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PEDS EXAM 2 QUESTIONS AND CORRECT VERIFIED
ANSWERS
Nursing care of a 9 month old who has recently undergone cleft palate lip repair can be expected to include feeding with a(n): a. Plastic spoon b. Open cup c. Pigeon bottle d. Special needs feeder B. A 3 month old infant is seen in the clinic with the following symptoms: irritability, crying, refusal to nurse for more than 2-3min, rhinitis, and a rectal temperature of 101.8F (38.8). The labor, delivery and postpartum history for this term infant is unremarkable. The nurse anticipates a diagnosis of: a. Acute Otitis Media b. Otitis Media with effusion (OME) c. Otitis externa d. Respiratory syncitial virus (RSV) a. A child with Croup is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the most appropriate nursing action?
- Tell the mother that the child must stay in the tent.
- Place a toy in the tent to make the child feel more comfortable
- Call the health care provider and obtain a prescription for a mild sedative
- Let the mother gold the child and direct the cool mist over the child's face
The mother of a hospitalized 2 year old child with Croup asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make?
- The child may be allergic to antibiotics
- The child is too young to receive antibiotics
- Antibiotics are not indicated unless a bacterial infection is present
- The child still has the maternal antibodies from birth and does not need antibiotics.
An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time?
- Prone position
- On the stomach
- Left lateral position
- Right lateral position
Which of the following statements about the inheritance of CF is most accurate?
- CF is an autosomal-dominant trait that is passed on from the child's mother.
- CF is an autosomal-dominant trait that is passed on from the child's father.
- The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF.
- The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF
- If the child is born to a mother with CF and a father who is a carrier, the child has a 50% chance of acquiring the disease and a 50% chance of being a carrier of the disease. The parent of a 4-month-old with CF asks the nurse what time to begin the child's first CPT each day. Which is the nurse's best response?
- "You should do the first CPT 30 minutes before feeding the child breakfast."
- "You should do the first CPT after deep-suctioning the child each morning."
- "You should do the first CPT 30 minutes after feeding the child breakfast."
- "You should do the first CPT only when the child has congestion or coughing."
- CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting The parent of a 10-month-old with CF asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion?
- "You may need to increase the number of fresh fruits and vegetables you give your child each day."
- "You may need to advance your child's diet to whole cow's milk because it is higher in fat than formula."
- "You may need to change your child to a higher-calorie formula."
- "You may need to increase your child's carbohydrate intake each day."
- Often infants with CF need to have a higher-calorie formula to meet their nutritional needs. Infants may also be placed on hydrolysate formulas that contain added medium-chain triglycerides. The parent of an 18-year-old with CF is excited about the possibility of the child receiving a double lung transplant. What should the parent understand?
- The transplant will cure the child of CF and allow the child to lead a long and healthy life.
- The transplant will not cure the child of CF but will allow the child to have a longer life.
A physician diagnoses a school-age child with strep throat and pharyngitis. The child's parent asks the nurse what treatment the child will need. Which is the nurse's best response?
- "Your child will be sent home on bedrest and should recover in a few days without any intervention."
- "Your child will need to have the tonsils removed to prevent future strep infections."
- "Your child will need oral penicillin for 10 days and should feel better in a few days."
- "Your child will need to be admitted to the hospital for 5 days of intravenous antibiotics."
- The child will need a 10-day course of penicillin to treat the strep infection. It is essential that the nurse always tell the family that, although the child will feel better in a few days, the entire course of antibiotics must be completed. A 5-year-old female is diagnosed with pharyngitis. The child is complaining of throat pain. Which of the following statements by the mother indicates that she needs more education regarding the care and treatment of her daughter's throat pain?
- "I will have my daughter gargle with warm saline three times a day."
- "I will offer my daughter ice chips several times a day."
- "I will give my daughter Tylenol every 4 to 6 hours as needed."
- "I will give my daughter her amoxicillin until all doses of the antibiotic are gone."
- Pharyngitis is a self-limiting viral illness that does not require antibiotic therapy. Pharyngitis should be treated with rest and comfort measures, including Tylenol, throat sprays, cold liquids, and popsicles. A school-age child is admitted to the hospital for a tonsillectomy. The nurse caring for this patient is assessing the child 8 hours after surgery. During the nurse's assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations should be of most concern to the nurse?
- The child's heart rate and blood pressure are elevated.
- The child complains of having a sore throat.
- The child is refusing to eat solid foods.
- The child is swallowing excessively.
- Soft foods are recommended to limit the child's pain and to decrease the risk for bleeding. A pediatric client is admitted in status asthmaticus. The parent reports that the child is currently taking Singulair, albuterol, and Flovent. What is the most important piece of information that the nurse must ask the parent in order to best treat the patient?
- "What time did your child eat last?"
- "Has your child been exposed to any of the usual asthma triggers?"
- "When was your child last admitted to the hospital for asthma?"
- "When was your child's last dose of medication?"
- The nurse needs to know what medication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.
A 2-year-old is diagnosed with asthma. The parents are big sports fans and want their child to play sports. The parents ask the nurse what impact asthma will have on the child's future in sports. Which is the nurse's best response?
- "As long as your child takes prescribed asthma medication, the child will be fine."
- "The earlier a child is diagnosed with asthma, the more significant the symptoms."
- "The earlier a child is diagnosed with asthma, the better the chance the child has of growing out of the disease."
- "Your child should avoid playing contact sports and sports that require a lot of running."
- When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging. The parent of a pediatric client with asthma is talking to the nurse about administering the child's albuterol inhaler. Which statement by the parent leads the nurse to believe that the parent needs further education on how to administer the medication?
- "I should administer two quick puffs of the albuterol inhaler using a spacer."
- "I should always use a spacer when administering the albuterol inhaler."
- "I should be sure that my child is in an upright position when administering the inhaler."
- "I should always shake the inhaler before administering a dose."
- The parent should always give one puff at a time and should wait 1 minute before administering the second puff. A 3-year-old female is admitted to the hospital with asthma. The nurse is trying to work with the child on breathing exercises to increase her expiratory phase. What should the nurse have the child do?
- Use an incentive spirometer.
- Breathe into a paper bag.
- Blow a pinwheel.
- Take several deep breaths
- Blowing a pinwheel is an excellent means of increasing a child's expiratory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child's expiratory phase. A pediatric client was seen at the pediatrician's office and was diagnosed with viral tonsillitis. The parent asks how to care for the child at home. Which is the nurse's best response?
- "You will need to give your child a prescribed antibiotic for 10 days."
- "You will need to schedule a follow-up appointment in 2 weeks."
- "You can give your child Tylenol every 4 to 6 hours as needed for pain."
- "You can place warm towels around your child's neck for comfort."
- Tylenol is recommended prn for pain relief.
- Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better. A 2-year-old is admitted to the hospital in respiratory distress. The physician tells the parents that the child probably has RSV. The parents ask the nurse how they will determine if their child has RSV. Which is the nurse's best response?
- "We will need to do a simple blood test to determine whether your child has RSV."
- "There is no specific test for RSV. The diagnosis is made based on the child's symptoms."
- "We will swab your child's nose and send those secretions for testing."
- "We will have to send a viral culture to an outside lab for testing."
- The child is swabbed for nasal secretions. The secretions are tested to determine if a child has RSV. An 8-month-old male twin is in the hospital with RSV. The nurse educated the parent on how to prevent the healthy twin at home from contracting RSV. Which statement indicates the parent needs further teaching?
- "I should make sure that both my children receive Synagis injections for the remainder of this year."
- "I should be sure to keep my infected son away from his brother until he has recovered."
- "I should insist that all people who come in contact with my twins thoroughly wash their hands before playing with them."
- "I should insist that anyone with a respiratory illness avoid contact with my children until the children are well."
- Synagis will not help the child who has already contracted the illness. Synagis is an immunization and a method of primary prevention. A 6-year-old presents to the ER with respiratory distress and stridor. The child is diagnosed with RSV. The parent asks the child's nurse how the child will be treated. Which is the nurse's best response?
- "We will treat your child with intravenous antibiotics."
- "We will treat your child with intravenous steroids."
- "We will treat your child with nebulized racemic epinephrine."
- "We will treat your child with alternating doses of Tylenol and Motrin."
- Racemic epinephrine promotes mucosal vasoconstriction. The parent of a pediatric client calls the ER. The parent reports that the child has had a barky cough for the last 3 days and it always gets worse at night. The parent asks the nurse what to do. Which is the nurse's best response?
- "Take your child outside in the night air for 15 minutes."
- "Bring your child to the ER immediately."
- "Give your child an over-the-counter cough suppressant."
- "Give your child warm liquids to soothe the throat."
- The night air will help decrease subglottic edema, easing the child's respiratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider. A 3-year-old female is admitted to the ER with drooling, difficulty swallowing, sore throat, and a fever of 39°C (102.2° F). The physician suspects epiglottitis. The parents ask the nurse how the physician will know for sure if their daughter has epiglottitis. Which is the nurse's best response?
- "A simple blood test will tell us if your daughter has epiglottitis."
- "We will swab your daughter's throat and send it for culture."
- "We will do a lateral neck x-ray of the soft tissue."
- "The diagnosis is made based on your daughter's signs and symptoms."
- A lateral neck x-ray is the method used to diagnose epiglottitis definitively. The child is at risk for complete airway obstruction and should always be accompanied by a nurse to the x-ray department. A 2-year-old child is brought to the ER with a high fever, dysphagia, drooling, rapid pulse, and tachypnea. What should the nurse's first action be?
- Prepare for immediate IV placement.
- Prepare for immediate respiratory treatment.
- Place the child on a stretcher for a thorough physical assessment.
- Allow the child to sit in the parent's lap while awaiting an x-ray.
- This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. The child should be allowed to remain in the parent's lap until a lateral neck film is obtained for a definitive diagnosis. A pediatric client is diagnosed with epiglottitis. The parents ask the nurse what treatment their child will receive. Which is the nurse's best response?
- "Your child will need to complete a course of intravenous antibiotics."
- "Your child will need to have surgery to remove her tonsils."
- "Your child will need 10 days of aerosolized ribavirin."
- "Your child will recover without any intervention in about 5 days."
- Epiglottitis is bacterial in nature and requires intravenous antibiotics. A 7- to 10-day course of oral antibiotics is usually ordered following the intravenous course of antibiotics. A 3-year-old is admitted to the hospital with a diagnosis of epiglottitis. The child is in severe distress and needs to be intubated. The mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response?
- "Children this age rarely get epiglottitis; you should not blame yourself."
- "It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen."
- "Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son's symptoms."
A newborn has just returned to the nursing unit after surgical repair of the a cleft lip on the right side. The nurse should place the infant in which best position at this time? a. prone position b. on the stomach c. left lateral position d. right lateral position c. left lateral position After a tonsillectomy, a child begins to vomit bright red blood. The nurse should take which initial action?
- Maintain NPO status
- Turn the child to the side
- Administer the prescribed antiemetic
- Notify the HCP.
- prevent aspiration then notify the HCP. NPO would be maintained and an antiemetic may be prescribed. The nurse is reviewing the lab results for a child scheduled for tonsillectomy. The nurse determines that which lab value is most significant to review? a. Creatinine b. Prothrombin c. Sedimentation d. Blood urea nitrogen b. post op bleeding is a concern, the prothrombin time would identify a potential for bleeding. The nurse is preparing to care for a child after a tonsillectomy. The nurse documents on the plan of care to place the child in which position?
- Supine
- Side-lying
- high fowlers
- Trendelenburgs
- the child should be placed prone or side lying to facilitate drainage. After a tonsillectomy the nurse reviews the health care providers postop prescriptions. Which prescription should the nurse question? a. Monitor for bleeding b. Suction every 2 hours c. Give no milk or milk products d. Give clear, cool liquids when awake and alert
- suctioning is anot performed unless there is an airway obstruction because of the risk of trauma to the surgical site. The nurse is caring for a child after a tonsillectomy. The nurse monitors the child, knowing that which finding indicates the child is bleeding? a. frequent swallowing b. a decreased pulse rate c. complaints of discomfort d. an elevation in blood pressure a. Antibiotics are prescribed for a child with otitis media who underwent a myringotomy with insertion of tubes. The nurse provides discharge instructions to the parents regarding the administration of the antibiotics. Which statement, if made by the parents, indicates understanding of the instructions provided? a. Administer the antibiotics until they are gone b. Administer the antibiotics if the child has a fever c. Administer the antibiotics until the child feels better d. Begin to taper the antibiotics after 3 days of a full course. a. A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all that apply. a. Provide a soft diet b. Position the child on the left side c. Administer an antihistamine twice daily d. Irrigate the right ear with normal saline every 8 hours e. Administer motrin for fever every four hours f. instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy a, e, f. A 10yo child with asthma treated for acute exacerbation in the ED. The nurse caring for the child should monitor for which sign, knowing that it indicates worsening of the condition?
- Warm, dry skin
- Decreased wheezing
- Pulse rate of 90 beats per min
- Respiration of 18 breaths per min
- Move the infant to a room with another child with RSV.
- Leave the infant in the present room because RSV is not contagious
- Inform the staff that they must wear a mask, gloves, and gown when caring for the child.
- Not transmitted via airborne. usually transferred by hands. Contact & standard precautions! gloves and gown. The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by RSV. Which interventions should the nurse include in the plan of care? Select all that apply.
- Place the infant in a private room
- Ensure the infants head is in a flexed position
- Wear a mask at all times when in contact with the infant
- Place the infant in a tent that delivers warm humidified air
- Position the infant on the side, with the head lower than the chest
- Ensure the nurses caring for the infant with RSV do not care for other high risk children. 1, 6. cool humidified air - not warm. private room or with another with RSV head and chest at 30-40 degree angle You are working with a new grad on the pediatric unit and your patient is returning from the cardiac cath lab. You feel the graduate understands the important nursing interventions when she says which of the following? a. Check pulses especially below the cath site for equality and symmetry. b. Check vital signs, which may be taken as frequently as 30-45 minutes, with special emphasis on the heart rate, which is counted for 1 full minute for evidence of dysrhythmias or bradycardia. c. Special attention needs to be given to the BP, especially for hypertension, which may indicate hemorrhage or bleeding from the cath site. d. Check the dressing for evidence of bleeding or hematoma formation in the femoral or antecubital area. e. Allow the child to ambulate because this will prevent skin breakdown from lying so long in one place. a, d. You are working in the pediatric clinic, and a child presents with symptoms that are suspicious of the acute phase of Kawasaki disease. Which of the following symptoms are included? Select all that apply. a. Periungual desquamation (peeling that begins under the fingertips and toes) of the hands and feet is present.
b. The bulbar conjunctivae of the eyes has become reddened, with clearing around the iris. c. A temporary arthritis is evident, which may affect the larger weight bearing joints d. Inflammation of the pharynx and the oral mucosa develops with red, cracked lips and the characteristic "strawberry tongue" e. Loud pansystolic murmur along with ECG changes are present. b, d. The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure. The nurse should assess the infant for which early sign of hf? a. Pallor b. Cough c. Tachycardia d. Slow and shallow breathing c. Early signs include tachycardia, tachypnea, scalp sweating, fatigue, irritability, sudden weight gain, resp distress. The nurse reviews the lab results for a child with a suspected diagnosis of rheumatic fever, knowing that which lab study would assist in confirming the diagnosis? a. Immunoglobulin b. Red blood cell count c. White blood cell count d. Anti-streptolysin O titer d. On assessment of a child admitted with a diagnosis of acute-stage kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? a. cracked lips b. Normal appearance c. Conjunctival hyperemia d. Desquamation of the skin c. The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further teaching? a. I will not mix the medication with food b. I will take my child's pulse before administering the medication c. If more than one dose is missed, I will call the health care provider d. If my child vomits after medication administration, I will repeat the dose. d.
When developing the discharge teaching plan for the parents of a child who has undergone a cardiac cath for ventricular septal defect, which of the following would the nurse expect to include?
- REstriction of the child's activities for the next 3 weeks
- Use of sponge baths until the stitches are removed
- Use of prophylactic antibiotics before receiving any dental work
- Maintenance of a pressure dressing until return visit with the physician. 3 A child diagnosed with TOF becomes upset, crying and thrashing around when a blood specimen is obtained. The childs color becomes blue and the RR increases to 44 breaths per min. Which of the following actions should the nurse do first?
- Obtain an order for sedation for the child
- Assess for an irregular heart rate and rhythm
- Explain to the child that it will only hurt for a short time
- Place the child in a knee to chest position 4 When teaching a child how to perform coughing and deep breathing exercises before corrective surgery for TOF, which of the following principles would the nurse address first?
- Organizing info to be taught in a logical sequence
- Arranging to use actual equipment for demonstrations
- Building the teaching on the childs current level of knowledge.
- Presenting the information in order from simplest to most complex. 3 When assessing a child after heart surgery to correct TOF, which of the following would alert the nurse to suspect low cardiac output?
- Bounding pulses and mottled skin
- Altered LOC and thready pulse
- Capillary refill of 2 seconds and blood pressure 96/
- Extremities warm to the touch and pale skin 2 Which of the following would the nurse expect to include in the plan of care for a child diagnosed with TOF who has undergone corrective surgery?
- Two -3g of sodium in the diet each day
- Physical activity restrictions
- Visits limited to a selected few
- Assignment to an isolation room
Which of the following would the nurse expect to include in the plan of care for a child who is diagnosed with rheumatic fever and carditis and admitted to the hospital?
- Ensuring continuous parental presence at the childs bedside
- Providing the child with periods of rest
- Encouraging participation in age appropriate activities
- Advising the child to eat as much as possible 2 Which of the following initial physical findings would indicate the development of carditis in a child with rheumatic fever?
- Heart murmur
- Low blood pressure
- Irregular pulse
- Anterior chest wall pain 1 Which of the following would the nurse perform to help alleviate a child's joint pain associated with rheumatic fever?
- Maintaining the joints in an extended position
- Applying gentle traction to the child's affected joints
- Supporting proper alignment with rolled pillows
- Using a bed cradle to avoid the weight of bed linens on joints 4 When developing a plan of care for a newly admitted 2yo child with a diagnosis of kawasaki disease, which of the following would be the priority?
- Taking vital signs every 6 hours
- Monitoring intake and output every hour
- Minimizing skin discomfort
- Providing passive ROM exercises 2 A child with kawasaki disease is receiving low dose aspirin. The mother calls the clinic and states that the child has been exposed to influenza. Which recommendations would the nurse make? Select all that apply.
- Increase fluid intake
- Stop the aspirin
- Alternate aspirin and acetaminophen
A. Side-lying with a blanket roll at the back B. Supine with the legs slightly elevated C. Prone position with the head elevated D. Upright in an infant seat d. The healthcare provider has an order to administer indomethacin to an infant with a patent ductus arteriosus. Which intervention is a priority to implement? a. Assess peripheral pulses b. Auscultate lung sounds c. Monitor urine output d. Monitor heart rate and rhythm d. The healthcare provider is caring for a child with congenital heart disease. When planning care, monitoring for which of the following complications will be included in the plan of care? a. Bradycardia and hepatomegaly b. Pulmonary hypotension and cyanosis c. Increased pulmonary compliance and cyanosis d. Congestive heart failure and hypoxemia d. The healthcare provider is planning the discharge for a child with a ventricular septal defect. Which of the following is a priority to include in the discharge instructions? a. Provide instructions for a monthly immunoglobulin shot during RSV season. b. Ensure the parents know how to take the child's blood pressure at home. c. Advise the family provide meals that are low in fat and calories. d. Suggest quiet activities for the child to decrease physical activity.
a. During an examination of an infant with a patent ductus arteriosus (PDA), the healthcare provider should expect to observe: Choose all answers that apply: A. Profound cyanosis B. Widening pulse pressure C. Systolic murmur D. Bounding peripheral pulses E. Clubbing of fingers and toes b, c, d. A 6-month-old infant who was seen in the Emergency Department with wheezing and coughing is admitted to the pediatric unit with a diagnosis of bronchiolitis. During the admission assessment, which of these will alert the healthcare provider the infant's condition is worsening? a. Respiratory rate of 38 breaths/min b. Decreased inspiratory breath sounds c. Irritability and crying d. Dysphasia and loss of appetite b A 10-month-old infant who was seen in the Emergency Department for respiratory distress is admitted to the pediatric unit with a diagnosis of bronchiolitis. Which of these, if assessed in the infant, alerts the healthcare provider the bronchiolitis is worsening? a. Head bobbing b. Inspiratory stridor c. Drooling d. Pleuritic chest pain
