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66 Cards in this Set

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The nurse is performing discharge teaching about using the home apnea monitor. Which of the following statements should the nurse include in the teaching?

a. “home apnea monitors are used to detect obstructive apnea or hypoxemia”
b. “cables and wires should be threaded through the lower end of the child’s clothes”
c. “use lotion on the child’s chest before attaching leads to prevent skin breakdown”
d. “immediately perform CPR if alarm goes off”
B. “Cables and wires should be threaded through the lower end of the child’s clothes”

Home apnea monitors don’t detect obstructive apnea or hypoxemia. The monitor interprets the struggle to breathe as respiratory activity. In responding to an alarm, first observe the infant if the alarm is for a real event or a loose lead. (ch. 20, p 560)
A nurse is teaching parents of a 2-month old infant about reducing the risk of SIDS. Which of the following statements should not be included in the teaching?

a. Use a blanket sleeper to keep the child warm
b. Place baby on a firm mattress w/ bumper pads
c. Place baby in supine position when sleeping
d. Recommend pacifier use for bedtime or naptime
B. Place baby on firm mattress w/ bumper pads

Bumper pads, pillows, or loose bedding should be avoided. Blanket sleepers can be used to keep the child warm. (ch. 20 p 562; see also notes: Reducing the risk for SIDS)
A nurse is caring for a 5-year-old child in the ER for frequent acute asthma episodes. Which of the following assessment findings would require admission of the child to the ICU?

a. Peak flow reading = 60% of the usual or normal level
b. O2 saturation = 92% on RA
c. PaCO2 = 42 mmHg
d. Use of respiratory accessory muscles
C. PaCo2 = 42 mmHg

A child whose hypoxemic, has a PaCO2 level of 42 mmHg or greater, and a peak flow reading of less than 30-50% of usual or normal level require admission to ICU and should be monitored closely. Barrel chest and use of accessory muscles are common in children who have repeated acute episodes. (ch. 20 p 575)
The nurse is performing educational teaching to the parents of a child w/ asthma. Which of the following statement by the parents would require additional teaching?

a. “Asthma can go into remission over time”
b. “continues medication therapy prevents development of chronic asthma”
c. “asthma triggers include exercise, infection, or allergies”
d. “I can give my child a corticosteroid when he has an asthma episode”
B. “continues medication therapy prevents development of chronic asthma”

Asthma may go into remission or increase in severity overtime. Although current treatments are effective in controlling symptoms, the underlying severity of asthma is not prevented. Oral corticosteroids may be given as rescue therapy. (ch. 20, p 574-579)
A 7-year-old child is being seen after a month of starting her asthma medications. Which of the following reports by the parents indicate well control of the child’s asthma symptoms?

a. Child is experiencing symptoms once or twice a week
b. Child uses albuterol daily for symptom control
c. Child only had 2 nighttime awakenings last month
d. Child can only play for 30 minutes before experiencing SOB
A . Child is experiencing symptoms once or twice a week

Signs of well-controlled asthma in children under 12 yrs of age include symptoms 2 or fewer days a week, no more than one night time awakening, and no limitations w/ normal activity, school, or exercise. (ch. 20, p 576)
A nurse is teaching the parent of a child w/asthma about medication administration. Which of the following should the nurse include in the teaching?

a. Use a long-acting beta-agonist (salmeterol) 30-60 minutes before exercise
b. Short-acting beta-agonist (albuterol) should be administered 15 minutes after inhaled corticosteroid
c. Long term oral corticosteroid is recommended for better control of asthma episodes
d. Administer oral corticosteroid 30-60 minutes before meals to prevent GI irritation
A. Use a long-acting beta-agonist (salmeterol) 30-60 minutes before exercise

Treatment for exercise-induced asthma is a SABA 5-60 minutes before exercise or LABA 30-60 minutes before exercise. SABA should be used 15 minutes before an inhaled steroid. (ch. 20, p 576-579)
The parent of a child w/ asthma asks her nurse what the purpose of the peak expiratory flow meter is. Which of the following should be the nurse’s response?

a. It determines the cause of asthma
b. It identifies specific triggers of asthma
c. It confirms diagnosis of asthma
d. It assesses the severity of asthma
D. it assesses the severity of asthma

Use of a peak expiratory flow meter can help assess the severity of asthma. The device measures the child’s ability to push air forcefully out of the lungs. (ch. 20, p 583)
One of the goals for children with asthma is to prevent respiratory tract infection because infections do which of the following?

a. Increase sensitivity to allergens
b. Lessen effectiveness of medications
c. Can trigger an asthma episode
d. Encourage exercise-induced asthma
C. Can trigger an asthma episode

Triggers are inflammatory or non-inflammatory stimuli that initiate an asthma episode. Triggers include exercise, infectious agents, allergens, fragrances, weather changes, and emotions. (ch. 20, p 574)
A nurse is reviewing the treatment plan for a 16-year-old patient w/ asthma. To determine the correct treatment plan, the nurse should classify the severity of the patient’s asthma. All of the following should be assessed by the nurse except:

a. Allergies
b. Lung function
c. Severity of exacerbations
d. Activity level
A. Allergies

Classification of asthma severity is determined by looking at the patient’s lung function, severity of exacerbations, and any interference in normal activity. (ch. 20, p 576-577)
A child having difficulty breathing is given humidified oxygen by the nurse. The correct rationale for the intervention is that humidified oxygen:

a. Improves oxygenation
b. Promotes ventilation
c. Prevent thickening of mucous membranes
d. Reaches lungs more rapidly
C. Prevent thickening of mucous membranes

Humidified oxygen is used to prevent drying and thickening of mucous membranes. (ch. 20, p 581)
A nurse is caring for a 7-month-old infant admitted for an apparent life-threatening event (ALTE). Which of the following assessment findings would indicate an impaired gas exchange?

a. Bicarbonate level = 38
b. Respiration rate = 50 per minute
c. HR = 110 bpm
d. Oxygen saturation = 70%
D. Oxygen saturation = 70%

A pulse oximetry reading less than 95% indicates hypoxemia. Infants who have a history of an ALTE may be at risk for cardiopulmonary arrest. (ch. 20, p 560)
A nurse is caring for a 2-year-old patient in the ER who is presenting signs and symptoms of bronchiolitis. Which of the following symptoms presented by the child indicate a need for an immediate intervention?

a. Wheezing during exhalation
b. Diminished breath sounds
c. Respiration rate = 60 breaths per minute
d. Low-grade fever
B. Diminished breath sounds

In patients w/ bronchiolitis, infective agents clog and obstruct bronchioles and irritates airway which eventually leads to hypoxia. As hypoxia develops, the patient becomes cyanotic, and breath sounds become diminished. (ch. 20, p 567)
A nurse is ordered to administer scheduled immunizations for a 4-month old child. The mother reported that the child received the 1st dose of palivizumab, an RSV prophylaxis one week ago. Which of the following should be the nurse’s action?

a. Administer immunizations 30 days after receiving palivizumab
b. Administer immunizations after completing palivizumab doses
c. Administer immunizations as scheduled
d. Hold all immunizations and contact physician
C. Administer immunizations as scheduled

Prophylaxis of palivizumab is given to children who are at risk for severe bronchiolitis caused by RSV. It is given every 30 days for 5 months. Palivizumab doesn’t interfere w/ administration of normal recommended vaccines. (ch. 20, p 568)
Which vaccine prevents development of epiglotitis in young children?

a. DTaP
b. HiB
c. IPV
d. Pneumococcal vaccine
B. HiB

Epiglotitis, previously a common serious illness, is rare in the US due to the HiB immunization. (ch. 20, p 562)
The nursing student assigned to the ER is tasked to do assessments on the following patients. Which of the following should the nursing student assess first?

a. A 2-year-old child who has fever, and coarse breath sounds
b. A 10-month-old child presenting w/ mild fever and cough
c. A 3-year-old who is restless, has mild fever, and a “barking-seal” cough
d. A 4-year-old who is drooling, anxious, and refuses to lie down
D. A 4-year-old who is drooling, anxious, and refuses to lie down

Children w/ severe respiratory distress and narrowed airway often sit in a tripod position w/ arms on the legs leaning forward. Drooling is a classical sign of epiglotitis, a life-threatening condition. The child’s anxiety increases as it becomes more difficult to breathe. (ch. 20, p 564-566)
Which respiratory findings would be present in patients diagnosed w/ cystic fibrosis? [select all that apply]

a. Wheezing
b. Diminished breath sounds
c. Fine crackles
d. Slow respiration rate
e. Unproductive cough
a. Wheezing

b. Diminished breath sounds

c. Fine crackles


Respiratory symptoms of cystic fibrosis include wheezing, fine crackles on auscultation, tachypnea, decreased breath sounds, and moist productive cough. (ch. 20, p 589)
A pediatric nurse is teaching a patient about needed supplementation of fat-soluble vitamins. The nurse would include which of the following?

a. Calcium, Vit D
b. Vitamins A, D, E, K
c. Vitamin C, and B-complexes
d. Calcium, phosphorous, magnesium
B. Vitamins A, D, E, K

Fat-soluble vitamins are vitamins A, D, E, K
The parent of a 10-year-old child w/ cystic fibrosis just received teaching instructions about administering medications for the child. Which of the following statements by the parent indicate a need for further teaching?

a. I can use a saline aerosol after giving a bronchodilator
b. My child should not take aspirin
c. My child should rinse his mouth after taking the bronchodilator
d. My child should take his enzymes after eating
D. My child should take his enzymes after eating

Pancreatic enzyme supplements aid in digestion of nutrients, decreasing fat and bulk in intestines. They should be given prior to food ingestion. (ch. 20, p 591)
When creating a health care plan for a patient w/ cystic fibrosis, all of the following should be considered, except:

a. Avoid prolonged or long-term antibiotic treatment
b. Chest physiotherapy for children under 2 years of age
c. Exercise and aerobic conditioning
d. Emotional and psychosocial support for the patient and family
A. Avoid prolonged or long-term antibiotic treatment

Because children w/ CF have an increased clearance of most antibiotics, they need higher doses and long treatment courses. In some cases, a central line may be placed for home IV therapy. (ch. 20, p 592-593)
A nurse is administering a nebulizer treatment of tobramycin for a patient w/ cystic fibrosis. Tobramycin is given to treat which specific type of bacteria?

a. Staphylococcus
b. Streptococcus
c. Pseudomonas
d. Clostridium
C. Pseudomonas

Tobramycin is given to children w/ chronic pseudomonas aeruginosa infection to suppress bacterial growth. It is given in alternating months. (ch. 20, p 590)
A nurse is administering a nebulizer treatment of tobramycin for a patient w/ cystic fibrosis. Which of the following is a potential side effect of the drug?

a. Anxiety
b. Lethargy
c. Weight gain
d. Hearing loss
D. Hearing loss

Like other aminoglycosides, tobramycin is ototoxic: it can cause hearing loss.
A patient w/ cystic fibrosis just received discharge teaching about her nutritional needs. Which statements by the patient would indicate a need for further teaching?

a. I can have up to 200% of the recommended dietary allowance for calories
b. I have to take my enzymes w/ food
c. I have to increase my fluid and salt intake
d. I should avoid all foods that have fat
D. I should avoid all foods that have fat

The diet should be well balanced, w/ emphasis on high caloric value. Fats and salt are both necessary in the diet. During periods of exercise and increased sweating, the child should be encouraged to drink more fluids and increase salt intake. (ch. 20, p 591-593)
A nurse received medication orders for an infant born at 30 weeks gestational age diagnosed w/ bronchopulmonary dysplasia (BPD). Which of the following medications from the order should the nurse question?

a. Prednisone
b. Albuterol
c. Furosemide
d. Palivizumab
A. Prednisone

Corticosteroids aren’t recommended for routine use in premature infants. Palivizumab is given monthly to prevent RSV infection. (ch. 20, p 587-588)
Which of the following is manifested on a patient w/ bronchopulmonary dysplasia (BPD)?

a. Fever
b. Tachypnea
c. Barking cough
d. bradypnea
B. Tachypnea

Infant w/ BPD has persistent sign of increased respiratory effort, including tachypnea, irritability, nasal flaring, grunting, and retractions. (ch. 20, p 586-587)
Which collaborative care intervention is appropriate for an infant w/ bronchopulmonary dysplasia (BPD)?

a. Increase fluid intake
b. Tracheostomy insertion
c. Assess infant’s length, weight, and head circumference
d. Monitor I/O, calorie count
B. Tracheostomy insertion

Infants w/ severe BPD are weaned off assisted ventilation. A tracheostomy may be needed for long-term airway management to prevent narrowing of trachea. (ch. 20, p 587)
The nurse is performing a teaching seminar about alterations in respiratory function in infants. The nurse would explain that Bronchopulmonary dysplasia (BPD) is:

a. An autosomal recessive gene disorder
b. A disease caused by a virus
c. A chronic lung disease
d. Defined as an episode of apnea and involves a significant cardiovascular event
C. A chronic lung disease

BPD, also called chronic lung disease, is the need for supplemental oxygen for at least 28 days after premature birth. (ch. 20, p 586)
When discussing about a higher risk for infants and young children getting an ear infection, the nurse should note that the Eustachian tube in infants and young children is:

a. Shorter, wider, and more horizontal
b. Shorter, narrower, and more horizontal
c. Shorter, wider, and more diagonal
d. Shorter, narrower, and more diagonal
A. Shorter, wider, and more horizontal

During sucking, yawning, and other movements, the tube opens for a short period which allows free passage of air between nasopharynx and middle ear – leading to an increased risk for infection. (ch. 19, p 512; see also notes: Pediatric differences of the ear)
Which of the following assessment procedures is used to detect strabismus?

a. 6 cardinal fields of gaze
b. Snellen eye chart
c. Cover-uncover test
d. Red reflex
C. Cover-uncover test

Corneal light reflex and cover-uncover test are used to detect eye muscle imbalance and used to confirm diagnosis of strabismus. (ch. 5, p 123-125; ch. 19, p 519)
A nurse is reviewing the treatment plan of a patient w/ ambylopia. Which of the following statements should the nurse question?

a. Administer atropine 1% 1gtt/day in unaffected eye
b. Patching unaffected eye Q4H daily
c. Order for vision therapy
d. Continue treatment until vision is improved
D. Continue treatment until vision is improved

For patients w/ ambylopia, treatment is d/c’ed when visual acuity no longer improves. (ch. 19, p 519)
A mother had a prenatal exposure to rubella. Which of the following conditions would be caused by a prenatal infection from rubella?

a. Chronic lung disease
b. Macrocephaly
c. Visual impairment
d. Cystic fibrosis
C. Visual impairment

Maternal infection during the first trimester of pregnancy may result in congenital defects (ophthalmic, cardiac, auditory, or neurologic). (ch. 16, p 417; ch. 19, p 524-525)
Which actions by the nurse are appropriate when caring for a visually impaired child? [select all that apply]

a. Lightly touch the child before speaking
b. Tell the child when you are entering or leaving the room
c. When walking, walk slightly behind the patient for safety
d. Encourage use of all senses
e. Encourage independence in child
B. Tell the child when you are entering or leaving the room

D. Encourage use of all senses

E. Encourage independence in child


When caring for a visually impaired child, call the child’s name and speak before touching the child. When walking, walk slightly ahead and have child hold staff’s arm. (ch. 19, p 525-526; see also notes: Nursing care of blind child)
A 9-year-old child comes to his mom and complains of hearing loud buzzing and that there’s a bee stuck inside his ear. His mom, a nursing student, should do which action first?

a. Wait and see if the bee will get out on its own
b. Use tweezers to safely remove the bee
c. Shine flashlight into the ear
d. Call 911
C. Shine flashlight into the ear

Insects can be coaxed out by a flashlight into the ear. If not effective, instilling a few drops of mineral oil, olive oil or alcohol kills the insect and irrigating the ear canal gently may remove it. Seek immediate help if those interventions aren’t effective. (ch. 19, p 540)
A nurse is reviewing medication orders for a patient w/ otitis media. Which medication from the order should the nurse question?

a. Benadryl
b. Amoxicillin
c. Tylenol
d. Antipyrine/benzocaine ear drops
A. Benadryl

Decongestants and antihistamines aren’t recommended due to the lack of benefit and concerns regarding side effects. (ch. 19, p 531)
Which of the following reduces the risk of a child developing otitis media?

a. Putting babies to sleep w/ pacifier
b. Using wood-burning stoves instead of gas-burning stoves
c. HepB and IPV vaccination
d. Breastfeeding
D. Breastfeeding

Breastfeeding is associated with a reduction in the number, and duration of all otitis media infections. (ch. 19, p 528, 532)
A nurse performed discharge teaching for the parents of a child w/ chronic otitis media w/ effusion (OME). Which of the following statements by the parents indicate understanding of the child’s condition?

a. The condition can lead to hearing loss
b. Amoxicillin is the drug of choice for the condition
c. The condition is caused by chronic inflammation
d. We have to stop giving the medication if the condition isn’t treated after 3 months
A. The condition can lead to hearing loss

OME is associated w/ hearing loss and cochlear damage. Inflammation isn’t present w/ the condition and OME isn’t treated w/ antibiotics but evaluated for hearing /speech development. (ch. 19, p 528-532)
All of the following interventions help relieve pain in a child w/ otitis media except:

a. Have child chew gum
b. Give analgesic ear drops PRN
c. Raise head on pillows
d. Apply cool compress or towel
D. Apply cool compress or towel

Heat / warm pads are used to relieve pain. Heat increases blood supply and reduces discomfort. (ch. 19, p 533)
Which of the following medications may cause hearing loss?

a. Rocephin
b. Furosemide
c. Aspirin
d. Amoxicillin
B. Furosemide

Ototoxic medications include aminoglycosides (gentamicin, tobramycin) and loop diuretics (furosemide). (ch. 19, p 534)
A nurse is teaching a parent of a pre-school age patient about hearing aid care and instructions. Which of the following statements by the parent indicate a need for further teaching?

a. The hearing aid should be cleaned w/ a damp cloth
b. I have to remove the batteries when my child isn’t using it
c. I have to turn the hearing aid on before putting it on my child’s ear
d. I may need to get my child a new hearing aid in a couple of years
C. I have to turn the hearing aid on before putting it on my child’s ear

The hearing aid should be placed in the ear w/ the volume off, and then slowly turn it up to half volume. Hearing aid fit is checked yearly, as the child’s growth may need a new fitting. (ch. 19, p 539)
The parent of a child who had a tonsillectomy 1 week ago calls the nurse and reports that the child has a sore throat. Which of the following should be the nurse’s response?

a. Advise parent to give cool liquids for the child
b. Advise parent to bring child to the emergency department
c. Advise parent to encourage child to do deep coughing exercise
d. Advise parent to give ibuprofen if pain persists
A. Advise parent to give cool liquids for the child

Most children have a sore throat 7 – 10 days after tonsillectomy. Have child drink adequate cool drinks to help bring down swelling. Ibuprofen should not be given due to an increased risk for bleeding. (ch. 19, p 545)
Which of the following foods isn’t appropriate for a patient who had a recent tonsillectomy?

a. Frozen juice pops
b. Mashed potatoes
c. Orange juice
d. Ice cream
C. Orange juice

Citrus juices may produce a burning sensation in the throat and should be avoided for the first week post-tonsillectomy. (ch. 19, p 545)
A home care nurse visits a child who had a tonsillectomy 1 week ago. During assessment, the nurse noted foul mouth odor and white patchy areas at the back of the throat. The child’s temperature is 100F. What should be the nurse’s best action?

a. Contact physician immediately
b. Have child rinse mouth w/ mouthwash
c. Document finding
d. Have child drink cool water w/ a straw
C. Document finding

Foul mouth odor and white areas at the back of the throat are normal findings 7-8 days after tonsillectomy. Straws and mouthwash should be avoided. Tylenol may be administered as prescribed. (ch. 19, p 545)
Which assessment finding would be present in a patient diagnosed w/ congenital heart disease experiencing obstructed systemic blood flow?

a. Cyanosis
b. Decreased urine output
c. Polycythemia
d. Murmur
B. Decreased urine output

Clinical manifestations of obstructed systemic blood flow include diminished pulses, decreased urine output, delayed capillary refill. (ch. 21, p 605)
A nurse is caring for a child post-cardiac catheterization. Which intervention isn’t appropriate for the patient?

a. Encourage fluids
b. Maintain on bed rest for 5 hours
c. Keep head of bed at fowler’s position
d. Keep leg straight when lying down
C. Keep head of bed at fowler’s position

After cardiac catheterization, head of the bed shouldn’t be elevated as flexion of hips isn’t permitted during the period. (ch. 21, p 607)
Heart defects that increase pulmonary blood flow include:

a. Coarctation of the aorta (COA)
b. Aortic stenosis (AS)
c. Pulmonic stenosis (PS)
d. Atrial septal defect (ASD)
D. Atrial septal defect (ASD)

Heart defects that increase pulmonary blood flow include patent ductus arteriosus (PDA), atrial septal defect (ASD), and ventricular septal defect (VSD). (ch. 21, p 608-617)
A nurse is ordered to administer medications to a child w/ congestive heart failure. To improve the child’s systemic blood circulation, the nurse will administer:

a. Lasix
b. Captopril
c. Digoxin
d. Prostaglandin E1
C. Digoxin

Digoxin increases myocardial contractility thus improving systemic circulation. (ch. 21, p 6224)
A child is receiving digoxin treatment for CHF. Which of the following assessment findings from the child should the nurse note as an early sign of digoxin toxicity?

a. Arrhythmia
b. Nausea
c. Anorexia
d. Visual disturbance
A. Arrhythmia

Early signs of digoxin toxicity in children include cardiac arrhythmias. Early indicators in adults (n/v, anorexia, visual disturbance) are rarely the initial signs of toxicity in children. (ch. 21, p 625)
Which if the following interventions are included in the nursing care plan for decreased cardiac output in a patient w/ CHF? [select all that apply]

a. Administer diuretics as ordered
b. Provide for rest periods each hour
c. Weigh diapers
d. Place child in semi-fowler’s position
e. Perform baseline developmental assessment
B. Provide for rest periods each hour

D. Place child in semi-fowler’s position


Rest decreases the need for high cardiac output and placing child in semi-fowler’s position facilitates adequate oxygenation. (ch. 21, p 626-629)
A nurse is caring for a child who had persistent fever lasting for 5 days. Assessment findings include swollen bright red tongue, diarrhea, peripheral edema, and an oral temperature of 103F. Which medication should the nurse administer for the child?

a. Amoxicillin
b. Aspirin
c. Tylenol
d. Tobramycin
B. Aspirin

Swollen bright red (strawberry) tongue, diarrhea, peripheral edema, and high fever lasting 5 days or longer are s/s of Kawasaki disease. High doses of aspirin are given while the fever is high and then a decreased dose once the fever has dropped. (ch. 21, p 632-633)
Surgery is performed on a child w/ a patent ductus arteriosus (PDA) to prevent which of the following complications?

a. Decreased pulmonary blood flow
b. Mixed pulmonary and systemic circulation
c. Increased pulmonary congestion
d. Left-to-right shunting of blood
C. Increased pulmonary congestion

A patent ductus arteriosus (PDA) allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary congestion can occur. (ch. 21, p 608)
Which of the following assessment findings should the nurse note in a child diagnosed w/ an acute stage Kawasaki disease?

a. Dry, cracking lips
b. Normal appearance
c. Joint pain
d. Diarrhea
D. Diarrhea

The acute stage of Kawasaki disease is characterized by irritability, high fever that persists for more than 5 days, and diarrhea. (ch. 21, p 632)
When caring for a child diagnosed w/ tetralogy of fallot (TOF), the nurse noted increased depth and rate of respirations. The child’s SpO2 is 88%, what should be the nurse’s next action?

a. Reposition child to a high-fowler’s position
b. Place child to a knee-chest position
c. Call a code
d. Administer high-flow oxygen
B. Place child to a knee-chest position

Hypercyanotic episodes become life threatening if not treated immediately. If a hypercyanotic episode occurs, the patient should be placed in a knee-chest position to decrease the return of systemic venous blood to the heart. (ch. 21, p 614-619)
Which intervention would be most appropriate when providing care for a child who recently had a plaster cast?

a. Use fingertips when assessing the cast w/in the first 24 hours
b. Use powder on the edges of the cast to prevent itching
c. Avoid elevating the extremity where the cast is applied
d. Use mole skin to cover rough edges of the cast
D. Use mole skin to cover rough edges of the cast

Rough edges of the cast may be alleviated by petaling – secure tape / padding inside the cast, pulling it over the edge covering the rough edges and securing to outer surface of cast. Moleskin may be used as well. (ch. 29, p 949)
Which of the following assessment method should be used to determine presence of hip dysplasia in a 3-month-old child?

a. Babinski reflex
b. Ortolani-Barlow maneuver
c. Moro reflex
d. Gower’s maneuver
B. Ortolani-Barlow maneuver

Physical exam for patients w/ hip dysplasia reveals Allis sign (one knee lower than the other when knees are flexed), and positive ortolani-barlow maneuver in children under 8-12 weeks. (ch. 29, p 954)
The nurse is performing discharge teaching to the parents of a child wearing a Pavlik harness. Which of the following instructions should not be included in the teaching?

a. Feed child in an upright position
b. Harness should not be worn during bedtime
c. Child should wear an undershirt under the harness
d. Encourage frequent repositioning
B. Harness should not be worn during bedtime

The harness is worn 23 hours / day and only removed for skin checks and bathing. (ch. 29, p 956)
Which assessment finding would be present in a patient diagnosed w/ scoliosis?

a. Uneven shoulder / hip height
b. Rounded shoulders
c. Prominent buttocks
d. Visible hunchback
A. Uneven shoulder / hip height

Classic signs of scoliosis include uneven shoulder and hip height, one-sided rib hump, and a prominent scapula. (ch. 29, p 960-961)
A parent of a child w/ osteogenesis imperfecta just received proper care instructions for the child. Which of the following statements of the parent require further teaching?

a. I have to use a blanket for support when lifting my child
b. I have to feed my child foods rich in vitamin c, d, and calcium
c. I have to feed my child calorie-rich foods
d. I have to hold my child on the hips when moving him
C. I have to feed my child calorie-rich foods

Calories should be limited to maintain weight at recommended levels since immobility can lead to overweight and child is generally short for age. (ch. 29, p 972)
Which interventions should be included in a nursing care plan for a child diagnosed w/ muscular dystrophy (MD)? [select all that apply]

a. Prescribed steroids and antibiotics to reverse progression of disease
b. Limit mobility and ambulation to prevent fractures
c. Teach ROM exercises
d. Encourage high-fiber, high-protein foods
e. Provide high-calorie, high-carb foods
C. Teach ROM exercises

D. Encourage high-fiber, high-protein foods


MD is characterized by progressive muscle fiber degeneration and muscle wasting. There is no cure for the disease and the goal of medical management is provide support and prevent complications such as infection or spinal deformities. (ch. 29, p 973-976)
The parent of a child diagnosed w/ type 1 diabetes received teaching about “sick day” care. Which of the following statements by the parent require further teaching?

a. My child may need an increased dose of insulin when he’s sick
b. I have to limit my child’s fluid intake to prevent polyuria
c. I need to check the blood sugar more often when he’s sick
d. I have to call the doctor if my child has persistent fever
B. I have to limit my child’s fluid intake to prevent polyuria

Increased fluid intake is encouraged and is essential if the child cannot eat as usual. Fluids should have carbohydrates to maintain the child’s usual caloric intake. (ch. 30, p 1010)
When teaching about diabetes management to the parent of a child recently diagnosed w/ diabetes, what should the nurse educator do first?

a. Teach signs and symptoms of hypo/hyper glycemia
b. Answer questions regarding the condition
c. Teach proper insulin administration
d. Provide local resources and referrals to support groups in the community
B. Answer questions regarding the condition

The timing and amount of information provided are especially important in the 1st days following diagnosis. This time should be used to assess learning needs and answer the family’s questions. (ch. 30, p 1010)
The nurse is assessing a child for signs of type 1 diabetes. Which of the following would be most indicative of this problem?

a. Complains of dysuria
b. Thick skin folds in the neck and axilla
c. Obesity
d. Excessive appetite
D. Excessive appetite

Classical signs of type 1 diabetes include polyuria, polydipsia, polyphagia. Obesity and presence of thick skin folds in neck and axilla area (acanthosis nigricans) are manifestations of type 2 diabetes. (ch. 30, p 1005-1007, 1018)
A nurse is closely monitoring a child w/ type 1 diabetes. Which of the following signs and symptoms would the nurse note as indication of presence of diabetic ketoacidosis (DKA)?

a. Moist mucus membranes
b. Hypoglycemia
c. Dehydration
d. Blurred vision
C. Dehydration

DKA is associated w/ severe metabolic, electrolyte, and fluid imbalances. Manifestations include polyuria, polydipsia, dehydration, weight loss, abdominal pain. (ch. 30, p 1016-1017)
A child is admitted to the emergency department w/ severe abdominal pain, irritability, and fever. Further assessment findings are 400 mg/dL blood glucose, deep / rapid respirations, fruity breath odor, and hypotension. Which action should the nurse do first?

a. Prepare to administer IV insulin
b. Administer short-acting insulin IM through the abdomen
c. Give child ½ cup of orange juice
d. Give glucagon IM
A. Prepare to administer IV insulin

Medical management for diabetic ketoacidosis (DKA) includes isotonic IV fluids and electrolytes for dehydration and acidosis. Short-acting insulin is administered by continuous infusion to decrease serum glucose level. (ch. 30, p 1016)
When planning care for a child with ketoacidosis, which consideration is highest in priority?

a. Assess neurological status
b. Monitor for cardiac arrhythmias associated w/ hyperkalemia
c. Administer bicarbonate during DKA episodes
d. IV bolus over 30 minutes for hypovolemic shock
A. Assess neurological status

Faster reduction of hyperglycemia and serum osmolality increases the risk for cerebral edema. Deteriorating neurologic status can indicate cerebral edema and a need to administer mannitol. Bicarbonate is no longer used for treatment of DKA, due to an increased risk for hypokalemia, acidosis, and cerebral edema. (ch. 30, p 1016)
A nurse is ordered to prepare and administer initial IV treatment for a child w/ type 1 diabetes experiencing signs and symptoms of diabetic ketoacidosis (DKA). Which of the following should the nurse prepare to administer?

a. IV infusion of NPH insulin
b. Normal saline IV infusion
c. 50% dextrose IV infusion
d. Potassium IV infusion
B. Normal saline IV infusion

Medical management for diabetic ketoacidosis (DKA) includes isotonic IV fluids and electrolytes for dehydration and acidosis. Rehydration is the initial step in treating DKA. NPH is never administered by IV route. (ch. 30, p 1011-1012, 1016-1017)
A newborn experiencing difficulty breathing and cyanosis soon after birth is ordered to receive supplemental oxygen and Prostaglandin E1 (PGE1). PGE1 is given to the patient for:

a. Prevention of pulmonary congestion of blood
b. maintaining systemic blood flow
c. prophylaxis for infective endocarditis
d. Prevention of hypercyanotic episodes
b. Maintaining systemic blood flow

Transposition of the great arteries (TGA) is manifested as cyanosis apparent soon after birth which progresses to hypoxia and acidosis. PGE1 is given to keep the ductus arteriosus open to maintain systemic or pulmonary blood flow until palliative procedure can be performed. (ch. 21, p 613, 616)
A mother of a child w/ CHF asks the nurse if breastfeeding is better than bottle-feeding. In answering the parent's question, the nurse should note that breast milk reduces infections and it:

a. is naturally low in sodium
b. doesn't cause dyspnea when feeding
c. is easily digested by the child
d. doesn't have contraindications w/ medications
a. is naturally low in sodium

The mother who chooses to breastfeed should be encouraged as breast milk reduces infections and is naturally low in sodium. (ch. 21, p 625)