Pediatric Answers III

61. (Answer: B) Rationale: Epispadias is a frequent anomaly associated with exstrophy of the bladder. The other conditions listed are not.

62. (Answer: B) Rationale: Edema is the major clinical symptom of nephrosis. The child may gain twice his or her normal weight in severe cases.

63. (Answer: C) Rationale: Diapers are weighed on a gram scale before using them and after removal (1gm=1mL). The weight of the dry diaper is then subtracted from the wet diaper to determine urine output.

64. (Answer: C) Rationale: Bubble baths are irritating to the meatus and increase the incidence of urinary tract infections.

65. (Answer: C) Rationale: Although children wit acute glomerulonephritis may feel well, they are confined to bed until hematuria resolves. This can lead to boredom, making it important for the nurse to provide activities that are fun for the child to help pass the time

66. (Answer: D) Rationale: Urinalysis allows for early diagnosis and treatment of acute glomerulonephritis, which is a serious complication that can follow group-A beta-hemolytic streptococcal infection

67. (Answer: D) Rationale: The open bladder allows bacterial to enter the urinary system, and urinary tract infections are common. At this age, sexual dysfunction would not be an appropriate diagnosis. The unformed bladder does not hold urine, so urinary retention would not be an appropriate diagnosis.

68. (Answer: A) Rationale: The ASO titer indicates a preceding infection with group-A beta-hemolytic streptococcus. The urinalysis would show hematuria, but this alone would not be diagnostic of acute glomerulonephritis. Blood cultures may be negative as the infection preceded the illness by 1 to 3 weeks.

69. (Answer: B) Rationale: Clean-catch specimens are not sterile urine samples; therefore, catheterization is not necessary. The urine does need to be obtained at the time of voiding.

70. (Answer: C) Rationale: With the inability to secrete urine, electrolytes will build up in the blood including sodium and potassium. The child should be on a low-sodium, low-potassium diet with restricted fluids and proteins.

71. (Answer: B) Rationale: Hypertrophy or enlargement of the thyroid gland is referred to as a goiter.

72. (Answer: B) Rationale: Tests done 24 to 48 hours after delivery may be interpreted as high because of the rise in TSH that occurs immediately after birth.

73. (Answer: C) Rationale: Sore throat and enlarged cervical nodes are common side effects of the medication. A dosage reduction or withdrawal of the drug should be considered.

74. (Answer: B) Rationale: If a child exhibits signs of hypoglycemia, a source of sugar such as orange juice can elevate glucose levels and prevent further signs of hypoglycemia. A 10-year old must remember to only take one serving and wait ten minutes for symptoms to be alleviated.

75. (Answer: D) Rationale: The peak action of NPH or Lente Insulin is 6 to 12 hours after administration subcutaneously. During peak times, the client may need a snack to offset potential hypoglycemia.

76. (Answer: C) Rationale: Since hypothyroidism is a lifelong condition, the levothyroxine will need to be taken indefinitely. It is important that the infant takes the medication in a small amount of food or liquid and not placed in the bottle since he/she may not receive the full dose if eth bottle is not consumed.

77. (Answer: A) Rationale: In each pregnancy, there is a 25 percent chance of the child having the disease, a 50 percent chance that the child will be a carrier of the gene, and a 25 percent chance that the child will be unaffected. PKU affects both sexes equally.

78. (Answer: C) Rationale: Decreased levels of tyrosine cause a deficiency of the pigment melanin, causing most children with PKU to have blond hair, blue eyes, and fair skin that are prone to eczema.

79. (Answer: C) Rationale: Foods with low phenylalanine levels include vegetables, fruits, juices, and some cereals and breads. The amount of protein in the diet is restricted based on phenylalanine blood levels

80. (Answer: A) Rationale: Keeping the levels of phenylalanine at a low level in children with PKU and daily administration of levothyroxine in children with congenital hypothyroidism will decrease the incidence of mental retardation by allowing normal brain growth.

81. (Answer: C) Rationale: The sensation of numbness or tingling is a sign of neurovascular impairment. Neurovascular impairment can lead to nerve ischemia and destruction, with possible permanent paralysis of the extremity. Any symptom of neurovascular impairment, such as paresthesia, lack of pulses, edema that does not improve with elevation, pallor, and pain, needs immediate attention.

82. (Answer: B) Rationale: The child with skeletal traction has a pin that passes through the skin into the end of a long bone. This procedure provides an entrance for microorganisms. Frequent monitoring of the pin site, pin care according to institutional policy, and frequent monitoring of signs of infection take priority over the other nursing interventions listed.

83. (Answer: A) Rationale: Slipped capitol femoral epiphysis is a slipping of the femoral head that occurs most frequently before or during the rapid adolescent growth spurt. The onset of symptoms is gradual, and includes limp, holding the leg in external rotation to relieve pain, restricted and painful internal rotation, and knee and hip pain.

84. (Answer: A) Rationale: The therapeutic management of the child with osteomyelitis includes limiting weight bearing on the affected part, immobilization, and administration of antibiotics. Antibiotic therapy may continue intravenously for 3 to 6 weeks, and orally for another 2 weeks, depending on duration of symptoms, response to treatment, and sensitivity of the organism. Discharge teaching needs to include follow-up antibiotic care at home, care of the IV site, and continuing antibiotic therapy even though it may seem as if all the symptoms are gone. Food sources such as calcium and protein should be provided for bone healing.

85. (Answer: C) Rationale: All four of these signs are assessment tests for developmental dysplasia of the hip. Ortolani and Barlow signs disappear after 2 to 3 months. Trendelenburg sign will be seen in the child who is able to stand. Allis sign, shortening of the affected limb on the affected side, is a reliable test at 4 months of age.

87. (Answer: C) Rationale: Clubfoot is apparent at birth, with the affected food fixed in an abnormal position. The affected foot is usually smaller, shorter, with an empty heel pad. The affected limb is usually shorter and has some calf muscle atrophy.

87. (Answer: C) Rationale: Children with this disorder have normal calcium and phosphorus and abnormal Precollagen type I. This prevents the formation of collagen, the major component of connective tissue. The Precollagen remains relatively unstable and unable to undergo final transformation into collagen.

88. (Answer: D) Rationale: The child with mild OI may be able to participate in sports, and many are able to participate in swimming. There are no current medications that stop this disease process. There are a variety of surgical procedures that may be done to help strengthen the bones; one is the insertion of intermedullary rods to provide for stability. The child with OI may participate in schools, though care must be taken to protect this child from injury.

89. (Answer: D) Rationale: Children with muscular dystrophy quickly suffer from complications of immobility. Therefore, when hospitalized, these children should have physical therapy, range of motion exercises, and bed-to-chair activity as soon as possible. Children with respiratory infections are treated with vigorous antibiotic therapy, as well as postural drainage and cupping.

90. (Answer: C) Rationale: The Milwaukee brace is worn for scoliosis, when the degree of curve is greater than 20 but less than 40 degrees. It is worn for 23 hours a day. Exercises to increase pelvic tilt, for lateral strengthening, and to correct lordosis should be done several times a day while in brace. The brace should be worn over a t-shirt to minimize skin irritation. The adolescent may experience muscle aches resulting from new alignment.

91. (Answer: C) Rationale: Hot water can exacerbate symptoms of eczema and increase pruritus. Tepid water feels more comfortable than cool water.

92. (Answer: B) Rationale: Impetigo remains contagious for 48 hours after antibiotics are begun. The presence or absence of crusts does not address the issue of contagion.

93. (Answer: C) Rationale: The characteristic appearance of Pediculosis capitus (lice) is nits that adhere to the hair shaft about ¼ inch from the scalp. They cannot be easily brushed off as dandruff. Scabies, eczema, and impetigo do not typically appear on the scalp and present as skin lesions elsewhere on the body.

94. (Answer: D) Rationale: The fluid shift that occurs in burns lead to edema, so the burned extremity should always be elevated above the level of the heart.

95. (Answer: A) Rationale: Eczema in a young child tends to be characterized by dry, scaly crusts that are well circumscribed. Pruritus is always present

96. (Answer: C) Rationale: About 60 percent of children with eczema have a family history of asthma or other allergy. Scabies is caused by contract with a mite; impetigo and cellulitis are bacterial infections.

97. (Answer: B) Rationale: Sinusitis frequently precedes Periorbital cellulitis. Facial cellulitis may be preceded by otitis media. A dog bite could cause cellulitis anywhere. Sun exposure causes a thermal injury.

98. (Answer: A) Rationale: The only way to eliminate the infectious agent is to complete the prescribed course of antibiotics. Strict bedrest is not indicated, although the child initially may feel more comfortable resting with the extremity elevated. Fluid intake has no effect on the course of the infection, which is not contagious; therefore, visitors do not have to be limited.

99. (Answer: B) Rationale: Use water that is a comfortable temperature for the child. Use about 2 ounces of the prescribed shampoo and leave on only as long as directed on the bottle (no more than 10 minutes) because it is toxic.

100. (Answer: C) A teenager can and should be part of the treatment plan. If itching is avoided to prevent excoriation and secondary infection, scarring is unlikely. Improvement is often slow, and the problem may persist into adulthood. Food avoidance will not change the course of the disease.