NURS 420: PediatricsExam 2 Questions1. A school aged child is seen in the oncology clinic for possible HodgkinsDisease. During the course of the nursing assessment findings would beexpected? SELLECT ALL THAT APPLYa. Poor appetiteb. Feverc. Painful cervical nodesd. Complaints of night sweatse. Painless cervical nodes2. Med calculation: Ordered: Claforan IV q8h. Claforan safe dose: 100mg/kg/day q8h. Patient weight: 8 kg. What is a safe single dose of Claforan?(Round mg down to nearest hundredth)100mg/1kg * 8kg/3dose = 266.66 mg/dose3. While the nurse is taking routine vitals, she notices that the infant is havinghypercyanotic episodes or TET spell. What should the nurse do first?a. Continue getting vital signs for a baseline comparisonb. Calm the infant and place the infant in a knee-chest positionc. Get a pulse oximetry reading and suction the infantd. Give morphine sulfate and call the physician4. Med calculation: Tetracycline safe dose: 8mg/kg/day in 4 divided doses. Patientweight: 50 lb. What is a safe single dose of Tetracycline? (round weightimmediately to hundredths. Round mg down to nearest hundredth)50/2.2= 22.73 kg8mg/1kg*22.73kg/4doses = 45.46 mg/dose
- The nurse assesses that the father of a chronically ill child is experiencingrecurrent feelings of loss and fear related to the child9s condition. The nurses9interpretation that the father is experiencing which of the following?a. Chronic griefb. Chronic sorrowc. Pathological grievingd. Compassion fatigueRationale: The stated recurrent feelings define chronic sorrow, which isconsidered a normal process involving grief that may never be resolved.6. Which of the following statements concerning idiopathic structural scoliosis istrue?a. Scoliosis is more common in malesb. Scoliosis is fully correctable with an orthoplast jacket or bracec. Characteristic signs include shoulder, prominent hip, exaggeratedrib hump ?d. Scoliosis is an abnormally exaggerated concave lumbar curvature7. Med calculation: Quinidine safe dose: 25 mg/kg/day q6h. Patient weight: 110lb. What is a safe single dose of Quinidine?110/2.2 = 50 kg25mg/1kg*50 kg/4 =1250/4312.5 mg/dose8. Delegation/ Prioritization- You have just received a change of shift reportabout the following pediatrics patients. Which patient will you assess first?a. A 5-year-old Hemophilia who was admitted because of decreasedresponsivenessb. A 3-year-old with Von Willebrand disease who has a dose of DDAVPscheduled
c. A 7-year-old with acute lymphocytic leukemia who has chemotherapyinduced thrombocytopeniad. A 16-year-old with sickle cell disease who is complaining of acute rightlower quadrant pain9. The nurse is caring for a school-aged child newly diagnosed with type 1diabetes melitus. Which nursing action supports the 2020 National HeatherGoals to reduce the long-term complications from this disease process?a. Schedule the child and parents to attend diabetes educationclassesb. Explain how the child9s physical abilities will be affected during schoolc. Recommend homeschooling so the mother can provide the neededmedicationsd. Discuss admission to a rehab facility to learn self-care with this diseaseprocess10. A sign of developmental dysplasia of the hip in a newborn isa. Limitation in abduction on the affected sideb. Less gluteal folds on the affected sidec. Apparent shortening of the unaffected legd. Negative Ortolani sign on the affected leg11. When a cognitively impaired child is admitted to the hospital, the nurse9sassessment should focus on the child9s:a. Developmental abilityb. IQ levelc. Medical historyd. Prenatal and birth history12. Which goal is appropriate for the child/ family with a chronic illness?a. To maintain the intactness of the familyb. To eliminate all stressorsc. To achieve complete cure
d. To obtain the highest level of normalcy13. Which of the following interventions should be included when feeding aninfant with congenital heart disease? SELECT ALL THAT APPLYa. Feed the infant in a warm environment to reduce oxygen demandsb. Keep the infant lying down flat to prevent stomach compressionc. Limit PO feeds to 30 minutes and then gavage the rest to reducefatigued. Concentrate the formula to increase caloric intakee. Offer large less frequent feedings to allow more time for rest periods14. The immediate management of syndrome of inappropriate antidiuretichormone (SIADH) consists of:a. Increasing fluidsb. Administering antibioticsc. Restricting fluidsd. Administrating vasopressin15. Which statement is true concerning the nursing care of a 5-year old who is inthe terminal stages of cancer?a. The child can be protected from the emotional pain of death bywhisperingb. The child is thinking about the future and knows that he may not be ableto participatec. The child may become clingy and act like a toddlerd. The child fully understands the concept of death16. Med Calculation: Ordered: Furosemide (Lasix) 15 mg IV now. Available:Furosemide 20 mg/2mL. How many mL will the nurse administer for onedose?2ml/20mg * 15mg =30/20 = 1.5ml - A 6-month old infant is receiving digoxin (lanoxin). The nurse should notifythe practitioner and withhold the medication if the apical pulse is which of thefollowing?a. 60 beats/minb. 70 beats/minc. 90 to 110 beats/mind. 110 to 120 beats/minRationale: If a 1-minute apical pulse is less than 90 beats/min for an infantor young child, the digoxin is withheld. Sixty beats/min is the cut-off forholding the digoxin dose in an adult. One hundred to 120 beats/min is anacceptable pulse rate for the administration of digoxin.18. Which of the following would be the best play activity for a 6-month old infantto provide tactile stimulation?a. Allow to splash in bathb. Show baby colorful picturesc. Play music box or CDsd. Place in sand box19. Parents of a 3-year old child with congenital heart disease are afraid to let theirchild play with other children because of possible overexertion. The nurse9sreplay should be based on which of the following?a. The child needs opportunities to play with peersb. The child needs to understand that peers9 activities are too strenuousc. Parents can meet all the child9s needsd. Constant prenatal supervision is needed to avoid overexertion20. The common symptoms of brain tumors in children are which of thefollowing?a. Ataxia and alopeciab. Seizures and decreased appetitec. Headache and vomiting
d. Fever and poor fine motor skills21. Med calculation: you receive an order for Claforan IV q8h for a child weighing8 kg. The drug guide recommends Claforan 100 mg/kg/day as a safe dose.Claforan is provided as 250 mg/5 mL. How many mL would you give?a. 5.33 mL22. Which physical assessment finding most likely indicates a cardiovascularalteration in a pediatric client?a. Loud harsh murmur heard on auscultationb. Capillary refill less than 2-3 secondsc. Inspiratory stridord. A palpable apical pulse in a thin child23. The nurse is obtaining a health history from parents whose 4-month old boyhas congenital hypothyroidism. What would the nurse most likely assess?a. The child has above-normal growth for his ageb. The child is active and playfulc. The skin is pink and healthy lookingd. It is difficult to keep the child awakeRationale: The parents may state, during the health history, that it is difficultto keep the child awake. Physical examination would reveal that the child isbelow weight and height, that his skin is pale and mottled, and that he islethargic and irritable.24. Complete the following nursing diagnosis most appropriate in the care plan ofa child with lumbarsacral spina bifida? Impaired physical mobility R/T__a. Neuromuscular impairmentb. Spasticity and muscle weaknessc. Pain and numbnessd. Fatigue and increased work of breathing
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- One of the most common causes of thyroid disease in children and adolescentsisa. Hasimoto diseaseb. Graves diseasec. Goiterd. Thyrotoxicosis26. When a thyroidectomy is planned, the nurse should explain to the child that:a. Iodine preparations will be mixed with flavored foods and then eatenb. He or she will need to hyperextend the neck postoperativelyc. The skin, not the throat, will be cutd. Laryngospasm can be life-threatening complications27. A child is undergoing chemotherapy. The nurse discusses the issue of hair losswith the child and family before chemotherapy begins. Later the family asks thenurse why this information was given to the child at this time. The nurse9sresponse will include information that:a. Hair loss is a symptom of toxic blood levels from chemotherapy, so thechild should be watching for this phenomenon.b. The presence or absence of hair is related to body image.Strategies for handling hair loss should precede the eventc. It is the nurse9s legal responsibility to discuss this issue with the childd. Hair loss can be prevented with appropriate nursing interventions28. Med calculation: Tetracycline safe dose: 8mg/kg/day in 4 divided doses. Patientweight: 50 lb. What is a safe single dose of Tetracycline? (round weightimmediately to hundredths. Round mg down to nearest hundredth)a. 45.46 mg
- A child with tetralogy of Fallot is being discharged home to await surgicalrepair of the defect. In the discharge teaching, the nurse instructs the parentson which of the following?a. To prevent the child from crying from crying at allb. To administer antibiotic therapyc. To perform cardiopulmonary resuscitationd. To identify growth and development milestones30. To assess for cyanosis in a child with cardiovascular disease, it would be best toassess the child9s:a. Toes*b. Trunk areac. Lips and oral mucosa membranesd. Fingertips for clubbing31. A nurse is caring for a 5 year old who is in the terminal stages of cancer. Whichstatement about the child9s impending death are most likely to be true?SELECT ALL THAT APPLYa. The parents may be at different stages of grief in dealing with thechild9s impending deathb. The child is thinking about the future and knows he or she may not beable to participatec. The dying child may become clingy and act like a toddlerd. The death of a child may have long term disruptive effects on thefamilye. Whispering in the child9s room will help the child to copef. The child does not fully understand the concept of death32. A child with cancer has the following lab results: WBC 10,000, RBC 5, andplatelets of 20,000. Which planning the child9s care, which risk should the nurseconsider most significant?a. Anemiab. Infection
c. Hemorrhaged. Pain33. Large body areas of sensory and motor impairment associated withmyelomeningocele necessitate which of the following nursing interventions?SELLECT ALL THAT APPLYa. Gentle stretching of joints through passive range of motionb. Teaching parents how to apply assistive devices such as splints orbracesc. Frequent turning and positioningd. Keeping skin clean and dry34. Which of the following factors contributes to the difficulty of maintainingnormal blood sugar levels in an adolescent with diabetes?a. Peer pressure, impulsivity and hormonal issuesb. Unpredictable activity, frequent exposure to childhood illnesses, foodjagsc. Frequent exposure to illness, greater sensitivity to insulind. Frequent activity, less sensitivity to insulin, erratic sleep patterns35. The nurse is caring for a 4 year old recently diagnosed with acute lymphocyticleukemia (ALL). Which statements made by the parents indicates effectiveteaching? Select all that applya. <I read that ALL is a rare form of childhood leukemia=b. <I understood that ALL affects all blood forming organs andsystems throughout the body.=c. <Because of the increased risk of bleeding, I will eliminate even teethbrushing.=d. <I realize that the adverse effects of chemotherapy includesleepiness, alopecia, and stomatitis.=e. <I am glad that there is a 95% chance of obtaining a first remissionwith treatment.=f. <I will not discipline by child during this difficulty time.= - Parents of the child with precocious puberty need to know that:a. Dress and activities should be aligned with the child9s sexualdevelopmentb. Heterosexual interest will usually be advancedc. The child9s mental age is congruent with the chronologic aged. Overt manifestations of affection represent sexual advances37. Which nursing intervention should be included in the plan of care for a childwho is currently undergoing chemotherapy for leukemia?a. Administer aspirin as necessary for relief of arthralgiab. Avoid high calorie, high protein foods in counteract nauseac. Make sure all immunizations are kept up-to-dated. Monitor activity and playthings to decrease potential for bleeding injury38. A child with type 1 diabetes calls a clinic nurse and tells the nurse that the childhas been sick. The mother reports that she has checked the child9s urine and itis positive for ketones. The nurse instructs the mother to:a. Come to the clinic immediatelyb. Hold the next dose of insulinc. Administer an additional dose of regular insulind. Encourage the child to drink sugar free liquids39. Nursing considerations related to the administration of chemotherapeutic drugsinclude which of the followinga. Emergency equipment should be available in case of a seriousreactions to drugsb. Chemotherapy drugs are rarely vesicants (sclerosing agents)c. Infiltration cannot occur, unless superficial veins are used for theintravenous infusiond. Medication side effects mostly affect the respiratory and cardiac systems
- Which of the following are important assessments to make on all newborns tohelp reveal coraction of the aorta? Select all that applya. Observe for excessive cryingb. Assess for the strength of femoral pulsesc. Record and compare blood pressures in all four extremitiesd. Assess for the strength of brachial pulses41. Which of the following statements or actions made by the parent of a 2-yearold child being discharged home in a hip spica cast indicates further teaching isrequired?a. <once the cast is dry, it should sound hollow and be cool to the touch.=b. <I will be sure to frequently check my child9s toes for warmth, color andmovement.=c. <If the cast becomes soiled, I will scrub it with soap and water.=d. <I will always supervise my child during mealtimes.=42. Which of the following nursing interventions would be most appropriate for aninfant with congestive heart failure?a. Restrict fluids to 2/3 maintenance per dayb. Monitor temperature during active periodsc. Organize activities to allow for uninterrupted sleepd. Withhold digoxin (Lanoxin) for an apical heart rate of 120/minute orless43. A child with growth hormone deficiency will exhibit the signs of:a. Poor weight gainb. Abnormal skeletal proportionsc. Malnutritiond. Short stature but proportional height and weight44. Of the following blood glucose levels, the value that most certainly indicates adiagnosis of diabetes would be a:a. Hemoglobin A1c of 2%
b. Random blood glucose of 100 mg/dLc. Fasting blood glucose of 160 mg/dLd. Glucose tolerance test (oral) value of 160 mg/dL for the 2-hour sample45. Which of the following congenital heart defects results in increased pulmonaryblood flow from left to right shunting of blood in the heart?a. Atrial septal defectb. Pulmonic stenosisc. Tetralogy of Fallotd. Transposition of the Great Arteries46. Teaching for parents in the use of a Pavlik harness for their 1-month old sonshould include which of the following? SELECT ALL THAT APPLYa. Remove and reapply the harness every 4 hours to check for skinirritationb. Hold and cuddle the baby as you would any other infantc. Explain that with consistent and correct application of the harnessthe baby9s hip will likely become stabled. Explain that the harness strap should be secure enough to keepthe baby9s hips flexed without being too tight47. Med calculation: Ordered: Claforan IV q8h. Claforan safe dose: 100mg/kg/day q8h. Patient weight: 8 kg. What is a safe single dose of Claforan?(Round mg down to nearest hundredth)266.66 (above)48. The nursing diagnosis for a child undergoing chemotherapy for leukemia is<imbalanced nutrition: less than body requirements related to nausea andanorexia.= The nurse would formulate which of the following as an realisticexpected outcome for this client?a. Administer antiemtics PRN
b. The child9s caloric intake will exceed daily requirements to accomplishweight gainc. The child dose not complain of nausead. Intake and output are approximately equal49. A nurse who is caring for a 7-year old is providing patient teaching to the childand caregiver. Which response by the caregiver demonstrates to the nurse thatthe caregiver understands the diagnosis of type 1 diabetes mellitus?a. <We will just have out child exercise and take medicine to cure this.=b. <I will just feed my child healthy foods and sign her up for more sports.=c. <Her body fights against the insulin.=d. <Her body doesn9t have any insulin.=Rationale: Type 1 DM is a disorder in which the child’s body has adeficiency of insulin because children with type 1 DM cannot produceinsulin. Type 2 DM is controlled through diet, medicine, and exercise. Type2 DM can be prevented through diet and exercise, but type 1 DM cannot.50. Which post-procedural interventions would be expected for a child following acardiac catheterization? SELECT ALL THAT APPLYa. Continue intravenous IV fluids until the infant is toleratingadequate oral fluidsb. Check the groin bleedingsc. Assess peripheral circulation of the extremitiesd. Keep the affected leg flexed and elevated51. A school aged child with type 1 diabetes has soccer practice three afternoons aweek. The school nurse provides instructions regarding how to preventhypoglycemia during practice. The school nurse tells the child to:a. Take one half prescribed insulins on practice daysb. Eat twice as much normally eaten at lunchc. Taking as much normally eaten at lunchd. Taking the prescribed insulin at noon instead of the morning
e. Eat 6 graham crackers or drink a cup of orange juice beforepractice.52. While the nurse is taking routine vitals, she notices that the infant is having ahypercyanotic episode or TET spell. What should the nurse do first?a. Continue getting vital signs for a baseline comparisonb. Calm the infant and place the infant in a knee-chest positionc. Get a pulse oximetry reading and suction the infantd. Give morphine sulfate and call the physician53. Med calculation: Tetracycline safe dose: 8mg/kg/day in 4 divided doses. Patientweight: 50 lb. What is a safe single dose of Tetracycline? (Round weightimmediately to hundredths. Round mg down to nearest hundredth)above54. The nurse is caring for 5-year-old Jimmy who has just been diagnosed with typeone diabetes. While assessing Jimmy and reviewing his history, the nurse wouldexpect to find: choose all that apply.a. HgbA1c of 8b. dry skinc. a history of weight lossd. dry, flushed skin55. Which of the following statements made by the parents of a child’s with spasticcerebral palsy indicates a need for further teaching?a. <I will place a toy in front of my child out of reach.=b. <I will make sure my child is well rested before therapy.=c. <I will keep my child in a stroller while at the playground.=d. <I will provide appropriate leg exercises as instructed by the therapist.=56. Med Calculation: Provider orders 1000 mL of normal Saline to infuse over 8hours. the drop factor is 15 drops per minute. A nurse prepares to set the
intravenous (IV) flow rate how many drops per minute? (remember to roundanswer to the nearest whole number)a. 31 drops per minute57. Which of the following occurrences would you assure that a child with diabetesinsipidus is responding to medical therapy?a. Urine specific gravity of 1.1558. How to screen for Scoliosis?a. Bend at the waist and hands placed together