Pediatrics Flashcards
The parents of a 1-month-old boy bring their son to the clinic for evaluation of a possible developmental dysplasia of the right hip. The nurse should observe for which of the following?
1. Limited adduction of the right leg. 2. Uneven gluteal fold and thigh creases. 3. Increase in length of the right limb. 4. Internal rotation of the right leg.
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Strategy: Think about each answer choice.
(1) will see limited abduction
(2) correct—folds and creases will be longer and deeper on affected side
(3) will be decrease in limb length
(4) may or may not see internal rotation
The nurse assesses the development of a 3-month-old boy in the well-child clinic. Which of the following behaviors, if observed by the nurse, is UNEXPECTED?
1. The boy holds his head erect when sitting on the examination table. 2. The boy tries to grasp a toy just out of reach. 3. The boy turns his head to try to locate a sound. 4. The boy smiles spontaneously when he sees his mother.
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Strategy: Picture the infant.
(1) expected at 3 months
(2) correct—unexpected until 6 months of age
(3) expected at 3 months of age
(4) expected at 3 months of age
A 2-month-old with a temperature of 102°F (39°C) is brought to the emergency department by his mother. The mother tells the nurse that the infant had a DPaT injection 1 week ago, and asks if this fever is related to the immunization. The nurse’s response should be based on which of the following?
1. If a fever does occur in a child after a DPaT, it usually occurs within the first 2 hours. 2. An elevated temperature is very rarely seen in a child after a DPaT immunization. 3. If there is a fever after a DPaT, it is usually low-grade and appears within the first 48 hours. 4. The child's high fever is a direct response to the DPaT immunization and should be treated.
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Strategy: Think about each answer choice.
(1) inaccurate; low-grade fever is expected within 24 to 48 hours
(2) inaccurate; low-grade fever is expected within 24 to 48 hours
(3) correct—low-grade fever and irritability frequent response to immunization
(4) symptoms should be reported to physician, antipyretic usually prescribed
The nurse in the well-baby clinic observes a group of children. The nurse notes that one child is able to sit unsupported, play “peek-a-boo” with the nurse and is starting to say “mama” and “dada”. The nurse determines the infant’s behaviors are consistent with which of the following ages?
1. 5 months of age. 2. 6 months of age. 3. 9 months of age. 4. 12 months of age.
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Strategy: Picture each infant.
(1) unable to sit unsupported until 8 months
(2) unable to sit unsupported until 8 months
(3) correct—can pull self up and assume a sitting position at 8 months, can say few words
(4) would be able to say three to five words in addition to dada and mama
A 4-month-old child is admitted with a tentative diagnosis of meningitis. To confirm the diagnosis, a lumbar puncture (LP) is ordered. While assisting the physician with the procedure, it is MOST important for the nurse to take which of the following actions?
1. Appropriately restrain the child. 2. Instruct the parents about the procedure. 3. Provide support to the child. 4. Elevate the head of the bed.
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Strategy: Think “Maslow.”
(1) correct—primary objective is to prevent trauma to child during the procedure; child must be restrained
(2) not as high a priority as preventing injury to the child
(3) should be done before and/or after the procedure
(4) elevating the head of the bed for a 4-month-old will not expose the spinal column
Which of the following is a correct instruction by the nurse to the parent of a 4-year-old client regarding collecting a specimen to be tested for pinworms?
1. Collect the specimen 30 minutes after the child falls asleep at night. 2. Save a portion of the child's first stool of the day and take it to the physician's office immediately. 3. Collect the specimen in the early morning with a piece of Scotch tape touched to the child's anus. 4. Feed the child a high-fat meal, and then save the first stool following the meal.
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Strategy: Answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) specimen should be collected early in the morning after the child awakens
(2) unnecessary; pinworms are not routinely found in the stool
(3) correct—pinworms crawl outside the anus early in the morning to lay their eggs
(4) inappropriate for this situation
The nurse cares for clients in the pediatric clinic. The mother of a child calls the nurse to say that after administering Dimetane-DC cough syrup to her child, her child becomes very excitable and restless. Which of the following actions by the nurse is MOST appropriate?
1. Report the child's behavior to the physician to alert the physician to the potential need for a change in medication. 2. Instruct the mother to administer half the ordered amount in all future doses to limit this behavioral response. 3. Instruct the mother to give the child a glass of warm milk to dilute any medication left in the stomach. 4. Chart the child's response to the medication, and alert the staff about the mother's phone call.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) correct—although this type of response to antihistamines is not uncommon in young children, it is undesirable and must be reported to the physician so that a change in drug therapy can be initiated
(2) is not within the realm of the nurse’s scope of practice; physician must order dose changes
(3) inappropriate
(4) response must be charted, and the child’s intolerance to the drug documented and reported to other nurses; this is not enough, physician must be alerted so that preventive action can be taken
A 2-year-old is admitted to the pediatric unit with numerous bruises, a fractured left humerus, and several lacerations with unexplained origin. The nurse identifies which of the following as a priority nursing action?
1. Report the findings to the child protection agency. 2. Share this information only with other health care professionals. 3. Document this information in the chart. 4. Share the information with the pediatric social worker.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) correct—any suspicion of child abuse should be reported to the child protection agency
(2) does not provide or plan for protection of the child
(3) does not provide or plan for protection of the child
(4) does not provide or plan for protection of the child
A 4-week-old infant with symptoms of pyloric stenosis is brought to the outpatient clinic by his mother. Which of the following statements does the nurse expect the mother to make about her son’s symptoms?
1. "My son's bowel movements have turned black and sticky." 2. "I really have to encourage my son to suck the bottle." 3. "My son is fussy and seems hungry all the time." 4. "My son spits up green liquid after feeding."
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Strategy: Determine how each statement relates to pyloric stenosis.
(1) not expected with pyloric stenosis, suggestive of blood in stool
(2) sucking problems not expected with pyloric stenosis
(3) correct—becomes lethargic, dehydrated, and malnourished
(4) would expect emesis to contain milk or formula, should not be bile-colored
The mother of an 8-month-old infant prepares to take her child home after treatment for bacterial meningitis. The mother confides to the nurse that she is afraid that her child will have brain damage as a result of his illness. Which of the following is the BEST response by the nurse?
1. "Trust your doctors. They are excellent pediatricians and will know what to look for." 2. "There is a 20% incidence of residual brain damage after this type of illness, but the odds are in your favor." 3. "It is an unlikely possibility, but if your child doesn't develop normally, your pediatrician will help you with any problems." 4. "You feel guilty about your son's illness, and that's understandable. You will feel better after you get home."
Show/hide explanation
Strategy: Remember therapeutic communication.
(1) nontherapeutic, diminishes person’s concerns and feelings
(2) nontherapeutic to discuss statistics with patients, wrong emphasis for discussion
(3) correct—if treated early, good prognosis; may be complications and long-term effects (seizure disorders, hydrocephalus, impaired intelligence, visual and hearing defects); therapeutic response
(4) nontherapeutic, interprets person’s feelings
The nurse cares for a 2-month-old infant diagnosed with reflux. Which of the following nursing actions is MOST appropriate?
1. Hold the next feeding. 2. Teach the mother CPR. 3. Maintain a normal feeding schedule. 4. Elevate the head of the bed.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) may not be necessary if positioning is effective
(2) inappropriate
(3) client’s feedings should be changed to small-volume, frequent feedings
(4) correct—infant with reflux should be maintained in an upright position; head of the bed should be raised at a 30° angle
A preschooler is brought to the emergency department after ingesting a bottle of baby aspirin. The nurse should observe the preschooler for which of the following signs and symptoms?
1. Nausea and vertigo. 2. Epistaxis and paralysis. 3. Dysrhythmia and hypoventilation. 4. Tinnitus and gastric distress.
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Strategy: Think about each answer choice and how it relates to aspirin overdose.
(1) dizziness not seen with aspirin overdose
(2) nosebleed may occur, but not paralysis
(3) may see hyperventilation with use of aspirin, does not affect heart rhythm
(4) correct—symptoms of overdose
While a 2-day-old infant is in surgery for repair of spina bifida, the infant’s mother expresses concern to the nurse because the doctor told her the infant would be confined to a wheelchair. Which of the following statements, if made by the nurse, is BEST?
1. "Physical therapy can restore the function to affected muscles." 2. "Orthopedic devices will allow your child to strengthen lower extremity muscles." 3. "Corrective surgery will return function to the affected muscles." 4. "The corrective surgery will not change your child's physical disability." A client has a subclavian triple lumen catheter used for administration of total parenteral nutrition (TPN). The physician orders all lumens be flushed with a diluted heparin solution BID. When the nurse attempts to flush the distal lumen, resistance is met. The nurse should take which of the following actions? 1. Clamp off the lumen and label it as "clotted off." 2. Gradually increase the pressure on the irrigating solution. 3. Aspirate blood from the lumen to restore patency. 4. Secure the lumen with a Luer-Lock cap and notify the physician.
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Strategy: Determine the outcome of each answer choice.
(1) not appropriate or true regarding this condition
(2) not appropriate or true regarding this condition
(3) not appropriate or true regarding this condition
(4) correct—spinal nerves that are destroyed by the myelomeningocele cannot be corrected; nothing can return function to portions of the body that are innervated by the spinal nerves below the site of the myelomeningocele
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) should be reported to the physician to see if patency can be re-established before it is labeled as clotted off
(2) force should never be used to irrigate the catheter
(3) blood should not be aspirated from the catheter
(4) correct—streptokinase may be used to dissolve clot; if unsuccessful, lumen is labeled as clotted off
