Pediatric Questions II

31. The mother of an infant who has had recurrent respiratory infections asks the nurse why infants are at increased risk for complications from respiratory infections. The best response by the nurse explains that in infants, the:

a. Airway structures are larger, allowing for larger numbers of organisms

b. Respiratory rate is slower than in adults

c. Parents are unable to accurately assess respiratory problems

d. Airways are narrower and more easily obstructed

32. The mother of a neonate hospitalized with upper respiratory tract infections asks why her baby won't take her bottle. The nurse's best answer would be:

a. "She's probably not hungry."

b. "It's okay because we're giving her intravenous fluids, therefore she is not hungry."

c. "Newborns breathe through their noses. Congestion may be interfering with her breathing and eating at the same time."

d. "She might need a different type of formula. We'll call the physician to get a new order."

33. A 4-year old female child presents to the emergency department with a sore throat, difficulty swallowing and a suspected diagnosis of acute epiglottitis. Which of the following should not be included in her initial assessment?

a. Throat culture c. Past medical history

b. Vital signs d. Auscultation of chest

34. The nurse is providing home care instructions to the parents of a child with cystic fibrosis. Which statement by the parents indicated that they do not understand the treatment regimen?

a. "We will perform chest physiotherapy and postural drainage four times a day."

b. "We will keep her away from the church nursery if any of the children are coughing and have fever or runny noses."

c. "If her bowel movements are normal and her appetite is good, she does not need her pancreatic enzymes."

d. "The relay races and swimming at our Sunday school picnic next week will be good exercise for her."

35. A 2-year-old child is being discharged after bronchoscopy for removal of a coin from his esophagus. The most important topic of discharge teaching would be the importance of:

a. Reassuring the child that he is fine

b. Proper nutrition for the next few days

c. Restricting his access to small toys or objects

d. Administering acetaminophen for his sore throat

36. A 15-year-old child with a history of cystic fibrosis is admitted to the pediatric unit with assessment findings of crackles, increased cough, and greenish sputum. A 2-week hospitalization is anticipated. Which nursing intervention holds the highest priority?

a. Referral to Child Life Services for school lesson plans

b. Arranging for liberal visitation from peers

c. Taking a diet history

d. Gaining intravenous access

37. A 7-year-old child is brought to the Emergency Department for an acute asthma attack. He is wheezing, tachypneic, diaphoretic, and looks frightened. The nurse should prepare to administer:

a. IV methylprednisolone

b. Racemic epinephrine

c. Oral prednisone

d. Cromolyn sodium

38. An appropriate nursing diagnosis for the family of a toddler being treated for acute laryngotracheobronchitis to:

a. Anticipatory grieving

b. Altered growth and development related to acute onset of illness

c. Impaired social interaction related to confinement in hospital

d. Fear/anxiety related to dyspnea and noisy breathing

39. A child with bacterial pneumonia is crying and says it hurts when he coughs. The nurse would teach the child to:

a. Hug his teddy bear when he coughs

b. Ask for pain medicine before he coughs

c. Take a sip of water before coughing

d. Try very hard not to cough

40. An infant with chronic bronchopulmonary dysplasia (BPD) and a tracheostomy is being discharged on home oxygen therapy. Which statement by the mother indicates that further teaching is needed before discharge?

a. "I will call my pediatrician if she gets a fever or has more secretions than usual from her tracheostomy."

b. "I have a cute bib to loosely cover her tracheostomy when she eats and when we go outside in the wind."

c. "We are so glad the baby will get to go with us on our camping trip to Yellowstone National Park. We have been waiting for her to get well so we can go."

d. "We have already notified Alabama Power Company that our baby is coming home today

41. An infant is admitted with an acyanotic heart defect. Which assessment finding should be discussed with the physician?

a. Heart murmur c. Weight gain

b. Dyspnea d. Eupnea

42. For an infant client with a cyanotic heart defect, which symptoms would indicate risk for congestive heart failure?

a. Respiratory crackles and frothy secretion

b. Decreased cyanosis

c. Increased blood pressure

d. Oxygen saturation increase

43. A child is admitted with a diagnosis of "rule out rheumatic fever". Which assessment finding supports this diagnosis?

a. Elevated antistreptolysin-O (ASO)

b. Elevated hematocrit

c. Decreased hemoglobin

d. Decreased salicylate level

44. A child is admitted with possible coarctation of the aorta. Which of the following orders should be questioned?

a. Regular diet

b. BP of upper and lower extremities q 4 hours

c. Intake and output

d. Vital signs on admission, then Q.D.

45. A child with tetralogy of Fallot becomes acutely ill with an increase in cyanosis, tachycardia, and tachypnea. Which nursing action would be most effective to relieve cardiac load?

a. Place child in Trendelenburg position

b. Place child in knee-chest position

c. Have oxygen equipment available

d. Maintain suction equipment available

46. A child with a cyanotic heart defect is being discharged home to await surgical repair. In the discharge teaching, the nurse instructs the parents:

a. To prevent the child from crying at all

b. To observe the child for signs of increased intracranial pressure

c. In cardio-pulmonary resuscitation

d. To identify growth and development milestones

47. A client with rheumatic fever is admitted to the nursing unit. The nurse's most important intervention is to:

a. Prevent spread of rheumatic fever

b. Provide comfort from arthralgia

c. Evaluate for nervous system complications

d. Teach parents about cardiopulmonary resuscitation (CPR)

48. A child with Kawasaki's disease is admitted to the pediatric unit. Since promotion of comfort is an appropriate nursing goal, the nurse:

a. Administers aspirin and immunoglobulins as ordered

b. Administers Tylenol and immunoglobulins as ordered

c. Keeps child NPO for the first 24 hours

d. Encourages a vigorous exercise program

49. A pediatric client is discharged after an acute phase of rheumatic fever. The priority discharge instruction given by the nurse is that the child:

a. Is to resume regular activities

b. Needs to take antibiotics as ordered

c. Needs to maintain complete bed rest

d. Will experience central nervous system (CNS) complications

50. A pediatric client with a cyanotic heart defect experiences a cyanotic episode. Symptoms consistent with this cyanotic episode would include:

a. Skin is ruddy or mottled prior to cyanosis

b. Decreased rate of respirations

c. Decreased heart rate

d. Lethargy

51. A child has been admitted with a history of a seizure 2 hours ago. The history reports fever, chills, and vomiting for the past 24 hours. In report, the nurse is told that the child has a positive Brudzinski's sign. The nurse knows that this is most likely caused by:

a. Increased intracranial pressure

b. Meningeal irritation

c. Encephalitis

d. Intraventricular hemorrhage

52. A nurse is assessing a new admission. The 6-month-old infant displays irritability, bulging fontanels, and setting-sun eyes. The nurse would suspect:

a. Increased intracranial pressure

b. Hypertension

c. Skull fracture

d. Myelomeningocele

53. An 8-year-old client with a ventriculoperitoneal shunt was admitted for shunt malfunction. He presents with symptoms of increased intracranial pressure. The mechanism of the development of his symptoms is most probably related to:

a. Increased flow of cerebrospinal fluid

b. Increased reabsorption of cerebrospinal fluid

c. Obstructed flow of cerebrospinal fluid

d. Decreased production of cerebrospinal fluid

54. A child with a myelomeningocele is started on a bowel management plan. the child's mother questions why this is being done. The nurse's response will be based on the understanding that:

a. Lack of innervations to the colon predisposes the child to diarrhea

b. Lack of innervations to the anal sphincter predisposes the child to being incontinent

c. Lack of mobility increases the gastric-colic reflex

d. Lack of mobility decreases the need for regular bowel movements

55. A child has just been diagnosed with bacterial meningitis. The parent asks the nurse how long the child will be in isolation. The nurse's reply will be based on a protocol that isolation continues until:

a. The organism is located

b. The antibiotics are initiated

c. The antibiotics have been administered for 24 hours

d. Ten days of antibiotic therapy have been completed

56. The nurse observes a client with the neck and back arched and extremities severely extended. The mother asks why the child is doing that. The nurse explains that this posturing is called:

a. Decerebrate c. Jacksonian seizure

b. Decorticate d. Opisthotonos

57. A child is being treated for increased intracranial pressure (ICP). Which intervention would be contraindicated to order to decrease ICP?

a. Keeping head of bed at a 30-degree angle

b. Providing supplemental oxygen

c. Turning head to one side

d. Administering IV osmotic diuretics as ordered

58. A 10-year-old boy receives a blow to his head with a hard baseball and is admitted to the hospital for observation. If the child were to develop an epidural hematoma, the child would most like display symptoms

a. In the emergency room or soon after arriving on the unit

b. On the unit over the next few days

c. After discharge home

d. Over the next two months

59. A 15-year-old client is seen in the emergency department following a head injury from football. During the first few hours after admission, he sleeps unless awakened, but he can be aroused easily and is oriented. In charting assessment findings, the nurse would describe this level of consciousness as:

a. Semicomatose c. Obtunded

b. Lethargy d. Stuporous

60. A young child has just been diagnosed with cerebral palsy. The nurse is teaching the parents how to meet the dietary needs of their child. The nurse would explain that children with cerebral palsy frequently have special dietary needs or feeding challenges because:

a. The paralysis of their muscles decreases their caloric need

b. The spasticity of muscles increases their caloric need

c. All children with cerebral palsy require assistance with feedings

d. The child's inactivity increases the risk of obesity

continue : PEDIATRIC III Questions