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NUR 254 EXAM 4 (GALEN) NEWEST 2026 ACTUAL
EXAM| MATERNAL AND PEDIATRICS EXAM 4
REVIEW WITH COMPLETE 25 0 REAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
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The nurse is assessing a child who has severe iron deficiency anemia. Which of the following assessment finds should the nurse expect to observe? - ANSWER - Pallor The nurse is caring for a child who is suspected of having bacterial meningitis. The results of the lumbar puncture are still pending. Which of the following actions by the nurse is the priority? - ANSWER - Assessing neurological status every 2-4 hours. The nurse is assessing a 6-year-old for manifestations of autism spectrum disorder. Which of the following manifestations should the nurse expect to observe in this child? - ANSWER - Monotone speech The nurse is developing a plan of care for a child diagnosed with attention-deficit hyperactivity disorder (ADHD). Which of the following information should the nurse include in the plan of care? - ANSWER - Psychostimulant medications and behavior modification. The nurse preceptor is observing a newly hired nurse care for a child who has Down syndrome. Which of the following manifestations, if
documented by the newly hired nurse, requires follow up by the nurse preceptor? - ANSWER - Protruding tongue The nurse is caring for a child who had a ventricular shunt placement 24 hours ago. The child is sitting up in bed crying and has vomited a small amount on the bed linens. Which of the following actions should the nurse take first? - ANSWER - Complete a neurological assessment. The nurse working in the emergency department (ED) is caring for a 2- month-old child who presents with intraocular bleeding, bradycardia, and bulging fontanels, but no trauma to the head, face, or neck. Health history and physical examination is incongruent, and abuse is suspected. Which of the following actions should the nurse perform? - ANSWER - Notify child protective services (CPS) The nurse is caring for a child who is hospitalized for 24-hour observation following a head injury. Which of the following actions by the nurse is the priority? - ANSWER - Checking pupil reaction every 4 hours The nurse is assessing a child in a coma and notes that the child has decorticate posturing. Which of the following findings should the nurse expect the child to demonstrate? - ANSWER - Rigid flexion with elbows, wrists and fingers flexed, and legs extended and rotated inward
A nurse is admitting an infant diagnosed with phenylketonuria (PKU). Which of the following should the nurse consider when planning care for this infant? - ANSWER - providing teaching about a low- phenylalanine diet. A nurse is caring for a child who has a new cast and is at risk for compartment syndrome. Which of the following manifestations should the nurse monitor with this child? - ANSWER - Paresthesia The nurse is caring for an infant who is undergoing serial casting for the correction of clubfoot and has had the initial cast applies. Which of the following actions should the nurse teach the parents? - ANSWER - Perform neurovascular checks every 2 hours The nurse is caring for a child who is diagnosed with severe scoliosis. Which of the following prescriptions should the nurse expect to be ordered? - ANSWER - A referral to an orthopedic surgeon for surgery The nurse is caring for an adolescent with a fracture. Which of the following nursing interventions is a priority? - ANSWER - Encourage peer visitation The nurse is caring for a client who has a fracture of the right femur with a newly applied cast. Which of the following assessment findings should the nurse report to the primary health care provider (PHCP)
immediately? - ANSWER - An unrelenting pain that is unrelieved by pain medication. The nurse is caring for a 5-year-old child who has been bitten on the leg by a dog. After cleansing the area with soap and water, which of the following actions should the nurse take next? - ANSWER - Report the bite to the local health department. The nurse is screening infants for early warning signs of cerebral palsy. Which of the following should the nurse recognize as 1 of the early warning signs of cerebral palsy? - ANSWER - Poor head control Consequences of Anemia - ANSWER - Decrease in oxygen-carrying capacity of blood and decreased amount of oxygen available to tissues Consequences of Anemia - ANSWER - When develops slowly, child adapts Consequences of Anemia - ANSWER - Diagnostic evaluation: Sometimes defined as a Hgb <10 or 11 g/dl; however, this cutoff may be inappropriate for children Newborn Anemia - ANSWER - 14 to 24 g/dl Infant Anemia - ANSWER - 10 to 15 g/dl
Anemia - ANSWER - Treat underlying cause: Transfusion after hemorrhage if needed Anemia - ANSWER - Treat underlying cause: Nutritional intervention for deficiency anemias Anemia - ANSWER - Supportive care: Intravenous (IV) fluids to replace intravascular volume, Oxygen, and Bed rest Anemia - ANSWER - Nursing Care Management: Prepare child and family for laboratory tests Anemia - ANSWER - Nursing Care Management: Decrease oxygen demands Anemia - ANSWER - Nursing Care Management: Prevent complications Anemia - ANSWER - Nursing Care Management: Support family Iron Deficiency Anemia - ANSWER - Caused by inadequate supply of dietary iron
Iron Deficiency Anemia - ANSWER - Iron-fortified cereals and formulas for infants Iron Deficiency Anemia - ANSWER - Special needs of premature infants Iron Deficiency Anemia - ANSWER - Adolescents at risk because of rapid growth and poor eating habits Iron Deficiency Anemia - ANSWER - Therapeutic management: Increase the amount of iron the child receives Iron Deficiency Anemia - ANSWER - Nursing care management: Diet and Iron supplementation Sickle Cell Anemia - ANSWER - A hereditary hemoglobinopathy Sickle Cell Anemia - ANSWER - Occurs primarily in African- Americans Sickle Cell Anemia - ANSWER - Occurrence 1 in 375 infants born in United States Sickle Cell Anemia - ANSWER - 1 in 12 have sickle cell trait
Sickle Cell Anemia - ANSWER - Pathophysiology: Hgb in the RBCs takes on an elongated shape Sickle Cell Anemia - ANSWER - Pathophysiology: rigid and obstruct capillary blood flow Sickle Cell Anemia - ANSWER - Pathophysiology: Microscopic obstructions lead to engorgement and tissue ischemia Sickle Cell Anemia - ANSWER - Pathophysiology: Hypoxia occurs and causes sickling Sickle Cell Anemia - ANSWER - No cure (except possibly bone marrow transplants) Sickle Cell Anemia - ANSWER - Supportive care/prevent sickling episodes Sickle Cell Anemia - ANSWER - Frequent bacterial infections may occur because of immunocompromise Sickle Cell Anemia - ANSWER - Bacterial infection is leading cause of death in young children
Sickle Cell Anemia - ANSWER - Strokes in 5% to 10% of children Sickle Cell Crisis - ANSWER - Anything that increases body's need for oxygen or alters transport of oxygen Sickle Cell Crisis - ANSWER - Trauma Sickle Cell Crisis - ANSWER - Infection, fever Sickle Cell Crisis - ANSWER - Physical and emotional stress Sickle Cell Crisis - ANSWER - Increased blood viscosity caused by dehydration Sickle Cell Crisis - ANSWER - Hypoxia Sickle Cell Crisis - ANSWER - Acute exacerbations that vary in severity and frequency Sickle Cell Crisis - ANSWER - Vaso-occlusive thrombotic Vaso-occlusive thrombotic - ANSWER - Most common type of sickle cell crisis; very painful
Aplastic crisis - ANSWER - Signs include profound anemia, pallorSickle Sickle cell manifestions - ANSWER - Possible growth retardation Sickle cell manifestions - ANSWER - Chronic anemia Sickle cell manifestions - ANSWER - Delayed sexual maturation Sickle cell manifestions - ANSWER - Marked susceptibility to sepsis Diagnosis of Sickle Cell - ANSWER - Cord blood in newborns Diagnosis of Sickle Cell - ANSWER - Newborn screening done in 43 states Diagnosis of Sickle Cell - ANSWER - Genetic testing to identify carriers and children who have disease Diagnosis of Sickle Cell - ANSWER - Sickle turbidity test Diagnosis
Sickle Cell Management - ANSWER - To prevent the sickling phenomena.... Keep hydrated! Sickle Cell Management - ANSWER - To treat the medical emergencies of crisis Sickle Cell Management - ANSWER - Aggressive treatment of infection Sickle Cell Management - ANSWER - Possible prophylactic antibiotics from 2 months to 5 years Sickle Cell Management - ANSWER - Monitor reticulocyte count regularly to evaluate bone marrow function Sickle Cell Management - ANSWER - Blood transfusion, if given early in crisis, may reduce ischemia Sickle Cell Management - ANSWER - Frequent transfusion decreases hemosiderosis (iron in tissues) Sickle Cell Management - ANSWER - hydroxyurea hydroxyurea - ANSWER - (cytotoxic) decreases production of abnormal blood cells and decreases pain
Thalassemia - ANSWER - Classified by Hgb chain affected and amount of effect Thalassemia - ANSWER - Autosomal recessive with varying expressivity Thalassemia - ANSWER - Both parents must be carriers to have offspring with disease Thalassemia - ANSWER - Anemia results from defective synthesis of Hgb, structurally impaired RBCs, and shortened life of RBCs Thalassemia - ANSWER - Chronic hypoxia: Headache, irritability, precordial and bone pain, exercise intolerance, anorexia, epistaxis Thalassemia - ANSWER - Detected in infancy or toddlerhood: Pallor, FTT, hepatosplenomegaly, severe anemia (Hgb <6) α-Thalassemia - ANSWER - α-chains affected α-Thalassemia - ANSWER - Occurs in Chinese, Thai, African, and Mediterranean people
B-Thalassemia - ANSWER - Occurs in Greeks, Italians, and Syrians B-Thalassemia - ANSWER - most common and has four forms B-Thalassemia minor - ANSWER - asymptomatic silent carrier B-Thalassemia trait - ANSWER - mild microcytic anemia B-Thalassemia intermediate - ANSWER - moderate-to-severe anemia plus splenomegaly B-Thalassemia major - ANSWER - "Cooley's anemia"; severe anemia requiring transfusions to survive B-Thalassemia - ANSWER - Diagnosis: By Hgb electrophoresis, RBC changes often seen by 6 weeks of age, Child presents with severe anemia, FTT B-Thalassemia - ANSWER - Therapeutic Management: Blood transfusion to maintain normal Hgb levels B-Thalassemia - ANSWER - Side effect of treatment: hemosiderosis
B-Thalassemia - ANSWER - Prognosis: Expect to live well into adulthood with proper clinical management B-Thalassemia - ANSWER - Prognosis: Bone marrow transplant is potential cure Neoplastic Disorders - ANSWER - Leading cause of death from disease in children past infancy Neoplastic Disorders - ANSWER - Almost half of all childhood cancers involve blood or blood-forming organs Leukemia - ANSWER - Most common form of childhood cancer Leukemia - ANSWER - Three or four cases per 100,000 Caucasian children <15 years old Leukemia - ANSWER - More frequent in males >1 year old Leukemia - ANSWER - Peak onset between 2 and 5 years of age Leukemia - ANSWER - Survivability
Leukemia - ANSWER - a broad group of malignant diseases of bone marrow and lymphatic system Leukemia - ANSWER - Complex disease with varying heterogeneity Leukemia - ANSWER - Classifications are increasingly complex Leukemia - ANSWER - Morphology: Acute lymphoid leukemia (ALL) Leukemia - ANSWER - Morphology: Acute nonlymphoid (myelogenous) leukemia (ANLL or AML) Leukemia - ANSWER - Morphology: Stem cell or blast cell leukemia Leukemia - ANSWER - Symptoms: ALL: lymphatic, lymphocytic, lymphoblastic, and lymphoblastoid leukemia Leukemia - ANSWER - Symptoms: AML: granulocytic, myelocytic, monocytic, myelogenous, monoblastic, and nonmyeloblastic leukemia Acute lymphoblastic leukemia (ALL) - ANSWER - Most common
