSWER IS A. Monitor the the infant's weight and number of wet diapers per day. - child should at least have 6 wet diapers per day. B. Increase the infant's intake per feeding by 1 to 2 ounces per week.- child is always fatigue, need to increase to 30 oz a day C. Allow the infant to rest and refeed on demand or every 2 hours.- child is always fatigue, this will ensure adequate feeding. D. Use a softer nipple or increase the size of the nipple opening.- this will save energy A 15-year-old girl tells the school nurse that all of her friends have started their periods and she feels abnormal because she has not. Which response is best for the nurse provide? - CORRECT ANSWER IS Explain that menarche varies and occurs between the ages of 12 and 18 years. Which finding in a 19-year-old female client should trigger further assessment by the nurse? - CORRECT ANSWER IS Menstruation has not occurred- menarche usually occur between the ages of 12 and 18 years old At 8 a.m. the unlicensed assistive personnel (UAP) informs the charge nurse that a female adolescent client with acute glomerulonephritis has a blood pressure of 210/110. The 4 a.m. blood pressure reading was 170/88. The client reports to the UAP that she is upset because her boyfriend did not visit last night. What action should the nurse take first? - CORRECT ANSWER IS Administer PRN prescription of nifedipine (Procardia) sublingually. -CA channel blocker -always assess physiological needs A 3-year-old client with sickle cell anemia is admitted to the Emergency Department with abdominal pain. The nurse palpates an enlarged liver, an x-ray reveals an enlarged spleen, and a CBC reveals anemia. These findings indicate which type of crisis? - CORRECT ANSWER IS Answer: Sequestration.- pooling of blood causes and pain and anemia d/t blockage of blood in the spleen
- Aplastic anemia- anemia d/t drugs
- Hyperhemolytic anemia- anemia d/t the breakdown of RBC 3.Vaso-occlusive anemia- sickle cells are clogging up small capillaries- and pain but not enlarged spleen and liver
A preschool-age child who is hospitalized for hypospadias repair is most strongly influenced by which behavior? - CORRECT ANSWER IS pre school age children are conceded about lost of body mutilation or body integrity. nurse should explain- they did not cause the illness, procedure is not punishment, restoring body image with a band-aid. The vital signs of a 4-year-old child with polyuria are: BP 80/40, Pulse 118, and Respirations 24. The child's pedal pulses are present with a volume of +1, and no edema is observed. What action should the nurse implement first? - CORRECT ANSWER IS Start an IV infusion of normal saline- patient is experiencing fluid vole deficit A 6-month-old boy and his mother are at the healthcare provider's office for a well-baby check-up and routine immunizations. The healthcare provider recommends to the mother that the child receive an influenza vaccine. What medications should the nurse plan to administer today? - CORRECT ANSWER IS 6 months:
- DTAP
- HEP -B (1st dose: birth, 2nd dose: 1-2 months, 3rd dose 6-9 months)
- PCV
- IPV
- INFLUENZA~ adminster at a different site A 3-year-old boy is brought to the emergency room because he swallowed an entire bottle of children's vitamin pills. Which intervention should the nurse implement first? - CORRECT ANSWER IS Determine the child's pulse and respiration~ always remember ABC assess: respiratory, cardiac, and neuro The parents of a 3-week-old infant report that the child eats well but vomits after each feeding. What information is most important for the nurse to obtain? - CORRECT ANSWER IS Description of vomiting episodes in past 24 hours.- assessment of what cause vomiting episodes leaning towards treatment The nurse is planning care for school-aged children at a community care center. Which activity is best for the children? - CORRECT ANSWER IS Playing follow-the-leader. erikson: industry vs inferiority achieve independence and productivity The mother of a 2-year-old boy consults the nurse about her son's increased temper tantrums. The mother states, "Yesterday he threw a fit in the grocery store, and I did not know what to do. I was so embarrassed. What can I do if this occurs again?" Which recommendation is best for the nurse to provide this mother? - CORRECT ANSWER IS Walk away from him and ignore the behavior -temper tantrums are normal, just ignore the behavior.
when to use numeric pain scale - CORRECT ANSWER IS minimum of 9 years old when to use verbal report - CORRECT ANSWER IS 3 year old can point out location and degree of pain nonverbal signs of pain - CORRECT ANSWER IS -grimacing -irritability -restlessness -difficultiy in sleeping or feeding vital signs of pain - CORRECT ANSWER IS -increased HR -increased RR -diaphoresis -decreased 02 levels when to use cries - CORRECT ANSWER IS 36-60 weeks pain rating scale (PRS) - CORRECT ANSWER IS 1-36 months of age A 6-year-old is admitted to the pediatric unit after falling off a bicycle. Which intervention should the nurse implement to assist the child's adjustment to hospitalization? - CORRECT ANSWER IS Explain hospital schedules to the child, such as mealtimes. -always keep a consistent schedule, if possible try to copy house schedule. this will decrease separation anxiety The mother of a preschool-aged child asks the nurse if it is all right to administer Pepto Bismol to her son when he "has a tummy ache." After reminding the mother to check the label of all over-the-counter drugs for the presence of aspirin, which instruction should the nurse include when replying to this mother's question? - CORRECT ANSWER IS Do not give if the child has chickenpox, the flu, or any other viral illness. Correct -pepto bismol: contains aspirin, aspirin + any viral, flue or infection = reye syndrome -->reye syndrome (encephalophy + hepatic dysfunction) A 5-month-old is admitted to the hospital with vomiting and diarrhea. The pediatrician prescribes dextrose 5% and 0.25% normal saline with 2 mEq KCl/100 ml to be infused at 25 ml/hour. Prior to initiating the infusion, the nurse should obtain which assessment finding? - CORRECT ANSWER IS Serum BUN and creatinine levels. add potassium = need adequate renal function + urine output The nurse is assessing an 8-month-old child who has a medical diagnosis of Tetrology of Fallot. Which symptom is this client most likely to exhibit? - CORRECT ANSWER IS Clubbed fingers d/t hypoxia -tachycardia > bradycardia
An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct the defect. The nurse recognizes that surgical correction is designed to achieve which outcome? - CORRECT ANSWER IS Prevent the return of oxygenated blood to the lungs The nurse is developing a plan of care for a 3-year-old who is scheduled for a cardiac catheterization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement? - CORRECT ANSWER IS Give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there. Correct When taking the health history of a child, the nurse knows that which finding is an early indication of hypothyroidism in children? - CORRECT ANSWER IS Cessation of growth in a child that had been normal. hypothyrodism-->d/t metabolism--> decrease metabolism--> cessation of the growth The nurse is teaching a 12-year-old male adolescent and his family about taking injections of growth hormone for idiopathic hypopituitarism. Which adverse symptoms, commonly associated with growth hormone therapy, should the nurse plan to describe to the child and his family? - CORRECT ANSWER IS growth hormone causes increase in blood sugar-->monitor for diabetes (Polyuria and polydipsia) The nurse is caring for a 12-year-old with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication? - CORRECT ANSWER IS Changes in level of consciousness. fluid retention + DILUTED hyponatremia A 4-year-old girl continues to interrupt her mother during a routine clinic visit. The mother appears irritated with the child and asks the nurse, "Is this normal behavior for a child this age?" The nurse's response should be based on which information? - CORRECT ANSWER IS Children need to retain a sense of initiative without impinging on the rights and privileges of others. Correct -Children aged 3 to 6 are in Erickson's "Initiative vs. Guilt" stage, which is characterized by vigorous, intrusive behavior, enterprise, and strong imagination. At this age, children develop a conscience and must learn to retain a sense of initiative without impinging on the rights of others develop a conscience and learn a sense of initiative without being rude to the rights of others-->vigorous, intrusive havior, enterprise and strong imagination
Preoperative nursing care for a child with Wilms' tumor should include which intervention? - CORRECT ANSWER IS Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN." Correct -prevent spreading the encapsulated tumor to other organs An 18-month-old is admitted to the hospital with possible Hirschsprung's disease. When obtaining a nursing history, the nurse asks about bowel habits. What description of the disease? - CORRECT ANSWER IS Ribbon-like and brown. Bile-colored and watery = gastroenteritis Foul-smelling and fatty = cystic fibrosis Semi-solid and yellow= normal in breast fed neonates The nurse is planning the care of a 2-year-old with severe eczema on the face, neck, and scalp from scratching the affected areas. Which nursing intervention is most effective in preventing further excoriation due to the pruritis? - CORRECT ANSWER IS Place elbow restraints on the child's arms lbow restraints prevent arm flexion and scratching of involved areas, but do not inhibit use of the hands for play activities The nurse assigning care for a 5-year-old child with otitis media is concerned about the child's increasing temperature over the past 24 hours. Which statement is accurate and should be considered when planning care for the remainder of the shift? - CORRECT ANSWER IS Tympanic and oral temperatures are equally accurate. Correct hypothalamus and eardrum are perfused by the same circulation causes the same core temp by ear and oral A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse warrants immediate intervention? - CORRECT ANSWER IS Apical heart rate of 60. Correct In developing a teaching plan for a 5-year-old child with diabetes, which component of diabetic management should the nurse plan for the child to manage first? - CORRECT ANSWER IS 5 year old = glucose reading (think of it as playing a game) 9 year old = can self administer the medication with proper demonstration
The nurse observes a 4-year-old boy in a daycare setting. Which behavior would the nurse consider normal for this child? - CORRECT ANSWER IS Demonstrates aggressiveness by boasting when telling a story. A burned child is brought to the emergency room. In estimating the percentage of the body burned, the nurse uses a modified "Rule of Nines." Which part of a child's body is calculated as a larger percentage of total body surface than an adult's? - CORRECT ANSWER IS child= head + neck adult= chest + arms The nurse receives a lab report stating a child with asthma has a theophylline level of 15 mcg/dl. What action will the nurse take? - CORRECT ANSWER IS theophylline: 10- 20 mcg/dl A 12-month-old boy is admitted with a respiratory infection and possible pneumonia. He is placed in a mist tent with oxygen. Which nursing intervention has the greatest priority for this infant? - CORRECT ANSWER IS Have a bulb syringe readily available to remove secretions. Correct Humidification will liquefy the nasal secretions All of the following interventions can be used to evaluate the effectiveness of nursing and medical interventions used to treat diarrhea. Which intervention is least useful in the nurse's evaluation of a 20-month-old child? - CORRECT ANSWER IS Assessing fontanels. by 20 months, the fontanels are suppose to be closed already. The nurse is assigning care for a 4-year-old child with otitis media and is concerned about the child's increasing temperature over the past 24 hours. When planning care for this child, it is important for the nurse to consider that - CORRECT ANSWER IS a tympanic measurement of temperature will provide the most accurate reading. A three-month old boy weighing 10 lbs 15 oz has an axillary temperature of 98.9° F. The nurse determines the daily caloric need for this child is approximately - CORRECT ANSWER IS 600 calories per day. 10.9 divide by 2.2 = 5kg x 108 kg/cal/day = x 5 = 540. since there is a 10% increase, 54 +540= 594, 600 calories per day. The nurse is preparing a health teaching program for parents of toddlers and preschoolers and plans to include information about prevention of accidental poisonings. It is most important for the nurse to include which instruction? - CORRECT ANSWER IS Store all toxic agents and medicines in locked cabinets.
adolescent: body image and peer acceptance are the main concerns. the stem of the question is stating that he is concerned about his distorted appearance. allowing email communication will still allow peer communication and acceptance while preserving his body image A 17-year-old male student reports to the school clinic one morning for a scheduled health exam. He tells the nurse that he just finished football practice and is on his way to class. The nurse assesses his vital signs: temperature 100° F, pulse 80, respirations 20, and blood pressure 122/82. What is the best action for the nurse to take? - CORRECT ANSWER IS Tell the student to proceed directly to his regularly scheduled class. Correct -the kid just came from football practice, which increases his muscle activity. 100.4 is a regular temp. -taking the child to drink cold fluids, then retake temp--> this would give false assurance. A child falls on the playground and is brought to the school nurse with a small laceration on the forearm. Which action should the nurse implement first? - CORRECT ANSWER IS Wash the wound gently with mild soap and water. -hydrogen peroxide +povidone-iodine = will irritate the wound. clean the wound first to prevent infection then put ice A 16-year-old is brought to the Emergency Center with a crushed leg after falling off a horse. The adolescent's last tetanus toxoid booster was received eight years ago. What action should the nurse take? - CORRECT ANSWER IS Administer tetanus toxoid booster. Detanus is part of DTAP vaccine. -first dose: 6 months -booster shoot: adolescent or adults -booster shot: traumatic injury-->contaminated with by dirt, feces, soil or saliva puncture or crushing injuries, avulsions, wounds from missiles, burns, or frostbite During administration of a blood transfusion, a child complains of chills, headache, and nausea. Which action should the nurse implement? - CORRECT ANSWER IS Stop the infusion immediately and notify the healthcare provider. Correct -adjust IV fluids -TPN- cannot d/c or increase fluids--> hypoglycemia -blood transfusion--> can d/c it -->anaphylic reaction The nurse is assessing the neurovascular status of a child in Russell's traction. Which finding should the nurse report to the healthcare provider? - CORRECT ANSWER IS Pale bluish coloration of the toes.
-skin traction: force is applied to the skin -skeletal traction: pin or wire applies pull directly to the distal bone fragment A premature newborn girl, born 24 hours ago, is diagnosed with a patent ductus arteriosus (PDA) and placed under an oxygen hood at 35%. The parents visit the nursery and ask to hold her. Which response should the nurse provide to the parents? - CORRECT ANSWER IS The oxygen hood is holding the baby's oxygen level just at the point which is needed. You may stroke and talk to her. Correct -room air is 21%, since the oxygen hood is at 35% the baby needs the oxygen hood. offer an alternative like stroke the patient and offer reassurance The nurse is teaching the parents of a 5-year-old with cystic fibrosis about respiratory treatments. Which statement indicates to the nurse that the parents understand? - CORRECT ANSWER IS aersol therapy then postural drainage before meals or 1 hour after aerosl therapy loosens up the secretions, then psutral drainage moves it up The clinic nurse is taking the history for a new 6-month-old client. The mother reports that she took a great deal of aspirin while pregnant. Which assessment should the nurse obtain? - CORRECT ANSWER IS Type of reaction to loud noises. Correct ototoxicity can cause tinnitus and vertigo in children if the mother uses aspirin during pregnancy. aspirin side effect of tinnitus only occurs during utero. -NO RISK FOR BLEEDING FOR THE INFANT, ONLY THE MOTHER The mother of a 4-year-old child asks the nurse what she can do to help her other children cope with their sibling's repeated hospitalizations. Which is the best response that the nurse should offer? - CORRECT ANSWER IS Encourage the mother to have the children visit the hospitalized sibling. Correct -remember: incorporate a house environment, prevent separation anxiety and allow sibling visitors to decrease stress and anxiety seperation anxiety- toddler or pre school - CORRECT ANSWER IS toddler greatest threat The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which approach by the nurse is most helpful in establishing communication? - CORRECT ANSWER IS Engage the child through drawing pictures.
COMPRESSION
ELEVATE
A nurse provides the parents with information on health maintenance for their child with sickle cell disease. Which information reflected by the parents indicates understanding of the child's care? - CORRECT ANSWER IS -hydration #1 priority to prevent viscosity of blood. -since the sickle cell can impact the spleen, liver, kidney, bones and CNS--> can increase for for infection d/t no function of the spleen. need to administer immunization shots The nurse reviews the latest laboratory results for a child who received chemotherapy last week and identifies a reduced neutrophil count. Which nursing diagnosis has the highest priority for this child? - CORRECT ANSWER IS low neutrophil count = risk for infection because body is no longer fighting the infection high neutrophil count= you have an infection and body is fighting it off A child is rescued from a burning house and brought to the emergency room with partial-thickness burns on the face and chest. Which action should the nurse implemented first? - CORRECT ANSWER IS any burn patient: always remember ABC!
