Pediatric Final Exam 294 Questions and 100% Verified Correct Answers Latest Update 2023-2024 Guaranteed A+ At First Attempt A 2 1/2-year-old ventilator-dependent child will be discharged home soon. The family expresses concern that their child might change the ventilator settings by exploring the control knobs and buttons. Based on the nurse's knowledge of child development, the most appropriate intervention by the nurse is to: - Correct Answer: recommend ways to cover the controls to reduce the risk of the child changing the settings.
Rationale:
If the equipment does not have "lock-out" capabilities, then clear plastic covers and tape should be applied, similar to how a parent might secure the knobs in a tub. The toddler is too young to understand the concept associated with harm. The child will need to be supervised while awake, and alarms must be on when the child is asleep. Toddlers can manipulate dials; therefore, protective mechanisms must be in place at all times.
A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions (ORSs) for acute diarrhea. Instructions to the mother about breastfeeding should include to: - Correct Answer: continue breastfeeding.
Rationale:
Breastfeeding should continue even if the infant has acute diarrhea. Culturing the breast milk is not necessary. Breastfeeding can continue with ORS to replace the ongoing fluid loss due to the diarrhea. Breast milk should not be diluted.
A 3-year-old child is scheduled for surgery to remove a Wilms' tumor from one kidney.The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation should be based on knowledge that: -
Correct Answer: chemotherapy with or without radiotherapy is indicated.
Rationale:
The determination of chemotherapy and/or radiotherapy as treatment modalities will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiotherapy is usually indicated. Additional therapy of some type is indicated after the tumor is removed. Chemotherapy or radiotherapy, or both, may be indicated as a postsurgical intervention. Most children with Wilms' tumor do not require renal transplants.
A 3-year-old child is status post shunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? 1 / 4
Select all that apply. - Correct Answer: Personality change
Vomiting Fever
Rationale:
Personality change can be a sign of shunt malformation related to increased intracranial pressure. Vomiting can be a sign of shunt malformation related to increased intracranial pressure. Fever can be a sign of shunt malformation and is a very serious complication.The anterior fontanel closes between 12 and 18 months of age. Dizziness is difficult to assess in a 3-year-old and is not necessarily a sign of shunt malformation.
A 3-year-oldhas just returned from surgery in a hip spica cast. The priority nursing intervention is to: - Correct Answer: check circulation, sensation, and motion of toes.
Rationale:
The chief concern is that the extremity may continue to swell. The circulation, sensation, and motion of the toes must be assessed to ensure that the cast does not become a tourniquet and cause complications. Elevating the head of the bed might help with comfort, but it is not a priority. The nurse must be observant to the risk of increased swelling in the extremities. Offering sips of water is acceptable once assessment of the extremities has been completed. The child's position should be changed every 2 hours.Positioning a child with a spica cast is important to prevent injury.
A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a: -
Correct Answer: spacer.
Rationale:
The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism to administer medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration.
A 4-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and complained of gastric pain an hour ago but "feels fine" now. The parent is not certain when the child ingested the iron tablets. The most appropriate recommendation by the nurse to the parent is to: - Correct Answer: bring the child to the hospital immediately.
Rationale:
The child should be transported to the hospital immediately for assessment and possible gastric lavage. The period of concern for complications of iron toxicity is from 30 minutes to 6 hours. Activated charcoal does not bind iron and, therefore, is not a course of treatment for this child. Ipecac is not recommended for poisonings. 2 / 4
A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to: - Correct Answer: notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation.
Rationale:
Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.Examination of the oropharynx may cause total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out.
A 4-year-old child is scheduled for cardiac surgery in a week. The child's parents call the hospital to ask how to prepare the child for the upcoming hospitalization and surgical procedure. The nurse's reply should be based on the knowledge that: - Correct
Answer: children who are prepared experience less fear and stress during
hospitalization.
Rationale:
Preparing the child for the hospitalization will reduce the number of unknown elements.Taking tours, handling some of the equipment, or being told stories about what to expect will increase the familiar items. Timing of the preparation must also be considered. Four- to 7-year-olds can be prepared up to 1 week in advance of the hospitalization. Preparation of a 4-year-old will reduce stress by having the child incorporate and assimilate the information more slowly. Children between the ages of 4 and 7 years should be prepared about 1 week before hospitalization. A reduction in fear is usually observed when children are prepared appropriately for hospitalization.
A 4-year-old's concept of death is that: - Correct Answer: death is temporary.
rationale:
Death is seen as a temporary departure, and the child assumes that the individual who has "died" will be back soon. The preschooler thinks of death as being an impermanent state. The 4-year-old believes that life and death can change places with each other.The concept of death as being personified in various forms is more typical of the beliefs of school-age children. The concept of the inevitability of death is more representative of the understanding of 9- and 10-year-olds.
A 5-year-old child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to the child's parent that the first action is to have the child evaluated for: - Correct Answer: possible urinary tract infection.
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Rationale:
Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection. A physical cause of the problem needs to be eliminated before a psychological cause is considered. Emotional causes should be investigated only once a physical cause has been ruled out. Possible structural defects would be explored as a cause after a urinary tract infection is confirmed.
A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? - Correct Answer: Vital signs Medical history Assessment of breath sounds Emergency airway equipment readily available
Rationale:
Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status.Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.
A 5-year-old child's sibling dies from sudden infant death syndrome (SIDS). The parents are concerned because the child showed more outward grief when their cat died than for the sibling's death. Based on the nurse's knowledge of development, the nurse explains that: - Correct Answer: the death may be so painful and threatening that the child must deny it for now to protect her psyche.
Rationale:
A child at this age has limited defense mechanisms. Often, the child will react with more overt grief to a less significant loss than to the loss of a significant person. The child's behavior is suggestive of limited defense mechanisms, not maladaptive coping. The child is beginning to understand the permanence of death. At age 5 years, the child will have formed relationships, including with a sibling.
A 6-year-old child with acute renal failure (ARF) is being transferred out of the intensive care unit. Which children, considering their diagnoses, would be the most appropriate roommate for this child? - Correct Answer: 5-year-old child who has a fractured femur
Rationale:
The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin. A child with pneumonia has an illness of viral or bacterial origin and should not be placed in the same room as a child
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