Peds Tests

Question 1

When caring for a child with rheumatic fever the nurse would anticipate that the child’s history would most likely indicate which situation?

Answer 1

Recent strep throat infection

*Rheumatic fever is precipitated by a streptococcal infection, which may be undiagnosed or untreated. The disease is not hereditary and is not necessarily seen in family members. Easy bruising and increased urine output are not symptoms seen with rheumatic fever.

Question 2

The nurse is reinforcing teaching with a family caregiver of a child who has had a tonsillectomy the previous day and is being discharged. The nurse would reinforce that which reaction should be reported immediately to the child’s health care provider?

Answer 2

The child has frequent swallowing around the sixth day after surgery

*Bleeding can occur 5 to 7 days after surgery and is often noted by frequent swallowing. This is a concern and should be reported immediately. A sore throat is common for several days after surgery. If an ice collar becomes uncomfortable, it can be removed. Vomiting dark, old blood may be expected within the first 24 hours after a tonsillectomy

Question 3

A toddler with a diagnosis of a respiratory disorder has a fever and decreased urinary output. When planning care for this child, what would be Most appropriate goal for this toddler?

Answer 3

The child’s fluid intake will be increased

*Dehydration can be a concern for the child with a fever. Therefore, the highest priority would be increasing fluid intake to help in the prevention of dehydration. Reducing anxiety, allowing caregivers to talk about their concerns, and promoting adequate caloric intake would be appropriate for the child and caregiver, but they would not be the highest priority.

Question 4

The nurse is reinforcing teaching to a group of family caregivers of children who have Asthma. The caregivers make the following statements. which statement indicates a need for additional teaching?

Answer 4

We will be sure our child does not exercise to prevent attacks

*Children with asthma should be encouraged to exercise using moderation. They should not become extremely tired, and activities should be spaced to provide for periods of rest. Statements about identifying allergic triggers, using bronchodilator before steroid inhaler, and drinking water to thin secretions indicate that the caregivers have an understanding of treatments important for their child with asthma.

Question 5

What intervention should be included in the plan ofcare for a child with cystic fibrosis?

Answer 5

Perform postural drainage in morning and evening

*Postural drainage is performed in the morning and evening to help loosen and move secretions out of the lungs. Maintaining the child in a semi-Fowler’s or high Fowler’s position will promote lung expansion. High protein snacks will help increase caloric intake. Children with cystic fibrosis need to be protected from infection but do not need to be isolated.

Question 6

When developinga plan of care for a child with sickle cell disease, which nursing interventionwould be the Highest priority to include?

Answer 6

Administer analgesics promptly

*The child with sickle cell disease has severe pain that should be treated promptly. Providing family support, monitoring for skin breakdown, and moving the extremities gently are interventions appropriate for the family and child with sickle cell disease, but they would not be the highest priority.

Question 7

After discussing measures used to stop bleeding with the caregivers of a child diagnosed with hemophila, the caregiver makes the following statements. Which statement indicates a need for further teaching?

Answer 7

Whenever my child gets hurt, I have him sit up with his head elevated and his feet down

*When the child with hemophilia has a bleeding episode, the child is placed so the area of bleeding is raised above the level of the heart when possible. The caregiver’s statement that the head should be elevated with feet down indicates additional teaching is required. Ice and cold packs, keeping pressure on the injury site, and using splints to limit bleeding are all measures used to stop bleeding when the child with hemophilia is injured and indicate that the caregiver understands the instructions.

Question 8

A nurse admits a child with a diagnoses of possible Leukemia. Of the following signs and symptoms, which would most likely be seen in a child with leukemia.

Answer 8

Low-grade fever, bone and joint pain

*Low-grade fever, bone and joint pain, fatigue, pallor, petechiae, and purpura are signs and symptoms seen in a child with leukemia. High fever; sore throat; swelling around the eyes, ankles, and abdomen; and eyes that are slanted upward and outward are not indicative of leukemia.

Question 9

In planning care for a child with leukemia, which goal would be most important for this child?

Answer 9

The child will remain free of signs and symptoms of infection

*The child with leukemia is susceptible to infection, especially during chemotherapy, and should be monitored closely for signs of infection. Participating in age-appropriate activities, eating at least 60% of each meal, and sharing feelings about changes in body image would be appropriate, but not the most important goal.

Question 10

The nurse is caring for a client who has leukemia. Which nursing interventions should the nurse implement to decrease the likelihood of bleeding or injury?

Answer 10

• Apply pressure to sites of injections of veinipuncture
• Use mouthwash composed of hydrogen peroxide and saline solution
• Use a soft, sponge-type brush or gauze strips to give oral care
• Using a soft, sponge-type brush or gauze will decrease the likelihood of injury when doing oral care. Mouthwash composed of hydrogen peroxide and saline will help in keeping the mucous membranes and mouth clean, but will not be irritating to the tissues. Applying pressure to sites of injections or venipunctures will help prevent excess bleeding at these sites. Neutropenic precautions (commonly referred to as reverse isolation) would be important to prevent infection if the child’s white blood cell count was extremely low. Wearing a cap or scarf would be appropriate if the child experienced hair loss. Wearing gloves to deliver the child’s meal tray would be inappropriate and unnecessary.

Question 11

If an infant has a diagnosis of pyloric stenosis, the child would have a history of which symptoms?

Answer 11

Projectile vomiting

*Children with pyloric stenosis usually have a history of vomiting, which increases with force and frequency and becomes projectile. Iron deficiency anemia, muscle spasms, and nasal congestion are not commonly seen in the child with pyloric stenosis.

Question 12

A child is admitted with a diagnosis of possible appendisitis. What signs and symptoms would most likely be seen in the child with appendicitis?

Answer 12

Fever, nausea, and vomiting

*Fever, nausea, and vomiting are common in children with appendicitis. The child with appendicitis may also have abdominal pain but may have a difficult time localizing the pain. Sore throat, bone and joint pain, itching and swelling around the eyes and ankles, convulsions, and weight loss or gain are not signs and symptoms seen in the child with appendicitis.

Question 13

The nurse is reinforcing teacing with a group of parents of toddlers about what to do in case of poisoning. If a toddler has swallowed an unknown substance, what should be the first action of the caregiver?

Answer 13

Call the poison control center

*The caregiver should always call the Poison Control Center immediately when a child has swallowed a known or unknown substance. Depending on the substance swallowed, the Poison Control Center will direct the caregiver as to what steps to take next in treating or obtaining treatment for the child.

Question 14

The nurse is working with a 12 year old child with type 1 diabetes Mellitus. The child asks the nurse why she cannot take pills instead of shotslike her grandmother does. What is the best response by the nurse?

Answer 14

Your body does not make it’s own insulin, so the insulin shots help replace it

*The child with type 1 diabetes mellitus will most likely have to take insulin injections to control the disease. Individuals with type 2 diabetes usually are adults, and their disease sometimes can be controlled by taking oral hypoglycemic agents. Most type 1 diabetics will always have to take insulin to control their disease.

Question 15

A child is Diagnosesed with failure to thrive because of malnutrition, And has inadequate intake of calories.In planniong care for this child, what goal would be the highest priorityfor the child?

Answer 15

The child will increase intake for appropriate wt gain

*The goals with the highest priority for the child with a diagnosis of failure to thrive will be to maintain and increase their current intake and weight. Although maintaining good mouth and skin integrity, increasing daily exercise, decreasing anxiety, satisfying sucking needs, and increasing fluid intake are important, they are not the highest priority for the child with failure to thrive.

Question 16

After discussing ways to lower a fever with the family caregiver of an infant who has a UTI; the caregiver makes the following statements. Which statement indicates an understanding of appropriate ways to lower an infants temperature?

Answer 16

I know I need to dress my baby lightly if she has a fever

*Dressing the child lightly will help keep the body temperature down. Heavy clothing and blankets will trap body heat and cause the temperature to rise. Aspirin is never given to children because of the concern of developing Reye syndrome. Sponging the child with cold water is not recommended as a method of lowering an elevated temperature. A normal body temperature for an infant should be in the range of 97.6 °F to 99.3°F.” so a temperature below 97°F.” would be too low.

Question 17

In caring for a child with nephrotic syndrome, what interventionwill be included in the child’s plan of care?

Answer 17

Weighing on the same scale each day

*The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child’s fluid gain and loss. The child with nephrotic syndrome is usually on bed rest, fluids may be retained and therefore are not increased, and urine is tested for albumin and specific gravity.

Question 18

What situation will most likely be noted in the history of a child diagnosesed with acute glomerulonephritis?

Answer 18

Recent illness such as strep throat

*Symptoms of acute glomerulonephritis often appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat. A sibling with the same disease, hemorrhage or history of easy bruising, or hearing loss with impaired speech are not commonly associated with acute glomerulonephritis in a child.

Question 19

The nurse is reinforcing teaching with the family caregiver of a 5 year old child diagnosesed with nephrotic syndrome regaurding the no added salt diet the child has been placed on.In additionto not adding salt to foods, the nurse has discussed with the caregivers that helping the child avoid foods high in sodiumis also recommended. The caregiver marks the following foods in the child’s menu selectionfor the next day. The nurse recognizes the family caregiver needs further teaching regaurding foods high in sodiumwhen which of the following foods were selected?

Answer 19

• Scrambled eggs and ham
• Macaroni and cheese
• Hot dog in bun
• Dairy products, poultry, processed foods, and some grain products are higher in sodium than fruits (apple juice and canned peaches) and fresh vegetables (green beans).

Question 20

In caring for a child with a UTI, the nurse would perform the following nursing interventions. What intervention would be the highest priority for this child?

Answer 20

The nurse will collect a clean catch voided urine.

*The nurse would collect the “clean catch” voided urine specimen before any treatment is started to increase the likelihood of being able to identify the bacterium causing the infection. Reporting and recording urinary symptoms and observing for possible sexual abuse would be appropriate, but not the priority. Instructing caregivers about avoiding bubble baths and teaching girls to wipe from front to back would be important later in the care of the child.

Question 21

The nurse is caring for a 2-year-old diagnosed with bacterial pneumonia. The child has been placed in a mist tent. In caring for the child, it is important for the nurse to:

Answer 21

monitor the child regularly for signs of cyanosis

*In some treatment of bacterial pneumonia a croupette or mist tent is used. Children have become cyanotic in mist tents, with subsequent arrest, due to the lack of visibility while in the tent; the child must be constantly observed. Ribavirin, an antiviral drug that may be used to treat certain children with RSV, is administered as an inhalant by hood, mask, or tent; it has a high risk for teratogenicity (causing damage to a fetus) so care must be taken when the drug is administered. In treating a client with bacterial pneumonia, the client may need to be placed on infection control precautions according to the policy of the health care facility, and the nurse should look for hyperthermia related to the infection process.

Question 22

The caregiver of a child with sickle cell disease asks the nurse how much fluid her child should have each day after the child goes home. In response to the caregiver’s question, the nurse would explain that for the child with sickle cell disease, it is best that the child have:

Answer 22

1,500 to 2,000 mL of fluid per day

*Prevention of crises is the goal between episodes. Adequate hydration is vital; fluid intake of 1,500 to 2,000 mL daily is desirable for a child weighing 20 kg and should be increased to 3,000 mL during the crisis

Question 23

The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child’s diet?

Answer 23

Bananas

*The young child should be started on a starch-free, low-fat diet. Bananas contain invert sugar and are usually well tolerated. Products that contain wheat, rye, or oats should be excluded.

Question 24

The nurse is discussing the diagnosis of intussusception with a group of peers. What statement demonstrates the nurse’s appropriate understanding regarding this disorder?

Answer 24

The stools of the infant are called currant jelly stools and consist of blood and mucus.

*In the child with intussusception, the stools consist of blood and mucus, thereby earning the name currant jelly stools. There is a telescoping of the upper portion of the bowel slipping over the lower portion. The condition occurs more often in boys than in girls and the highest incidence occurs in infants between the ages of 4 and 10 months. The infant who previously appeared healthy and happy suddenly becomes pale, cries out sharply, and draws up the legs in a severe colicky spasm of pain. This spasm may last for several minutes, after which the infant relaxes and appears well until the next episode, which may occur 5, 10, or 20 minutes later.

Question 25

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine “looks funny.” He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:

Answer 25

Acute glomerulonephritis

*Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.